[CP/ADR/003
ENGLISH ONLY
~ING GROUP ON HEALTH CARE OF THE ELDERLY
!
Convened by the •
REGIONAL OFFICE FOR THE WESTERN PACIFIC OF THE WORLD HEALTH ORGANIZATION
Manila, Philippines 18-24 August 1981
Not for resale Printed and distributed by the Regional Office for the Western Pacific of the World Health Organization Manila, Philippines December 1981
•
NOTE The views expressed in this r(~port are those of the members of the Working Group and do not necessarily reflect the policies of the Organization.
•
,
This report flas been I'ndfi c of the World Health in the Region and for. those Health Care of the Elderly. 18-24 August 1981.
prepared by the Regional Office for the Western Organization for governments of Member States ",ho participa ted in the Working Group on which ",as held in Manila, Philippines, from •
Contents
1.
INTRODIICTION OIlJECTlVES PROCEDURES 3.1 3.2 3.3
2. 3.
. .. . .... ... .. . .. ..... '" '" ........ ,. ... ,. .. .. . .'" .. ,. ......... ..... . .. . .. ...... .... ....... .. '" ..... . .... ,. ,. ..... ........ .. . ..... .... .... ,. ,. ,. '"
,. ,.
,. ,.
,. ,.
'"
,.
'"
I
'"
,. ,. ,.
,.
'"
,.
,.
,. ,.
'"
,.
2 2 2
,.
,. ,.
,.
,.
,.
,. ,. ,.
,.
,. ,.
,.
Questionnaire .• ,..,. ............ ".,.. '" ........ ,. •.....•. ,.,.. Conduct of the Working Group Sessions •••••••.••••••••••• Organization of the Working Group •••••••••••••.•••.•..•• IO .. .
3 5 5 9 9
!
4. • 5.
SHORT OVERVIEW OF THE DELIBERATIONS RKCO~NDATI0NS
... ,. ..... ,. .,. .,. ..... ,. ....... ,. IO. '" •••• ,. • '" •••• ,. ••••••••• <II
•••• ,. • " ••••• ,. •••••••• ,. •••• ,. •• ,. •••••• '" ••••••• " • ,.
5.2
6.
.................................. Services 5.3 Education and training ••.•.•••..•.••.••••••.••••.••••••• 5.4 Manpower ·.............................................. . 5.5 5.6 Research ·.................. ............................ . CONCLUSIONS .................................................... General recommendations • • • • • ,. ,. • • • • ,. • • • • • • • • ,. • ,. • ,. • • ,. • • 10 • • ,. ,. . . . . . . . . . . . . . . ~
5.1
Introduction ,. ••.. ,. .•• ,.,..,. ....• ,.
9
12 14 16 17 19 22
7.
SUMMARY ANNEXES
.................... , ................................. . INFORMATION BULLETIN NO. 2 - LIST OF MEMBERS, CONSULTANTS, OBSERVERS AND SECRETARIAT •••••••••• LIST OF SMALL WORK GROUPS ' OPENING REMARKS BY THE REGIONAL DIRECTOR AT THE WORKING GROUP ON HEALTH CARE OF THE ELDERLY, MANILA, 18-24 AUGUST 1981 '
ANNEX 1 1.1 2
.................. .....
25
31 35
3 4 5
.... .................. .
AGENDA ........................................... .
37 41 53 55
COUNTRY QUESTIONNAIRE - SOCIAL AND HEALTH STATUS OF THE ELDERLY .................................. ..
CURRENT STATUS OF WELL-BEING AND HEALTH CARE OF THE ELDERLY IN COUNTRIES OF THE REGION ••••••• Table 1 2.2 2.3
Demographic, Socio-Economic and Health Situations ••••••••••••••••••
Range of Schoolchildrens' Attitudes and Perceptions of Aging as Mentioned in Country Questionnaires ••••••••••
59
•
Old People's Perceptions of Themselves, Their Needs and Specific Problems as Mentioned in Country Questionnaires .•.•..••••••.•••••...
61
- ii -
•
Table 1
Ratios of General Hospital Beds to Population, Separate Acute Geriatric Facilities and Percentage of Beds in General Hospitals Occupied by the Characteristics of Day Care and Long Term Institutional Care •••• Services for the Elderly and their Families as Mentioned in the Country Questionnaires ••••• Ratios of Medical Doctors, Registered Nurses and other Nursing Personnel.............. Numbers of Medical Schools, Nursing Schools (Registered, Assistant, Aids) and their Annual Output ••••••••••••••••••• Professional Education in Gerontology.................... Countries' Overall Policy and Objectives in Care for the Aged and Plan of Implementation ••••• Ministries and Government Agencies in Care of the Elderly and Levels of Responsibility.............. Private Activities in Care of the Elderly.................... Manpower Development and Country Goals for the Year 2000 •••••••• Suggestions for Support from International Agencies (e.g. Elderly .".,,""""""""""""""""""""" 63
4 5 6 7
65 67 69
71
8
-'
73 75 79
9.1 9.2 9.3 10 11
81 83
WHO).................. ..........
87 ,
l
I . ' INTRODUCTION
Both developing and developed countries are witnessing demographic aging, namely, the increase in the size of the aging population aged 60 and above, both in absolute and in relative tenaa. By the year 2000, some two thirds of the world's 565 million aging citizens will reside in the developing world, 262 million of them in Asia alone. In the Western Pacific Region the insufficiency of data available on the needs, demands and problema of thi.s age group aa well aa the inadequacy of skills and knowledge in providing for their health and social care have so far prevented efforts to formulate national policies in many Hember States. Such programmes muat be based on a multisectoral approach necessary to meet the vsried and interrelated needs of the elderly population ot bO years and above. In order to promote the further development of the programme on health care of the elderly (HCE) of the WHO Regional Office for the Weatern Pacific lWPRO) and to aasist this Office in making recommendationa for intercountry activities and suggestions to countries for national measures and provisions, a Working Group on Health Care of the Elderly was convened at the WHO Regional Office in Hanila, Philippines, from 18 to 24 August 1981. Fourteen temporary advisers and two observers from nine Hember States were brought together and assisted by a WPRO Secretariat comprising the Regional Nursing Adviser as Focal Operational Officer, the nine members of the Focal Group for Health Care of the Elderly, the Regional Officer designste for the Programme on Health Care of the Elderly at the WHO Regional Office for Europe and two short-term consultants (medicine and nursing) (Annex 1). The Regional Director, Dr Hiroshi Nakajima, in his welcome address to the Working Group (Annex 2), declared that the moat immediate concern of this timely meeting was the health of the elderly in countries of the Weatern Pacific; the goal was to enaure that by the year 2000 theae people would have, aa far as pos.ible, a fulfilling and meaningful life. He stressed the importance of a holistic approach. The socio-cultural milieu in which care was provided was inherent in the concept of this approach • In this respect, the long tradition of reverence and duty to the aged in the countries of this Region waa essential. Hoat countries in the Region rel1ed heav1ly on the provision of care by the fa.ily and community. Through a prlmary health care approach based on the strength of filial responsib11ity, the elderly would have the opportunity to be involved in planning for their care. As a contributory force within society, the elderly, particularly in the rural ca.munity, where in fact most of the aged lived in this part of the world, could receive this care in a setting that wa. familiar and non-threatening and preserved their dignity and self-esteem. Concluding his address to the Working Group, Dr Nakajima declared that the task of the Working Group would be: ll) to determine priority needs in the content of health csre of the elderly, and
!
•
•
• 2 -
(2)
to develop guidelines for WHO and country collaboration in the development of a com.unity-based programme on health care of the elderly, 'with emphaaia on the promotion of health and prevention of diseaae.
The Working Group elected Hr D. Haeda, Chairman and Profeasor Each day, two other teaporary advisers aerved as Rapporteura ao that all _bera were involved in this ta.k, but could still participate fully in the various deliberations.
D. Prinsley, Vice-Chairman.
2.
OBJECTl VIS
The Working Group had a. its overall aim to advise on WHO's collaborat1ve role in developing the regional progr.... on health care of the elderly. The specific objective. of the meeting were: (1)
to review the current status of well-being and health care of the elderly in countriea of the RegioD; to determine priority needs in the .rea of health care 'a. a baais for prolra... development; to develop guidelines for WHO and country collaboration in the development of a ca.aunity-baaed progr...e OD health care of the elderly with empha.i. on the promotion of health and prevel.cion of diseaaea.
(2)
(3)
3. J.1
PROCEDUIlES
Questionnaire
Prior to the Working Group meeting, the teaporary adviaera received an extenaive questionnaire on the aocial and health statu. of the elderly within their respective countries (Annex 4), which has been developed by the WHO Regional Office Operational Officer on Health care of the Elderly. The questionnaire had as coaponenta: (al The demographic, socioeconomic and health situation of the elderly (for the specific purpose of this queatioDnaire" the elderly were referred as to people of 55 yeara and above), with subcomponenta on population, sociocultural aspecta, economic aapects, attitudes and awareness toward aging and the aged, and teaching of gerontology and geriatrics; •
- 3 -
(b)
health services of the country, with subcomponents on manpower, education, health agencies for the total population and specifically for the elderly (ca.aunity and institutional care), and range of available health care service. in rural and urban areas;
(c)
programmes for the elderly (health, welfare, etc.), witb subcomponents on progra..es at national, intermediate and cOllllaunity level, private activitiea in care of the elderly, manpower for and evaluation of tbe progr..... ; tbe support tb.t intern.tion.l agencies like WHO could provide for progra.... on c.re of the elderly.
(d)
!
