The goal of health care of the elderly is to maximise the person’s independence and shorten any period of morbidity. Older people are the biggest users of health care services, and with the increasing age of the population this is becoming a major public health issue. Demographic changes will impact on the ability of society to provide health care for the older person, however it is not necessarily inevitable that the increasing age of the population will be a major factor in the increasing costs for health care. It has been shown that the relative age of the population is likely to only be a minor factor in the future growth in health care costs .
Characteristics of health problems in the older person:
• multiple pathologies
• multiple aetiologies
• typical signs and symptoms may be absent for many diseases
• rapid deterioration from disease
• common occurrence of complications
• more time is required for recovery
• social factors are more important in aetiology and recovery
Compression of morbidity hypothesis:
• lifestyle and medical advances reduce the risk of death and postpone the progression of non-fatal diseases
• theory has a premise that there is a fixed biological limit of lifespan
• as the onset and progression of disease are changing more people will get closer to this biological limit morbidity and disability will be compressed into a shorter duration before death
• the hypothesis postulates that the onset of morbidity can be postponed more rapidly than life expectancy can be increased, so there will be a shorter duration (compression) of morbidity less impact on society
• the human survival curve will have a rectangular shape to it
Expansion of morbidity hypothesis:
• reductions in death rates from fatal diseases expose the population saved to a longer duration of time in which the non-fatal disabling diseases can be expressed increase in incidence and prevalence of chronic diseases and disabilities
• there will be a longer period of survival of those with chronic disease and disability increased susceptibility to co-morbidities
• overall evidence to date favours this hypothesis
Ageing changes and health service requirements :
Changes: Needs created: Service requirements:
Significant external contribution to age related decline in function Increase in disability free years.
Reversibility of impaired function in old age Increased availability of fit, active people aged 70-plus as a social resource.
Potential value of physical activity programs for elderly people
Failure of homeostasis Need for prompt access to professional attention No financial barrier to primary medical care
Availability of domiciliary care
Resources available in acute care hospitals
Threshold effect Maintenance of function Requirements for domiciliary rehabilitation services
Early mobilisation in acute hospital wards.
Assessment and rehabilitation wards
Clinical difficulties Increased diagnostics delay and inaccuracy Access to base hospitals with appropriate diagnostic services.
Teaching in gerontology and geriatric medicine in professional courses
Senile dementia People with dementia will be major users of resources Access to diagnostic services
Family support systems
Appropriately designed institutional care
Fractures and osteoporosis Increased demand on orthopaedic services Prevention programs – individual and public health
Geriatric orthopaedic rehabilitation services
Individually directed domiciliary services
Cardiovascular disease Increased presentation in older people Emphasis on prevention in young and middle aged people
Continued attention to risk factors
Resources for cardiovascular surgery
Chronic disability and family support Need for state to support families who are the main providers of care Subsidise domiciliary and institutional care equally.
Increase flexibility by enabling purchase of individual care rather then selection from a limited menu of traditional services.
Increase home help availability
Relief admission, day care.
It has been shown that older people tend not to use a wide a range of health service as younger people. “They tend to concentrate all their attention on calling the general practitioner or, as in the case of foot trouble, the podiatrist, without recourse to other services. In particular, they tend to avoid using the emergency services, even where appropriate, and prefer to refer problems to the general practitioner, rather than the practice or community based nurses” .
It appears that older persons with a chronic illness of the same severity as a younger person receive the same or even less physical interventions than younger persons . The costs associated with the treatment of chronic illnesses is related to the adjustment to the chronic illness rather than a function of age itself. Those who are less psychosocially adjusted cost the health system considerably more than those who are more adjusted to the chronic illness. It is possible that psychosocial interventions to improve adjustment to chronic illness may have major implications for the cost of health care delivery.