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HEALTH MANAGEMENT FOR OLDER PERSONS

HEALTH MANAGEMENT FOR OLDER PERSONS . WHY WE NEED SOMETHING SPECIAL. Dr. Enrique Vega Regional Advisor in Aging and Health PAHO/WHO vegaenri@paho.org. POPULATION AGING SOCIAL & PUBLIC HEALTH RESULTS AND … A NEW ISSUE . THE DEMOGRAPHIC TRANSITION: A FAST PROCESS.

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HEALTH MANAGEMENT FOR OLDER PERSONS

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  1. HEALTH MANAGEMENTFOR OLDER PERSONS WHY WE NEED SOMETHING SPECIAL Dr. Enrique Vega Regional Advisor in Aging and Health PAHO/WHO vegaenri@paho.org

  2. POPULATION AGING SOCIAL & PUBLIC HEALTH RESULTSAND … A NEW ISSUE

  3. THE DEMOGRAPHIC TRANSITION: A FAST PROCESS • In 2006, just over 50 million of the Latin American and Caribbean population was 60 or older. In less than 20 years the amount will be more than 100 million. In 2050, 24% of the population—some 200 million people—will be older adults. • In 2006, the life expectancy of people 60 years old was an additional 19 years for men and 23 years for women.

  4. Aging in Latin America and the Caribbean FAST PROCESS

  5. Aging in Latin America and the Caribbean: Aging Population Growth IS NOW Population in Millions

  6. Aging Index: Barbados 2025

  7. LIFE EXPENTANCY INCREASE

  8. The more important increase: in the oldest population

  9. WE HAVE A LOT OF OLDER PERSONS: SO WHAT?

  10. EXPENTANCY OF LIFE AND MORBIDITY SCENARIOS JF Fries Aging, natural death, and the compression of morbidity. NEJM 1980, Volume 303:130-135.

  11. John Glenn. 77 years old, 1998 Spatial Mission, Discovery’s

  12. Florence (101 years old ), the oldest Facebook user….

  13. WHAT IS THE REAL AGING CHALLENGE?

  14. EXPENTANCY OF LIFE AND MORBILITY SCENARIOS JF Fries Aging, natural death, and the compression of morbidity. NEJM 1980, Volume 303:130-135.

  15. How healthy we will live?The reality: We are growing old without health

  16. LIFE EXPECTANCY WITHOUT HEATH

  17. LIFE EXPECTANCY WITHOUT HEATH • In the United States only 22.7 percent of people over 65 and only 32.2 percent of those 75 and older report having fair or good health. • In the Caribbean and in Latin America the majority report having fair or poor health: 58% of women and 51% of men. • In the Caribbean and in Latin America women reported worse health and poor health status.

  18. HEALTH SELF REPORT AND CHRONIC CONDITIONS IN SENNIORS Source: SABE/2000 – PAHO

  19. Seniors with at least one treatable chronic condition Source: SABE/2000 – PAHO

  20. Seniors reporting at least one disabling conditions Source: SABE/2000 – PAHO

  21. Heath costs increase with multiple chronic conditions Average Per Capita Health Care Spending Source: Medical Expenditure Panel Survey, 2006; Adapted from Anderson G. Chronic Conditions: Making the Case for Ongoing Care, February 2010, Robert Wood Johnson Foundation.

  22. Chronic Disease and functional status in Seniors. Bridgetown, Barbados 2000

  23. THE DISABILITY BURDEN

  24. SOCIAL DETERMINANTS OF HEALTH • Around 50% of those surveyed in the SABE study said that they did not have sufficient resources to meet their daily needs. • 33% of the elderly in urban areas and 50% in rural areas live in poverty. One-third of persons 65 or older do not have retirement benefits, pensions, or gainful employment. • Older adults have levels of schooling lower than the rest of the population, with very high levels of illiteracy that reach 80% in rural areas in some countries.

  25. THE TOTALLY NEW SCENARIO A lot of people are growing old without health High incidence of chronic diseases and conditions, especially multiple chronic conditions. High influence of several harmful social determinants of health. High impact in functional decline and disability with a consequence of high level of dependency and demand of long term care.

  26. Who cares for older persons and how are we caring for older persons?

  27. WHO CARES FOR ELDERS? • Health care professionals without training in the medical care of older persons • Community health workers without the supervision or the tools to care for older adults • Family caregivers without the support of the community

  28. WHO CARES FOR ELDERS? • In the region, it is families, and especially women (90%), that provide most of the care for older people. • Caregivers, usually over 50, are subject to very high levels of stress, with 60% of them saying that they “cannot do any more”. • More than 80% reporting problems “meeting expenses”.

  29. HEALTH SERVICES AND AGE

  30. Forty percent of those surveyed by SABE who suffered from hypertension had not had a primary care consultation in the last 12 months. • Only 27% of women reported having had a mammogram in the last two years. • 80% of respondents reported having unmet dental needs. • According to the research, 69% of older adults were not vaccinated against influenza. • Only 2% of the countries have health promotion goals for people over 60 years of age.

  31. THERE IS A GREAT DISPARITY IN THE REGION BETWEEN THE AVAILABILITY AND ALLOCATION OF TECHNICAL AND HUMAN RESOURCES BETWEEN AND WITHIN COUNTRIES.

  32. We are still forming more Pediatricians than Geriatricians. • In the Medical School and in Family Medicine Residence Program, the students receive 24% more learning time in pediatrics than in geriatric issues. • 60 % of managers who head aging programs on the National level have not received previous preparation in aging issues and 45% have not received any training in public health.

  33. HAVANA CITY SCENARIOS 2010 BASIC HEALTH TEAM POPULATION OF 600 HABITANTS • Demographic Situation • 96 children (0-14 years) • 7 births in the years • 7 with less than 1 year • 35 children between 1 to 5 years • 118 elders (60 years and over) • 32 with more than 75 years • 9 will live long Health Situation (SABE) 12 Cognitive Disturbance 22 with ABVD limitations 10 with incontinence 29 with falls in a last years 23 with bad hearing 43 with bad seeing

  34. DEFICIT SITUATION AGING SOCIETY PERCEPTION Few Contributions' Great Needs High Cost

  35. EXPENTANCY OF LIFE AND MORBILITY SCENARIOS JF Fries Aging, natural death, and the compression of morbidity. NEJM 1980, Volume 303:130-135.

  36. Investment Aging Society could balance needs and benefits Challenges/needs Benefits

  37. GROWING EVIDENCE

  38. DISABILITY PROJECCION IN SENIORSUSA Millions Manton and Gu, 2001

  39. Aging and Health Running against time

  40. WE NEED LEADERSHIP TO TACKLE THE CHALLENGES

  41. TO DO WHAT: • Promote the health of older person as a human right guarantee and transform the issue into a real public policy priority. • Contribute to adapt health systems to population aging challenges and the health needs of older persons especially in the community and in PHC. • Encourage retooling of human resources to meet the health needs of older persons. • Strengthen the capacity to generate evidence based decisions to improve the health of the elderly population in sustainable ways.

  42. The next 40 years, the Region’s demographic situation will offer a window of opportunity. Only through adequate social and health investment will it be possible to achieve healthy and active Longevity resulting in a lower economic burden in the future. A WINDOW OF OPPORTUNITY PLAN OF ACTION ON THE HEALTH OF OLDER PERSONS, INCLUDING ACTIVE AND HEALTHY AGING. PAHO, 2009

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