The replies to tbe.e country questionn.ires (reports) were reviewed, categorized and tabularized in eleven major table •• Obviou.ly, answers could not .lways be provided since pertinent d.ta were not avail.ble, 'or only rougb e.timates could be given. Moreover, it w•••ameti... difficult to ••• eaa certain replies accurately becauae of tbe l.rge differencea in many reapecta between the reaponding countries. Nonetbele •• , tbe v.rious t.ble. gave. cert.in inaigbt and overview, whicb w.a uaeful aa b.ckground inform.tion for tbe Working Group. A very gener.l but not aurpri.ingconclulion ia tb.t gre.t dlfferericea exist between so very different countries, •• for example in rel.tive and absolute numbers, bealtb atatua .nd care of tbe elderly, e~tent .nd v.rious kinds of formal and inform.l c.re, educational possibilitiea, manpower availability, etc. But tbere are also Ca.aQn patterns of care, e.g. tbe very important role of tbe family, ca.aon problems (such as lack of profession.l intereat) and commonly perceived optlona tor solving certain major problem. (sucb .s increasing tbe .w.reneas ot government a and tbe public; the need for more infor.ation on the sging proceaa.a .nd possible a.rvices for tbe elderly; more educatlon). Thare .ppe.rs to be • grest demand for support by intern.tion.l org.niz.tiona aucb .a WHO. The Working Croup apent ita firat plenary aeaaion on • diacuaaion of the v.rioua t.ble.. Correctiona .nd .dditions were pre •• nted .nd .re included in the fin.l vereion (Annex 5). , 1/ 3.2 Conduct of tbe Working Group Sea.ionaDeliber.tiona focuaa.d firat of allan the apecific probl . .a of tbe elderly by diacua.ing tbeir peraon.l expect.tions .a to being old in tbe future. They ware .aked to conaider the implic.tiona of old .gefrna the viewpoints of the individu.l, the family .• nd the ca..unity, in order to optimize involvement in the complex .nd coaplic.ted he.ltb .nd aocial problema of the elderly and in their care.
•
,
])
Annex 3.
- 4 -
Next, from a .ore general point of view, demands lneeds expressed or felt by the elderly themselves) and needs lprovisions considerednecesaary by the care providers) for both physical and mental health care a"a well aa for aocial care were considered.
These deliberations were followed by extensive considerations regarding existing resources, and aervices felt to be immediately necessary. This .. jor item of the agenda sddressed three main themes with the focus upon: la) high priority, and lb) feasibility of short-term implementation, naaely: ll) (b) (c) Priorities in resoures and services development Manpower needs Education and training.
To highlight the specific problems of health care of the elderly in a rural area of a developing country, a field trip was organized to a village (barrio) on the outskirts of Metro Manils. This visit enabled participant. to learn about a community health aervices project of the School of Nursing of the University of the Philippines and to c~ into direct contact with a number of elderly people living in the barrio. In informal talka with individual older people and by a visit to their houses, scae insight was obtained into their health condition, health and other problems and into the ways they and their families were attempting to cope with theae problems and find solutions. This via it waa most rewarding in many reapecta, in particular io streaaiog the need to be very practical in the .earch for rcc~mmendation., which should mainly build on existing roa.ibilitiea snd simple potentialities. Since the ultimate goal of health care of the elderly ia to reduce the need tor ita sarvicea and to prevent premature agiog and ulaease/dlsabl1ity frequent in old age, it seemed useful to devote one plenary aesaion more apecifically to prevention and slso to rehabilitation. Another plenary aeaaion gave particular attention to the issue of reaearch. Not only is much more knowledge needed 00 the basic biological processes and the ecology of sging but there atill exista a great lack of insight with respect to the clinical/medical/nuraing/behavioural/economic and other aspects of health and disease a.ong aging individuals. Particularly from the WHO point of view, epidemiological (crosa-country coaparative) reaearch ia very important. This appliea even more to health services lsyat . .s) research. After discussion of these various items, conaiderable time waa devoted to the development of guidelines for action for both WHO Regional Office and country collaboration and Member States. Apart from beiog geared specifically to the three main the... of (1) resource. and .ervice. development, (2) manpower needa, and (3) education and training, .ecommendations were fo~ulated for:
,
•
- 5 -
la) lb)
research pertinent to these themes, and research in general with respect to gerontology and health care of the elderly.
The WHO document entitled Proara~ Profile 3.1.411) Care of the Aged, dated July 1981, aerved a8 an i.portant basic guideline in formulating the recomaendations as.igning an order of priority to the•• The last .orning was used to review the general and specific recommendatlons and the suggested priorities within the five areaa mentioned. After discus.ion some revi.ions were ••de and the recommendation. were accepted by the Working Group. In clo.ina the ... tina, the •• gional Dir.ctor . .phasized that such a broad topic •• health care of the elderly did not per.it, in one week, in-depth discu.sions of .11 the vital issue. concerning the aged, given also the heterogeneous nature of the Region. He once .are pointed out th.t the .ultidisciplinary char.cter of health care of the elderly nece •• itated the involvement of . .ny categorie. of profe•• ional, auxiliary and lay personnel. 3.3 Organization of the Working Group
Since ao . .ny topics had to be covered and such varied experiences, knowledge and opinions had to be aha red , the Working Group . .de frequent use of small group discuaaions. The specific the.. a discu.sed and the na.es of participants are reported in Annex 1.1. The composition of the s.all work group. re. . ined the .... throughout the whole week ao a. to enaure a b.tter continuing ba.e of work. The ••all work group• •et each day exc.pt the la.t. In aeneral, short plenary .e •• ion. were held b.fore and after di.cu •• ion. on the various .p.cific it ••• of the a,anda in which ai•• and goal. of tha •• di.cu •• ion. w.re introduc.d by the con.ultant.; report. of the •••• ion. of the ••all work group. were pr.a.nt.d to the plenary working ,roup for di.cus.ion. Often in the pl.nary •••• ion and the ...11 work group., contributions were made by .everal offficers of the Regional Office; the agenda ite.s on prevention and rehabilitation, and on re.earch, were introduced by them in panels, which con.isted al.o of .elected temporary advisers and an observer. 4. SHORT OVERVIEW OF THE DELIBERATIONS
In the following section, sa.e of the issues raised during the deliberations are presented, more or less in the Chronological order of discussion, to indicate certain important points or probl . .s.
I
- 6 -
ll)
The queat ion of a pract ical chronological ".tarting" point for diacu •• ion of aervice., education and training and for compari.on of reaearch data came up quite frequently. Although the country que.tionnaire had a. a .tarting point the age of 55, it was agreed to have the .tarting point .et in general at age 60, in line with the propoaal of the forthco.ing World A....bly on the Aging (July/Auguat 1982, Vienna) • Functional age or .ocial age were considered aa far aore appropriate age factora for purpoaea of gerontology and health care of the elderly than chronological age. Ti.. and again the heterogeneity of "the aged" wa • . .pha.ized. In particular, the health proble.a and care of the faateat growina population group, the very old (15+), need attention, apacifically in regard to women. The .o.t i.portant goal and objective of all health care of the elderly ehould be the .. intenance or regaining of independence when growing old, which mean., among other. to reaain in one'. own home and to stay active and healthy. In all re.pect. the role of the family i8 of the ut.o.t i.portance. The aged ahould continue to be part of the c~nity and their rights, a. well a. their contribution. to aociety, ahould be recognized. Income .ecurity i. e ••ential for health care of all people, including the elderly. Acce •• ibility of health care of the elderly ia of vital i.portance; priaary heelth care in the ca.aunity .bould therefore be eapha.i.ed at all ti.... The entire range of .upport .y.t . .a for healtb care of the alderly need. to ba con.idered, particularly in the ca.aunity .etting. In.titutional cere ha., however, a place in tbi. range. The variou. level. of develop.. nt in Meaber Statea ahould be taken into account in a ••••• ing neede and .ugge.ting and promoting appropriate .olution•• Mental health probl ... aaong the elderly are aa iaportant a. phyaical health probl ... and deaerve att.ntion accordinlly. A. a lot of inforaation on health condition. and health care of the elderly i. already available, a. well aa data froa gerontological re.earch, the Working Group .everal ti... atre •• ed the need to collect and di •• eainate all thi • . . terial, ao a. to avoid duplication of data gatbering and of certain gerontological inv•• tigationa.
(2)
(3)
(4)
(5) (6)
(1)
(8)
(9) (10)
- 7 -
(11)
aegarding manpower needa, it i. clear tbat eacb country ba. ita own wiabea and priorities. While.ome countries bave no need for more doctora, otbers do, and particularly tbo.e educated and trained for bealtb care of tbe elderly. The .a.. was expre •• ed a. regard. nur.e., all~ bealtb staff, auxiliary peraonne I, etc. Many participants atressad tbe need for tbe lons-tera projection of manpower. During tbe di.cu.sion., it appeared tbat in .oae countries tbere exi.ted already a range of .ervice. for tbe elderly, but often a thorough evaluation of their uaefulnes., effectiveness, coats, etc. wa. clearly lacking. TUDe and a,ain the ab.olute necea.ity to build on exi.tin, .ervices, manpower, family and caaDUnity support wa. e~ha.i.ed. In thie reepect, the often ~ortant role of the village health worker., barefoot doctor, etc. va. mentioned. To provide better care and services in the hoae, provi.ion of aid. and appliances, and adaptation of housing ate nece ..ary. At present many older people h.ve low expectation. about their health, tberefore, they often do not .eek cont.ct with h•• lth care workers. The next ,eneration . .y be .ar. de-.ndin" e.,. periodic bealtb cbeck-up.. Thi. issue vas discu ••ed at soae l.n,th and soas particip.nts advoceted this type of s.rvice. Otber., however, were not .0 .ure about it. i.p.ct and cone.quences. Healtb .urveillance of the elderly va., however, considered to b. of . . jar iaportanc., if not •••• nti.l (vith re.pect to both phy.ical and .. ntal functioning). ln conn.ction vith the .bove, h.alth education .nd ,en.ral information in the field. of gerontology and health c.re of tb. eld.rly for botb tbe elderly and their feaily were felt to be i.portant .spect. of health c.re .upport. The e •• y .ccessibility and quick .veil.bility of heeltb end .ocial car. provi.ion. wa •. repeatedly .tres •• d. In the context of the di.cua.ion. of this Working Group, it vaa .,re.d that . .npower involved in car. of the .ld.rly inc Iud••• ny per.on or ,roup involved in any kind o~ .ervice. for the elderly. Th. non-prof ••• ional ,roup. or volunte.rs include the feaily, nei,hbour., civic .nd youth ,roup. aaong other.. They may neturally include al.o the elderly th...elves. It va••_ph•• i •• d, however, that ,roup voluntary •• rvic •• were not very .i,nificant in .everal countries of the ae,ion.
(12) (13)
(14)
(IS) (16)
(17)
(18)
(19) (20)
- 8 -
•
(21)
The apecial plenary aeaaion on prevention and rehabilitation appeared to be uaeful becauae .. ny ia.ue. acattered throu,hout the diacuaaiona could be brou,ht to,ether and new point. raiaed. lt waa felt, however, that .ince the a.pecta of prevention and rehabilitation in particular were diacu •• ed .0 often during the week, and could even be conaidered the . . in ",uiding line" or principle in health care of the elderly, this major emphasia should be .treased in the Summary. As atated before, lack of knowledge in the field of ,erontology and health care of the elderly for.. an enonaous blockage to planning, developing and i.ple.. nting a great number of proviaion. for health and social care of the elderly. The re.earch a.pect needs to be dealt with specifically in plenary .e.sion.
(22)
Research (23) As an introductory stat.-ent the followin, comment by one of the ob.ervers wa. con. ide red to be a u.eful general ob.ervation on .hort- and lona-ter. reaearch:
Reaearch in the Region with re,ard to ,erontolo,y and health care of the elderly could be undertaken on a ahort-ter. and lona-ter. baai •• Short-ter. reaearch would be .ainly in the for. of infor.ation ,atherin, whereas the lona-ter. studies would be concerned with .ettina up .tudie. not to provide reaearch data in the future. Thua Short-term atudie. mi'ht be undertaken for purpo •• a of plannin, and priority .ettin,. dev.lo~nt
The approaches would include cooperation in cen.u. collection., of .tandard definition. for comparability of data and the provi.ion by WHO of a clearina-hou.e function.
Studie. in this cate,ory include demo,raphy, morbidity, mortalilty, utilisation of aervices and collection of bade .ocial -infor.ation, while LonlLter. studies .hould be undertaken to underpin future development in education, manpower plannin, and pro'r.... developaent. The diver.ity ot the Re,ion provide. potential for important compari.on. and contra.ta with re,ard to: culture, attitudes, perceptions, exprea.ed need., pattern. of health care delivery, etc. Comparative .tudie. could be undertaken on effectivene •• , co.t. and outca.e •• Studiea in the area. of demographic, clinical, .ocial and health Care delivery could include: cauae. of breakdown in health and well-being: needa of the elderly; evaluation of alternative aodela of health care delivery; co.t effectivene •••
- 9 -
Member St.t •• in the Reaion .hould al.o ..k. a contribution to ba.ic .tudie. of the bioloaical, b.h.vioural .nd social a.p.cta of aaina aad to knowledge of the natural hi.tory of di ••••• in aainl, epid. .ioloay, ca •• atudi.a. clinic.l trial • •nd atudie. of the outcome of h.alth car. aarvic.a. Initial .t.p••hould be und.rtak.n to initi.t. ahort-t.r. .tudie. of: d..ography, b•• ic .ocial dat., aorbidity .nd .ort.lity dat., .nd h•• lth c.re delivery. The d.velop.. nt of appropriate .yst... of •••e ....nt of individual n•• da .nd evalu.tion of proar. . . . . .hould be in.tituted now. It w •• atr••• ed th.t WHO .hould proceed tow.rd. the develo,..nt of cro ••-nation.l compar.tive atudi •• throuah monitorina of .tudie. throulhout the Reaion to promote comp.r.bility and then eventu.lly the pro.pect of undert.kina • cro••-n.tion.l study ba.ed upon the WHO reaional .tudy in Europe, modified to reflect local, reaional end national char.cteri.tic., with particul.r eaph•• is upon the role of the f ..ily, urbaniz.tion .nd developaent. 5. 5.1 Introduction RECOMMENDATIONS
The deyelopina countrie., .v.n if the probl. . of aaing i. not at pre.ent .cute for the., .hould p.y incre.aina atteation to their demoar.phic atructure. Th. plannina of be.ltb c.r. of tbe elderly .hould be undertaken f.r in .dv.nce of .ctu.l require.ntl aad take into consider.tion the current environaental .ad .conomic chana•• , auch aa rapid urbaniz.tion, induatrializ.tion, miar.tion .nd tbe i~lic.tion. of the.e ch.naea in relation to the f . . ily p.tt.rn .nd future way of life of the elderly .nd .a.d. Althouah the ahoy• • tateaant i. valid, only a fev prioritie. are indicat.d, .ince the Workina Group on H •• ltb Cer. of the Elderly i. awar. tbat r.aourc ••• re extr... ly limited in the R.gion. Wherever po •• ible, recoaaaendations within the .uhject categorie. were order.d a. to import.nce and .cope. Special eaph•• i.* i. given to reco....ndationa that the Working Group consider. to be either e ••• nti.l or of hiah priority .nd comp.rativ.ly ea.y to impl... nt. 5.2 General recoaaendation. Th. following r.coaaaend.tions ar. for the con.ideration of WHO. 5.2.1* Recognizina the i~ort.nce of tbe i~eading i.pact of the acing popul.tion on bealtb .nd .oci.l .eryice. in the Weatern P.cific Region, WHO should .ppoint •• SOOn a. po.sible • full-time Region.l Adyi.er to furtber develop and coordinate the progr..... On he.lth c.re of the elderly (BCE). Tbe impl.ment.tion of ..ny of tbe .pecific reaa.end.tiona will be more .ffective if tbi. appointment i . . .d. in • not too di.tant future.
"priority
• - 10-
5.2.2* A pri. . need that the Declaration of Alma-Ata addresses il that of equity. Often, elderly peraons are the poore at and most dil.dvant.ged memberl of contemporary aociety. Thi. i. un.ccept.ble aoci.lly, .conomic.lly .nd politically. WHO .hould .tron,ly .ncour.,. Me.b.r Stat.a to con.ider ....ur•• of income .aintenance for the eld.rly, aince this ia a vital precondition to health c.re of the elderly. 5.2.3* Health surveillance of physic.l .nd mental he.lth ia imper.tive and requires thorough planning and the org.niz.tion of .n integr.t.d ayatem of delivery of h.alth aervices to the .lderly. The objectiv.s of theae eervices are to: (.) (b) enable elderly people to maint.in .nd r.a.in functional independence;
aaKu.u.
provide appropriate care wh.n full independence cannot be achieved. In most c.ses thia .hould conlist in community care supplied to the eld.rly .nd/or the family in their own home. However, for lome people appropri.te c.re will be provided in .n inltitution of aome type.
5.2.4* Since .t.tiiticil information .nd aerontoloaic.l r .... rch data .re .a.eti. .1 .lready .v.ilable, there is not alw.y. n.ed to undert.ke DeV research. WHO ahould therefore est.blish a d.t. b.nk of cross-n.tional infor.atioo in p.rticul.r and .ncour.a. Member St.tes to p.rt.ke in tb• .... • ctivity on • national .cal •• 5.2.5* WHO .hould: (.) .xplor. the f ••• ibility of e.c.blisbiDa • few coll.bor.tive centr.a (a.a. in J.p.n, Au.tr.li.) for re ••• rch in a.rontology .nd h.alth c.r. of the .ld.rly, .nd id.ntify centre. of excellence in the .r•• of be.ltb care of the elderly delivery for tbe purpo •• of demon.tration .nd trainina·
(b)
5.2.6* WHO should sponlor r.gional workshop. of .xperts to det.rmin• • re.s of res.arch prioriti.a and .ddr•• a queation. of methodology. 5.2.7* WHO ahould identify and .ncouraae pot.nti.l fundina IDurce. to lponeor research in aerontology and he.ltb c.r. of tbe elderly in the R.,ion. 5.2.8* WHO Ihould collaborate in the dev.lopment of • comprehensive learnina reSource centre on agina and he.lth care of the elderly. The centre .hould be loc.ted within the Reaion and inform.tion about what ie available should be videly di •• e.inat.d and reaul.rly upd.ted throu,hout the ••,ion.
*p. . flOflty
- 11 -
~.2.9* WHO .xp.rt ca..itte.a, vorkinl Iroupa. conf.r.nce., workahop., etc ••hould refl.ct the rapidly incre •• inl n•• d for h•• lth c.re of th. elderly in the aelion. Prolr....-ori.nt.d <•• 1 . . .nt.l he.lth. huaan •• npower develop.. nt. reae.rch). di •••• e-ori.nted (e. I. c.rdio-v••cul.r. tuberculo.ia, diacipline-oriented (e ••• nurainl, ..d~cine, .rchitectur.> .nd .pecific r ••e.rch-ori.nt.d ca.aitt •••• etc •• hould include aeaber. with ap.ci.l intere.t .nd exp.rti •• in h•• lth c.r. of the .ld.rly.
;.2.10 WHO Ihould encour.l. Member St.tea to con.id.r th. potenti.l of the elderly themaelvel. They have c.p.city for contributina to the ca.aunity lener.lly and .lao .pecific.lly a. volunte.ra .nd .a prof.aaionala in prOlr.mmea of c.re for tha eld.rly. By thia ...n., • .or. effective utiliz.tion of exiatinl .killa .nd . .npower reaourc.a c.n be .chieved. ~.2.11
WHO ahould encour.le loverna.nta to d.v.lop luidelinea for
enviro.... nt.l deailn to f.cilitat. the adapt.tion of the eldarly to ch.n.aa in their c.p.biliti•••nd th.ir .urroundinaa (e.l. deailn of .adal pl.na for build in,. for the aled. interior daai,n. public tranaportation, ate • • llowin, • aaxiaua of function.l indep.ndence). Th... ,uidelinea ahould .1.0 t.ka cultur.l ••pect. into con.ider.tion, e.,. uae of .pace. ~.2.12 The f ••• ibility of he.lth educ.tion prolr...... for .,in, .nd .Ied people ahould be .tudied and eventu.lly auch prolr...... should be developed. P.rt of .uch prolr..... should be directed tow.rda eob.ncina po.itive attitude. toward. old ••e .nd old people. Such po.itive .ttitudea .hould .lso be promoted in younger people.
5.3 St.ta.:
Service. The followinl .ction• • ra propo •• d for con.idar.tion by M ..bar
5.l.1* Servic •• for tha eldarly .bould be developed •• p.rt of tbe b•• ic b•• ltb c.r• •nd .oci.l .ervic~. wbicb .re .lre.dy provided to otb.r popul.tion Iroup' in countri •• of tb. l.,ion. 5.3.2* Gan.r.l ..dic.l .nd paycbi.tric •• rvic •• for tbe eld.rly .hould be coorciinat"d •• far aa po.aible. 5.3.3* Aaaea ..ent proc.dura. auat be dev.loped for tbe elderly witb not only pbY'Lcal but .110 bab.viour.l problem•• 5.3.4* He.ltb c.re .ervice •• includinl drul', .bould be .fford.ble (or fre.>. in p.rticul.r to tbe elderly. However, tbere i •• need to an.ure that druis .re pre.cribed .nd uaed .ppropriately to avoid over-..dic.tion and tbe probl ..a of polypbar..cy le.dinl to i.trolenic diae •• e. 5.3.5* 1be entire r.n,e of P.ycboleri.tric .ervice. abould be developed (boae, community. d.y care, institution). ~.3.6* Exi.tinl f.cilitiea, .apaci.lly tho.e for tb. elderly witb aenil. br.in diap •• e (de.. nti.). wh.re axi.tant. abould be reviewed .nd of tan i.provad.
*Pr lority
- 12-
).1.7* The future aeeda, particul.rly in rel.tion to the develo,.ent of c.pit.l re.ource., .hould now be projected (e.g. ~.t countries will, in the future, require aome long-tera in.titution.l c.re).
).l.H* The t . . ily 18 the .o.t u-port.nt provider of he.lth aad .oci.l c.re to the elderly in .11 countries of the Region. , .. i1ie., however, .hould be provided with community •• rvice., wh.r. n.c •••• ry .nd fe•• ib1e, to support thea in their c.r• •ctiviti.s, •• for in.t.nce: maintenance
home
he1p~ day c.re food service chiropody l.undry .ervic.
nursing
(fir.t priority)
provi.ion of equip.ent home .d.pt.tion .nd r.p.ir transportation friendly visiting rehabilit.tion .ervice. f . .ily coun.el1ing, h•• lth educ.tion .nd .ociop.ycholog ical' support.
Addition.l recoaaended ..asures, where n.c •••• ry .nd fe.lible, for f .. ily support .r.: tax deduction for care givers: fin.ncial support of car.giver. for 10 •• of income: .oral education. ~.3.9
~.3.l0 The emph.sia in the Region should be on coaaunity .ervice., but there exists also • need for institutional c.re:
(a)
in Sage countri •• asse.sment centre., which can serv•••• de.onstration progra.... for health service delivery, tr.ining .nd r •••• rch: long-term care institution. for the ag.d with sev.re phy.ic.l .nd p.rticul.rly .. ntal iap.ir.ent: .hort- .nd/or lona-term faciliti •• for frail .lderly per.on. without f ••ily .upport: in.titutional b.d. for .hort-term relief of the f ..ily:
(b) (c) (d)
*p' . rl0rlty
- 13-
le) ~.l.ll*
wh.re fe •• ible. in.titution•• hould .1.0 •• rve .cae .ld.rly living in the co.aunity ••• g . . . dic.l .nd he.lth clinic ••
Eff.ctiv• •od•• of co.aunic.tion .hould be d.v.lop.d to facilit.t. continuity of c.re lin.titution to co.aunity and vic. ver.a). More nurae •• hould work in che co.aunity (including the hoae) •• nd the .lderly .nd their caregiver••hould be part of th.ir r •• pon.ibility. The .... applies Co general pr.ctitioner •• ~.l.l2
5.3.13 Countriea ahould be encouraged to t.st various .odel. of care for the ag.d and adopt the .oat appropriate to their cultural ••ocial and h.alth .yat.... 5.3.14 D.y care .ervice. should be provided for phyaically a. well a. mentally frail old people both by the coaBunity .nd by in.titution. where they exist (day hospit.la. day nur.ing hoae.). ~.J.l) Wh.r. nec •••• ry and f.a.ible • .ure bed. in lone- and ahort-ter. nuraing hcae. lr••ctivation c.ntr•• ) .hould be provided for. ~.J.lb
Th. for.ation of •• If-h.lp group. of .g.d and/or car.givinl f . .ily
.a.ber. ahould be .ncouraled. ~.4 ~.4.1
Education and trainiDl * WHO ahould encoural. M ..ber Stat •• : ll) to d.v.lop .duc.tion.l activit i •• in l.rontololY .nd h•• lth c.r. for the .ld.rly; th••••ctiviti•••hould p.rticul.rly focus upon •• li.nt probl . . . .uch •• .ubility. f.ll •• confu.ion. copinl with .tr•••• to .dd g.rontololY .nd h•• lth c.r. for the eld.rly ••p.ct. to .xi.tinl .duc.tion.l activit i •• : l.) (b) di ••••e-r.l.t.d .ctiviti•• ( •• 1. ment.l h•• lth. c.rdio-v•• cul.r. tuberculo.i.) r •• e.rch.
l2)
di.cipline-r.l.t.d .ctiviti•• ( •• 1. nur.ing. d.nc.l c.r•• ment.l h.alth)
Prof ••• ion.ls 5.4.2* WHO should .pon.or work.hop. di8ciplinary work.hop• • r. n.c •••• ry. 1n the .r•• of ,.rontology .nd h•• lth luid.line. for curriculua d.velopment health c.r. of the .ld.rly. for teach.r. (.ano- and aultiboth at n.tion.l and r.lion.l l.v.l.) c.r. of 'the .ld.rly to d.velop .nd the t ••chin, of ,erontololY and
~.4.3.0 WHO .hould .pon.or r.lional .nd n.tional work.hop. for phy.ici.n •• nura •••• tc. on brain f.ilure (.enil. dementi.) .nd ment.l health guid.lin•• in the .ged.
"r' , nonty
• - 14 -
5.4.4*
WHO reaearch training activities: la) lb) should include gerontology and health care of the elderly aa content are •• i
ahould include participants from various d~aciplines ldoctors, nuraea, social workers, social scientiats, etc.) who are involved in health care of the elderly.
5.4.5 WHO should encourage the development of poat-basic and poat-graduate training in gerontology and health care of the elderly for practiaing phyaiciana and nuraes wi8hing to specialize in this field. 5.4.6 WHO ahould particularly reca.aend the urgency of such courses in all fielda of mental health of the aged. 5.4.7 WHO abould develop a basic modular training progr.... for leaeral uae particularly emphaaizing ca.munication skills.
5.4.8 WHO .hould develop basic modules for inclusion in nursing, medical letc.) cour.ea on health care of the elderly. 5.4.9 WHO ahould encourage the inclusion of lerontololY and health care of the elderly in basic traininl of rehabilitation personnel. Auxiliary workera lnuraing aida, home help., etc.) 5.4.10 WHO ahould develop a baaic modular training progra....
Traditional h.alth work.ra 5.4.11 WHO ahould collaborate with Kamber States in developing r.gional workshopa for traditional health workera in order to: la) lb)
lather experience on th.ir potential knowledge contribution to health care of the elderly; teach traditional health workers about health care of the elderly; encourage their cooperation with other workera in health care of the elderly.
lc)
Family care givers 5.4.12 Educational and *p' . nonty ~tual
aupport groupa ahould be eatabliah.d.
- 15 -
5.4.13 WHO ahould conaider reaearch in aerontology and health care of the elderly (including eocial care)a priority area for the allocetion of reaearch trainina arants). 5.4.14
WHO ahould encoureae exchanae proar...... : (a) (b) (c) for underaraduate and graduate studenta in area. related to health care of the elderly; for profeeeional. working in health care of the elderly; for acadeaic faculty (re.earcher. and/or teachera).
Pru..ry health care workers 5.4.15* WHO should explore the feaaibility of adding health care of the elderly .killa to their traininl.
The following actiona are propo.ed for consideration by M.-ber Statee. 5.4.16* Since old people and health care profea.ione1e accept too ea.i1y phy.lea1 and ..ntal deterioration a. auppo.ed1y no~l in old aga. there i. a lack of recognition of treatability. At ti.... health care .ervice. are under-utiliaed. Thue, health education to the elderly and health profea.ionals ia necelaary.
1n collaboration with WHO, H..ber State ••hou1d: ).4.17* 1ntroduce into the curricula of all ..dica1 and nur.inl .c~ool. the .tudy of adult hwaan develop.. nt (inc1udinl esins) in all it. phY.10lolical. p.ycholoaical, patholoaica1, clinical. epid.. io10sica1 a" .ociololical a.pect.. Thi ••hould belin early in the curricu1ua and entail lecture . . . . . 11 work Iroup. on attitude. and clinical experieace in an optt.el .ettinl. 5.4.18* Incoureae profe •• ional reliltration and licen.ing board. (.edicine, nur.inl, etc.) to include gerontololY and health Care of the elderly a. requireaenta for reli.tration and licen.ing. 5.4.19'" Provide continuinl education and ia-.ervice training in health care of the elderly to phy.ician., nuraea and other peraonne1. 5.4.20 Di.eeainate information on available health and locial aervice. in order to proaote acceasibility to the aged theaaelve •• their f ..ilie. and health profea.ionale.
*Pnor1ty . .
• - 16 -
!i.4.21 Sponlor co_unity education progra_el to promote and lIaintain pOlitive attitudel toward. the elderly. Thil should be achieved throuah: prelchool and school education media-b. sed progra. .ea programmes directed at .pecial target groupB, e.g. the elderly to: develop individual capabilities provide knowledae on aging and discourage stereotypes improve lifeBtyle and aafety behaviour. !i.4.22 Include component I on aging and on health and diaeale in the elderly in existing and planned health education and health promotion progra_a. !i.4.23 Encourage universities to create teachina and re.earch appoint. .nta in gerontology and health care of the elderly and eatabliah wherever fea.ible: chairs in gerontology; interfacul ty (interschool) chairs in aerontol,oay and health care of the elderly (e.g. lIedicine, nuraina, behavioural Icience, locial work, etc.); aeriatric .edicine chairl. 5.4.24 When aareeable, develop and provide guidelinea for pre-retir...nt and poat-retire..nt courlea. Thia le ..1 aore relevant to countriea, luch aa Jspan, AUltralia and New Zealand. !i.!i Manpower The followina reca.mendations are for the conaideration of WHO. !i.!i.l WHO should urge Member States to continue to cODduct abort- aDd lODg-term projection of manpower atudies so that a baae of knowledge ia available. !i.5.2 lD this reaard, WHO ahould provide conaultaDt .ervice. iD the methods of auch projection atudiel. Future manpower Deed. depeDd OD the ability to attract and hold reaearcher. in the' area. of . .dicine, nur.iDI, related health profe.aionl and the gerontololical aciencea in geDeral.
'"
'"Pr1or1ty . .
- 11 -
~.~.3 WHO .hould .ncour.l. Meab.r St.t•• to give .p.ci.l con.id.r.tion to .ncour.ginl .xi.tinl r •••• rch.r. to p.rticip.t• •nd und.rt.k. h•• lth c.r. re ••• rch r.l.t.d to the .I.d. by pr.f.renti.l f.vour.ble fundinl' Additional pr.f.r.nti.l inc.ntiv•• n••d to b. d.v.loped to .ttr.ct newly Ir.du.t.d r •• e.rch.r. into this .r•• < •• 1. tr.ininl Ir.nte. po.t-gr.du.te f.llow.hip •• etc.).
The following actions are propo.ed for consid.ration by Maab.r States: 5.5.4* He.lth car. of the elderly ahould be included in the gener.l h.alth c.re .ervices provided by exi.ting per.onnel who h.ve eome pertinent tr.ininl in the .re. of health car. of the .lderly. 5.5.5 Sp.ci.list. in v.riou. field. r.lated to h.alth c.re of th. elderly ( •• 1. g.riatric _dicine. aUriiag) ahould be used in .n advhory. t ••chinl .nd r •••• rch c.p.city .nd in • •ervice c.p.city where .ppropri.te .nd fe •• ible. ~.5.b Examination needa to be ..d. of wh.ther the di.tribution of .peciali ••d h•• lth c.r. progrea.e. i. unduly conc.ntrated in urb.n .r•••• It i. reco.aended that. wh.r. rur.l r.gion.l centres .xi.t. the speciali •• d training of h•• lth c.r. of the ...d be ••calat.d.
a.habilit.tion .t.ff 5.5.1 The n•• d. the type .nd the traininl of "reh.bilit.tion staff" ahould be inv.stilated in tho •• countri•• which do not have .chool. for the tr.ininl of r.habilitation .taff .uch a. phy.ioth.rapi.t ••nd occupaCion.1 tharapi.ta. One .hould con.id.r in this context propo•• l. of the f ••aibility of .ulti-purpo•• thar.piat •• 5.5.8 'eraona with .ocial aci.nc. traininl in developing countri.a .hould be encourag.d to p.rticip.t • .are fully in car. of the alin,. 5.5.9 WHO should encourage lov.rn.ent. to pro.ote the soci.l. econo.ic and moral contributions of the elderly to theirca.aunity. :'.b Research Th. tollowing rec~nd.tion •• re
for the con.ider.tion of WHO.
5.b.l* WHO should add ...bars with experti.e in gerontology and he.lth c.re of th. elderly to it. Advi.ory Ca.aittee on Medical Rese.rch. 5.b.2* In order to make future pl.nning and action .are efficient. WHO .hould a •• i.t countries in the coll.ction .nd proce.aial of .tatistic.l d.t •• t.kial into account the .aia vari.ble ••uch .s ••x •• igaific.at .Ie Iroup', the .ise. of hou.ehold •••ocioecono.ic cl•••• occup.tion, cultural f.ctor •• etc. With the d.velo,..nt of co.put.ri.ed prolr...... it would then ba po•• ibla to produce various cro ••-cl ••• ific.tion••nd wei,htin, of variabla.. .
*PrlOrlty . .
- 18 -
•
5.6.3* WHO should monitor national studies on the aging and health services for thp. elderly to ensure that, wherever possible, methodology allows for cross-national comparison. 5.6.4* WHO should provide expert guidance acknowledging the financial restraints on the development of manpower in health care of the elderly. Affirming the notion of quality of health care in the aged, it is recommended that research should be concentrated on the type of disability experienced by the aged and the most appropriate method, setting, level of professional involvement and resultant type of care (institutional, community or some combination of these). This research should lead to a more informed cost-effective deployment of manpower without sacrificing the quality of care of the aged. 5.6.5* WHO should use its research reserve fund to stimulate high priority research in the area of gerontology and health care of the elderly. 5.6.6* WHO should promote research on diseases common in old age, taking into account their incidence and medico-social management. Other epidemiological studies of the elderly should be encouraged. 5.6.7 Research is needed on the cost-benefit and cost-effectiveness of periodic health screening in the elderly in specific areas (e.g. diseases, physical and mental functioning). 5.6.8 WHO should suggest that existing academic research programmes be evaluated on an inter-regional basis, so that modules of training and research developed in this specific region can be formulated. 5.6.9 WHO might assist in indicating worldwide funding resources which are interested in research on gerontology and on care of the elderly. 5.6.10 WHO should ensure that research findings are widely disseminated within the Region and can be utilized by policy and decision-makers. WHO should slso encourage dialogues between researchers and policy-makers. 5.6.11 The following examples are suggested research topics on an intercountry basis: Epidemiological studies Demographic studies Brain failure (senile dementia) studies (including cultural and socioeconomic variables influencing family and community tolerance and patterns of care) Functional dependence and independence studies (including cultural, socioeconomic and disease variables) Family studies (kind of families, kind of impairment, kind of family support, kind of community support, length of time and coping) *Priority
!
- 19 -
Investigation of survival and coping with long-term conditions, e.g. stroke
Consequences of nutrition a. related to aging and di.ea.e patterns {e.g. salt intake} Research into the rights and legal status of the elderly Research into the benefits of exercise by the elderly The position of acupuncture and other traditional treatments in health care of the elderly (e.g. chronic joint pain in old age) The con tributions and implications of treatment and non-treatment in the care of the elderly. Sta tes. The following actions are proposed for consideration by Member
5.6.12 It is necessary to specify in each country for research purposes where chronological old age ''begins''. 5.6.13 Minority groups within regional countries may need special considerstion as to the most appropriate type of health care of the aged. Research needs to be conducted to establish these needs. 5.6. 14 The effectiveness of pre-retirement courses should be evaluated.
5.6.15 Research into physical, emotional and financial requirements needed by families {communities} to care for frail elderly persona is necessary in order to plan progrlllllmes to encourage and support such fami lie ••
6.
CONCLUSIONS
Falling birth rates and longer living have combined to push up the life expectancy of the world's population. By the year 2000, there will be twice as many people in the world aged 80 years and over as there were in 1970. Between 1980 and 2000, the number of these very old people will rise by 1 million in Japan and by 5.7 million in China. Demographic aging, defined as more than 7% of the total population having reached the age of 60, has become already a reality in Australia, New Zealand, Hong Kong, Japan and Singapore. In all of the Western Pacific Region, mortality trends are downwards while morbidity patterns point toward chronic disease and accompanying disability. The consequence of these two,factors is that, if
• - 20 -
he.lth c.re eervice. do not find new and better way. to anawer phy.ic.l .nd ..ntal he.lth c.re needs, exiating eenices will be overwhel.ed by .n incr •• eing .ged population and. aleep riae in chronic conditione and function.l dependency. Urb.nization •• igr.tion, the incr•• sed p.rticipation of woaen in the l.bour force, and. gener.l trend towards a•• ller f •• ilie. decre ••e t . . i~y capaclty to c.re for the .ged, even though tr.dition.l re.pect for the eLderly ..y continue to be a v.lue widely .dhered to in the legion. The lncre.sing pre.lure of neede of the elderly could pl.ce other he.Lth prlor1tlel in jeop.rdy if action ie not taken eoon. There ie • pre •• ing need to .vold the we.tem aodel of he.lth care for the elderly in the developing world in manyrelpecta (e.g. seeking so frequently 1natitutional .olution.). If the u.proved be.lth .nd well-being of .11 of tbe popul.tion i • • go.L th.t 1a con.idered .eriou.ly, it i. nec••••ry-to actively develop he.lth c.re of the elderly progr..... throughout the Region which will: eaph.size a preventive approach; reduce potential coata of care; prevent the need for in at itut ionalization; and increa.e the potential for f .. ily support. This Working Group feel • • trongly th.t eaph•• i. should be pl.ced upon tbe .trengtha and abilitie. within tbe elderly, their f"ilie., coaaunitie. and .lre.dy exi.tent c.re IYlteas. Elderly people, like all other., h.ve a c.p.city for .elf-c.re, which ahould be opti.ized, .nd f .. ili •• ar. tbeir •• in .upport. Neverthele •• , .alf-c.re .hould not be .aen a • • n .ltern.tive to, or •• ub.tituta for, he.lth c.re. There i • • thin bord.rlin. betwe.n .elf-c.r• •nd .elf-neglect in the live. of . .ny di •• bl.d alderly. It is .1.0 nece •• ary to be reali.tic about the rola of f ..ilia. in rel.tion to c.re of it. elderly ...ber., for av.n in devaloping countrie., where extended f ..ilie. atill exiat, not .11 .re .ble to provide the nece ••• ry care .nd not .11 elderly h.ve (av.il.ble) f . .ilie. (urban .igr.tion, etc,). Still, f .. ily contribution• • re .0 iaport.nt that a •• jor objective of the health care lervices should be to support, .nd not to 8uppleaent, thi. continuing care. Identified .t an e.rly .t.,e, ..ny potanti.l ha.lth and .ocial probl ... of old .ge can be controlled or even .voided. Thi. i.plie. continuous surveillance of the elderly popul.tion at the pri.ary c.re level, .nswering .ri.ing he.lth c.ra nead., reh.bilitating where dieability i. un.voidable, .nd .aintaining level. of functional .bility after rehabilit.tion.
- 21 -
Healtb education, early treat.ent, aelf-care, f .. ily and ca..unity care notvitbatandina, for a minority of old people vitb pbyaical or ..ntal impairment and/or vitbout fa.iliea, care in ao.e kind of inatitutiona viII be unavoidable. There ia a place for health care of tbe elderly at pri.ary, aecondary and tertiary levela, and coordination of tbeae aervicea ia of pri.e i.portance. Tbia Working Group considers tbe folloving iaaues as crucial to tbe development of adequate care: Raiaing public and profeasional avarenea. of tbe tcope of the probl ..a and encouraging poaitive and reali.tic attitudea Education and training Manpower development Servicea development, and Reaearcb. Each of tbeae iaauea carrie. top priority and an effort to develop one at the expen.e of another vould be doomed to failure. The dark aide of care for the elderly ae ..a to reault from crucial i.auea dealt vitb inadequately, leadina to a neaative cycle of inadequate information and reaearcb. This cycle determines and ia deterained by inadequate education, manpower and aervicea. Eacb of tbeae variablet adver.ely affecta the otber and all of them are caused by and add to negative atereotypea. NJl:ATlVE C\t:1..E OF HEALTH CARE or THE ELDERLY
Avarenea Attitude.
Education Knovledae • Skill -
RESEAaCH
Servicea-
~--------~
Manpover-
The Working Group urgea WHO and the countriea of the Weatern Pacitic Region to turn thia partially negative cycle into one vbere health and vell-beina can be a reali.tic expectation for .any of tbe aaed.
•
- 22 -
Developina relev.nt re.e.rch (.ee reco.aend.tion. on re.e.rch), incre •• ing knowledae .nd .kill. throuah educ.tion .nd tr.inina, dev.lopina .dequ.tely pr.p.r.d manpower, .nd developina • r.nae of nec •••• ry •• rvice. will be ..de po•• ible by incre•••d .w.ren•••• nd will in return cr•• te re.li.tically po.itive .ttitude., wh.re further re ••• rch will cre.te .v.n better educ.tion, manpower .nd •• rvice ••
·POSITlVE C'lICLE
or
HEALTH CAU
or
THE ELDERLY
Av.rene ••+ Attitudea
~
~
:I
Service.4-
~ ~
RESEARCH+
, / ..
Educ.tioll+ (Educ.t ion , Skill)
l~
Manp_r+
rhe D.cl.r.tion of Al..-At • •ddr•••••• quity .nd h•• lth •• pri.. n.ed. of the .ld.rly. Oft.n the .Ced .r. the poore.t .nd ~.t di ••dv.ntac.d .nd tho •• vith .. ny h•• lth c.r. ne.d. ua.et. If OUr co.l i. the h•• ltn and .. ll-bainc of all, raaourc. allocation (takina into .CCount co.t effectiv.n.aa .nd coat b.n.fit) ~.t nOW t.k. the Cr•• tly incr••••d ne.da of thia popul.tion croup into .ccount to .void • ~r.lly .nd aoci.lly un.cc.pt.bl. aitu.tion. 7. SUMMARY
Ke.lth c.r. of the elderly auat be d.velop.d .a .n int.cr.l p.rt of the he31th .ervice. to the entire popul.tion. E.,ha.i ••hould be l.id upon .tre~ath.nilll .nd aupportilll faaily .nd ca..unity c.re, but. vide r.nae of service., includinC aODe kinda of in.titutional c.r. for • • inority 3f the di.abled. elderly, vill be needed. Due attention . .at be p.id to tne specific mentsl he.lth need. of the .Ced .nd aervice. d.veloped to •• n.ae beh.viour.l probl ... (.ince even in developina countries the incidence of senile dementia is iner.a.ins rapidly). Il•••• rch i. vit.l in C1V1nC direction to h•• lth c.re .ervic•• Th. Work inc Croup f .. l. th.t it i. i.p.r.tiv. to coll.ct ca.p.rabl~ d.t •• HiCh priority i. civ.n to epide.iolocic.l .tudi•••nd to
d.velop_~t.
- 23/24 -
re.eerch concerned with the cultural and locial factor. influ.nciDi faaily carina. tolerance of dilability and the .ffectiv.ness (benefit a. vell a. co.t) of a ranae of h.alth care I.rvic... Thi. latter r •• earch could be a unique contribution by the R.aion to the Icientific body of knovled ••• In order to anlver the rapidly arowina need. inten.ive effort. in education .nd trainina on all l.ve1. ar. of i...diat. u.portanc •• Geroatoloay and bealtb c.re ot tbe eld.rly mu.t ~. includ.d in the ba.ic curr~cula ot all h.alth care profellioaall. Ther. il a n.ed tor coatiauin. educat~on and tra1n1na tor thole health care profellionall practi.ina now. Aux~l~ary personael mu.t allo b. trained. There i. a areat need for the education of a few Ipeeialiltl (..dicine. our.ioa. etc.). whOle .olt influential contribution. are lik.ly to be ..de in teachina. advi.iaa. relearch and in providina back-up 8upport for pri.. ry health .ervic.s. Con.iderina the laa ti.e invo1v.d in the d.velopment of .ound relearch r.su1t •• education and trainina of ..npover and develo,..nt of .ervic ••• this Work ina Group ureatly .u••e.t. aa ..bitiou. pro.r.... to both WHO and the Meaber Statel of the I.aion. A full-time coordinator will be need.d to actively d.v.lop tho.e •••• ntial pro.r..... which .ak. provi.ion for the rapidly .rowia. aa.d population in the aoal of Health for All in the Year 2000.
•
- 25 ANNEX 1 INFORMATION BULLETIN NO. 2 LIST OF MEMBERS, CONSULTANTS, OBSERVERS AND SECRETARIAT
1.
MEMBERS Professor Derek Prins ley Vice-Chairman Director Mt. Royal National Research Institute of Gerontology & Geriatrics Victoria Mr Keith Bennett School of Behavioural Sciences Macquarie University North Ryde, N.S.W. 2113
AUSTRALIA
CHINA
Dr Zhou Guangyu Chief, Surgical Department Beijing Hospital Beijing Professor Cai Rui Sheng Vice Director Institute of Cardiovascular Diseases Fuwai Hospital Chinese Academy of Medical Sciences Beijing
FIJI
Dr Y.R. Sadhu Assistant Director Hosp.ital Services Ministry of Health Suva
- 26 -
Annex 1 cont'd.
HONG KONG
Dr Ng Yau-yung Honorary Lecturer/ Consultant Geriatrician Medical and Health Department Lee Gardens, Fourth Floor Hysan Avenue Causeway Bay Mr Mui Kan-kit Senior Social Work Officer Development Branch Social Welfare Department 19th Floor, World Trade Centre Causeway Bay
JAPAN
Mr', Daisaku Maeda Chairman Director, nepartment of Sociology Tokyo Metropolitan Institute of Gerontology 35-2, Sakae-cho, Itabashi-ku Tokyo nr Haj ime Orimo Associate Professor Department of Geriatrics Faculty of Medicine University of Tokyo 7-3-1, Hongo, Bunkyo Tokyo
NEW ZEALAND
Dr A. John Campbell
Senior Lecturer Geriatrics Faculty of Medicine University of Otago Dunedin PHILIPPINES Dr Dolores Recio Dean College of Nursing University of the Philippines System Diliman Quezon City Ms Leticia C. Generoso Director National Capital Region Ministry of Social Services and Development Kansas St. cor. P. Gil St. Malate Manila REPUBLIC OF KOREA Professor Kyu-Sang Cho Dean Catholic Medical College Seoul
- 27 Annex 1 cont'd. SINGAPORE Mr Bernard Soo Fook Onn Principal Nursing Officer Singapore General Hospital Singapore 0316 2. CONSULTANTS
Dr Miriam Hirschfeld Lecturer Department of Nursing Tel-Aviv University National Coordinator for the Care of the Aged and Chronically III Kupat Holim Tel-Aviv, Israel Professor R. van Zonneveld Secretary and Director of the Bureau Council for Health Research P.O. Box 297 2501 BD, The Hague The Netherlands 3. OBSERVERS
Professor Gary Andrews Regional President International Association of Gerontology Asia/Oceania Region Science Centre 34-43 Clarence Street Sydney, N.S.W. 2000 Australia Ms Adele Go Opera Pia International University of Santo Tomas Espana St., Manila 4. SECRETARIAT
Ms Helen E. Fillmore (Operational Officer) Regional Nursing Adviser WHO Regional Office for the Western Pacific Manila
- 28 -
Annex 1 cont'd.
MEMBERS OF THE WHO FOCAL GROUP FOR HEALTH CARE OF THE AGED
Dr S. Endo Acting Director Health Protection and Promotion and Regional Adviser in Chronic Diseases WHO Regional Office for the Western Pacific Mani la Mr H. Dhillon Chief, Human Resource Development WHO Regional Office for the Western Pacific Manila Dr Jean-Paul Menu Regional Adviser Health Manpower Development WHO Regional Office for the Western Pacific Manila Dr N. Shinfuku Regional Adviser Mental Health WHO Regional Office for the Western Pacific Manila Dr N.V.K. Nair Regional Adviser Nutrition WHO Regional Office for the Western Pacific Manila Dr J. Tuomilehto Medical Officer Cardiovascular & Metabolic Diseases WHO Regional Office for the Western Pacific Manila Dr C. Sundram Dental Officer Oral Health WHO Regional Office for the Western Pacific Manila
, - 29/30 -
Annex 1 cont'd.
Dr S.J. Krister Regional Adviser Organization of Medical Care WHO Regional Office for the Western Pacific Manila Dr D. Stern Regional Adviser Health Services Development WHO Regional Office for the Western Pacific Manila EURO Dr Hana Hermanova Regional Officer designate for the Programme on Health Care of the Elderly WHO Regional Office for Europe Copenhagen
- 31 -
ANNEX 1.1
LIST OF SMALL WORK GROUPS
GROUP I Topics Individual focus on: Future aging: Expectations and Implications
Demands and needs for physical and mental health and social care (Prioirities in) Resources and services development Recommendations on resources and services development Research on resources and services development, and general (including recommendations)
Participants Professor D. Prins ley Mr B. Soo Fook Onn Mr Mui Kan-kit Dr Y. R. Sadhu Dr Z. Guangyu Ms Adele Go
• - 32 -
Annex 1.1 cont'd.
CROUP II Topics Family focus on: Future aging: Expectations and implications
Demands and needs for physical and mental health and social care Manpower needs Recommendations on manpower needs Research on'manpower needs and general (including Recommendations)
Participants Mr K. Bennett Dr Ng Yan-Yung Ms L. Ceneroso Dr H. arimo Professor Cai Rui Sheng
- 33/34 -
Annex 1.1 cont'd.
GROUP III Topics Community focus on: Future aging: ~
Expectations and Implications
Demands and needs for physical and mental health and social care Education and training Recommendations on Education and training Research on Education and training and general (including Recommendations)
Participants Dr A. John Campbell Mr D. Maeda Professor Kyu-Sang Cho Professor G. Andrews Dr D. Recio
- 35 -
ANNEX 2
OP~N1NG K~HAKK~
AT
TH~
BY TH~ K~GIONAL UIRE~.OR WORKING GROUP ON HEALTH CAK~ OF THE ELDERLY /'IAN ILA, 111- 24 AUGUST 19111
Ladles and Gentlemen,
It gives me grest pleasure to welcome you this morning to this Worklng Group on Health Care ot the Elderly. This meeting is most timely for the world is now witnessing a process of demographic aging. In both developing and developed countries, the extension of life expectancy has resulted ln lncreasing numbers of the population enterlng the age groups bO years and above. There lS now emerglng a global concern tor the weltare and well-being ot the aging. An indication ot the extent of this concern is the resolution adopted by the United Nations General Assembly at its Thlrty-Second Session to organize a World Assembly on the Elderly in 1982. Actlvltles of the WHO programme on the care of the elderly were accelerated by the World Health Assembly resolution which requested the DirectorGeneral to taKe actlve steps to maximize the activlties of the global programme in anticipation ot the prominent role WHO will be invited to take ln organlzlng the Unlted Nations World Assembly. You will all have recelved coples ot the report ot the WHO Preparatory Conference for the UN World Assembly on Aglng, WhlCh was held ln Mexico City trom II to 11 December l\lIlU. we, gathered here today, have a more immediate concern. We are concerned about the health Of the elderly in countries of our Region. What strategles and plans can be developed within the limits of a country's resources to ensure that by the year 2000 the elderly of our Region will have a fultllling and meaningful life? ~xperience and good sense have made us realize that only throush a hollstic approach to care of the elderly csn success be attained. Inherent ln the concept ot holistic care is the sociocultural milieu in which the care lS provlded. Countries ln our Region have a long history of reverence and duty to the aged. The idea of a government social security plan to care tor the aged is alien to many cultures, as the old expect to be cared tor by their families, and fsmilies recognize and respect this commitment.
Industr18lized countries are striving toward the pr.ovision of care and service in the community; developing countries still rely heavily on care provlded by the extended family and community. This filial responsibllity is still strong in our Region and this strength should be promoted. Through a primary health care approach, the elderly in the rural communlty, where incldentally most of our elderly live, will have the opportunlty to be lnvolved ln planning tor their care and receive this care in a settlng which is famlliar and non-threatening and does not place in Jeopardy the dlgnlty and self-esteem ot the aged person. The task set tor you as a group is to determine priority needs in the context ot health care ot the elderly and to develop guidelines tor WHO and country COllaboration in the development ot a community-based programme on health care ot the elderly wlth emphasis on the promotion of health and preventlon ot dlseases. It is a formidable task to undertake in the time allotted but I am Bure that thoae ot us who have yet to enter this age
- 36 -
Annex 2 eont'd.
group Wi!! Deneflt tram the truits at your labour. We are tortunate in having Dr van Zonneveld trom The Netherlands and Dr Miriam Hirschfeld trom israel to collaborate with you in your deliberations. I wish you a stimulating and rewarding meeting. I know that the outcome ot your discussions will reflect the Group's belief about the selt-esteem and· worthiness at the elderly and their role, both real and potential, as a contributory force within their society.
- 37 -
ANNEX 3
AGE1fIlA.
Tuesday, 18 August 8:30 a.m. Registration Opening ceremony: Opening Address by Regional Director, Dr Hirosbi Kakaji. . Self-introduction by participants Election of Cbair..n, Vice-Chair..n and Rapporteurs 10:00 a.ll. 10:30 a.m. Coffee break and group photo Orientation to the Working Group - Prosrand Process Adoption of tbe Provisional !a_nda 11:00 a.m.
9:00 a.m.
Plenary session: Current Statu of ve11bei and bealtb care of the elder' in countries ot tbe Region Australia, ople" Republic of Cbina, Fiji, Hong Jeong, Japan, Kew Zealand, Philippines, Republic of KOrea, and Singapore) Luncb Plenar;r session: and Implications Future agi!/l.lj: Expectations
12:30 p.m. 1': 30 p.ll. 2:00 p.m.
Small group discussions I II III Individual focus Famil;y,focue Community focus
... /
- 38 Annex 3 cont'd. 3:00 p.m. 3: IS p.m.
Coffee break Plenary session: Adjournment Group Reports
4:00 p.m. Wednesday, 19 August 8:00 a.m.
Plenary session: Demands and needs for physical and mental health and social care* Small group discussions I II III Individual focus Family focus Community focus
8:30 a.m.
10:00 a.m. 10:30 a.m. 11:30 a.m. 12:30 p.m. 1:30 p.m. 2:00 p.m.
Coffee break Small group discussions Plenary session: Lunch Plenary session: Existing and necessary resources and services* Small group discussions I II III Priorities in resources and services development Manpower needs Education and training Group Reports
3:00 p.m. 3:15 p.m. 4:00 p.m. Thursday, 20 August 8:00 a.m.
Coffee break Small group discussions (cont'd.) or Plenary session: Group Reports Adjournment
Visit (field trip) to Barrio Silangan for community health service and exchange of ideas with Filipino elderly
*Focus on primary health care and strengths and contributions of the elderly; Consideration of range of services including institutional care; Integration and continuity.
- 39 -
Annex 3 cont'd. 12:30 p.m. 1:30 p.m. 2:00 p.m.
Lunch Plenary session: Existing and necessary resources and services* Small group discussions I II III Priorities in resources and services development Manpower needs Education and training
3:00 p.m. 3:15 p.m.
Coffee break Plenary session: Adjournment Group Reports
4:00 p.m.
Friday, 21 August 8:00 a.m. 10:00 a.m. 10: 30 a.m.
Plenary session: Prevention and rehabilitation - Panel Discussion Coffee break Plenary session: Research (basic. Elinical, epidemiological, health behaviour and health services research) Panel Discussion Lunch Plenary session: Development of guidelines for action for: (a) (b) WHO and country collaboration Member countries
12: :10 p.m. l:~~O
p.m.
2:()O p.m.
Small group discussions Conclusions and recommendations: Priorities in resources and services development Manpower ~lanning
Education and training Research *F,.cus on primary health care and strengths and contributions of the elderly; Consideration of range of services including institutional care; Int,'gration and continuity.
- 40 -
Annex 3 cont'd.
3:00 p.m.
Coffee break Small group discussions (cont'd.) Conclusions and recommendations Adjournment
3:15 p.m. 4:00 p.m.
Saturday, 22 August 8:00 a.m. 10:00 a.m. 10:30 a.m.
Small group discussions (cont'd.) Conclusions and recommendations Coffee break General recommendations Adjournment
12:00 noon Monday, 24 August 8:00 a.m. 10:00 a.m. 10:30 a.m.
Discussion and approval of recommendations Coffee break Discussion continued Acceptance of recommendations
12:30 p.m. 1:30 p.m.
Lunch Final remarks Closing session
2:45 p.m.
- 41 -
ANNEX 4 COUNTRY QUESTIONNAIRE SOCIAL AND HEALTH STATUS OF THE ELDERLY
Country:
Reporter:
If the data are not available from national sources, please U8e any other materials to reply and indicate the sources. In case the spaces provided for your answers are not sufficient, please attach additional sheets.
Annex 4 can t' d. 1. A.
- 42 -
Demographic, socia-economic and health situation Population l.
Year
Data
l.ates t es timated population popuLation at latest census Census popuLation prior to latest census
19 19 19 19
-______ per sq m/ sq km
Z.
Population density Percentage of population: 15-54 yrs 55 yrs & above (or 55 + yrs) = Male = Female
3.
19
____ x ____ X
% %
4.
Population 55 yrs + in the year 2000: Estimated total population Estimated percentage of papulation Vital statistics (latest available data): Crude birth rate 19 19Crude death rate 19Annual rate of increase Life expectation at birth = most recent data 19 19= 1965-1970 data
____ x %
5.
per 1000 pop _______ per 1000 pop % yrB _ _ _ _ _ yrs
B.
Socia-cultural aspects l. Percentage of population in: rural areas urban areas
19
____ X
%
(Give definition for rural/urban in the country.)
Is there an outward migration to towns and cities? Year
Yes/no Data
2.
Percentage of population 55 yrs + living in: rural areas - total male female urban areas - total male female Major ethnic groups:
19
____ x ____ X % % % ____ X % %
19
3.
(Please specify)
____ X
- 43 -
Annex 4 cont'd.
4.
Rp.ligiou9 compos1t1on: Buddhist r.hris t i an r.atholic Protestant Mus 1 im
____ I
---_% % %
-_ __ % _ _ I
Others (specify)
5.
Average age at marriage: Male Female Average family size (nuclear)
19 19
yrs yrs
6. 7. 8.
Average length of married life before one spouse dies 19 Average age of death of first spouse Usually: husband wife Pattern of family life: nuclear elCtended 19
_ _ _ _ _ y>:8
_____ yrs
9.
% %
Is pattern changing?
yes/no % % % % % % % %
10.
Percentage of population 55 YrS + living: 19 with spouse wi th thei r ch i l dren with other relatives/friends alone in institutions 3
= private
government owned owned yes/no
Is this pattern changing? 11.
Literacy rate for: Adult population 19 = Male = Female Population 55 yrs & above = Male = Female Percentage of population completing: primary education secondary education college/university Percentage of 55 yrs + completing: primary education secondary education college/university
___ I
____ I ____ I
___ X ____ X
___ I
- 44 Annex 4 cont'd. Is equal opportunity offered for female education? Is this opportunity of recent origin? when? _____ C. Economic aspects 1.
yes/no yes/no
Main economic base:
agriculture/industry/service yes/no _____ yrs yrs % %
If agriculture, is there an increase in industrialization? 2.
Age range of the economically active population If age range is different for women, please include their age range.
3.
Percentage of population economically active Percentage of women economically active
4.
Do women have equal opportunity for emp loymen t ? If no, what jobs are open to women?
yes/no
5.
Average annual per capita income (Please specify currency used and exchange rate to US$l.OO)
6.
Average age of retirement for: Males Females Is this age applicable to both public and private sectors? If no, please explain: yes/no
yr. yrs
7.
Approximate percentage of population who work after retirement?
%
What type of jobs are likely to be selected? (Give three major types) ___________________
- 45 -
Annex 4 cont'd.
ij.
Do you feel tnat retirement on the whole causes an economic crisis in the family?
yes/no
Please e><plain 9. What percentage of retired persons are~ financially independent? partially financially independent totally dependent financially
% ____ I ____ X
10. Percentage of sources of income for retired persons~ pensions
____ I
Government = Private savings family from second job others (please specify) =
____ X ____ ____ ____ ____ ____ ____ I I I I I I
none
11.
Food production Country's staple food. [s country self-sufficient 1n staple food production? Major food imports 1. malnutrition a major health problem? In person. 55 yr. + ?
yes/no
yes/no yes/no yes/no yes/no
Is obesity a major health problem? In persons 55 yrs + ?
o. Attitudes and awareness toward aging and the aged Attitudes toward aging and tbe aged To the bes t of your mow2. Why do you think people ledge, how do people of the an tbese categories bave following categories view the values and attitudes the process of aging and tbe .entioned in query 11 aged person? (e.g. sick, ... 1.... ~~ ~ ':' ~ , : e ... ... ~",,:..a ~ .. ...• - ~ -- ........ r ..- - '" - , a new start, a necessary eveat, revered, a burden, a sacrifice) 3.1 ·~at is your ilapression of how aware are the following categories of the growing nu.bers of people in the pop 55 yrs + , do they feel ~_-.G.'"
Categories
.. : •.; 46':'..:! :-,a·.. a .ipe.::.i:
needs?
3.2 Did you hear anybody in the following categories state that the growth in the nu.bers of people in the pop 55 yrs + is a present or potential problea? If yes. in . _. - . . . . _.1.: .• .......... ... • ..... _ .... <- .... e:. .... 60:;; ....... v •• sidered a problea! Please list some of the probleu identi ned. -~ -b~ ~
§ " .,. ID
I~
::
o
(')
a)GoYera.eat off~c~.ls and aeadellic grou ps •
b)Urbaa aiddle clas.
clLov inca.! urban people
d)lIural vi 11a", people
.,. a.
e)Scboolebildrea
f)The elderly th••• l •••
I
- 47 Annex 4 cont'd.
4.
Is gerontology/geriatrics taught as a separate medical schools nursing schools other allied health schools (specify)
sub ject yes/no yes/no yes/no
in~
Is gerontology/geriatrics integrated into other subjects? medical schools yes/no yes/no nursing schools Do you feel that the teaching of gerontology/geriatrics need strengthening? If yes, how? yes/no 5. Is there any data in your country on the average state of well being of the elderly? yes/no If yes, give information on the percentages who are: physically and emotionally well & function independently emotionally well but physically handicapped I sick (partially independent) physically well but emotionally handicapped/ sick (partially independent) physically and emotionally handicapped (totally dependent) Please give three pertinent publications and studies done on the aged in your country:
%
% % %
6.
.'
It.
Health service. of the country 1. 2. Please attach an organizational chart of the Health Services of the country. Manpower Category of health personnel Doctors Registered nurses Other nursing personnel (include: home help, granny sitter, etc.) NuIIIber Ratio
Health educators Dentists Occupational therapist Physio-therapist Medical social workers Others
- 48 -
Annex 4 cont'd.
3.
Medical, nursing, allied health education Type of school Medical Nursing (for trained nurse) Assistant nurse
Number of schools
Annual output
Aid nurse Dentist occupational therapist Physio-therapist Social worker 4. 4.1 Health agencies General hospitals No. of general hospitsls No. of beds With separate geriatric facilities? If yes, No. of beds Occupancy rate If no, annual % of total beds occupied for geriatric use 4.2 Day care centres for elderly No. of day care centres for elderly Average daily attendance Fees charged? If yes, amount per day/per month (Please state currency used) Services provided~
Government
Private
yes/no
yes/no
____x Government Private
yes/no
yea/no
4.3 Nursing homes and homes for the aged (Please define these terms in country context as they have different meanings.) Government No. of nursing homes and homes for the aged No. of beds Occupancy rate Monthly charges (Please state currency used) Services provided~
Private
4.
Health care in urban and rural 4"aas Are any special arrangements made for the elderly attending health centres or clinics in: Urban areas (If yes, please explain and/or describe)
4.1
Rural areas (If yes, please exp'.ain and/or describe)
4.2 .
Please list any services provided oy the urban and rural communities for the elderly, in the table below: Queries Home help I
Services in URBAN Other Meals Home on Nurs- Specify wheels ing
j I
Other Specify
I SerVices in RURAL Other I Other Home Meals Home Nurs- Specify Speci f) help on wheels ing
lIE
Is this service provided by the urban/rural community ;for the elderly? yes, give approximate Icost if fees are charged. (Please state currency used)
yesl no
yes!
,.0
yes! :10
yes! no
! I ,
yes! no
yes/l no
-yes! no :I; . L.
;--,
!Do ~f
!
-yes! no
-I • yes I ~
- - --- -yes/ no yes/ no yes! no
I I
yes! I yes! no ! no
yes! no
I
vesl no
;
, i
... '"
I yes! no
I ,
-- -- i yesl
the elderly use these
services? JLf yes, what proportion
yes! no
yes/ no % %
I I I
the elderly use fhese serv ices
--
%,_% _ ]_% -_.
no
no %
--
% --
I
I :>
I
I
%
---L-- -
-
-
!
:2
iii x ~
" g ~
Q.
Annex 4 cont'd.
- 50 -
III.
Programmes for the Elderly (health, welfare. etc.) (a)
Does the country have an official programmers) for care of the elderly? yes/no (If yes, continue with question (c» If no, does the Government support private activities for care of the elderly? yes/no (If yes, continue with question g, below ) What are the country's policies/objectives for its programmers) for care of the elderly?
(b)
(c)
(d)
What are the overall plan of the Ministry of Health for attaining these objectives?
(e)
What other Ministries or government agencies are involved (besides the Ministry of Health) for development of programmes for the elderly?
(f)
The organization of the programme. Specify where activities for health care of the elderly fit into the existing structure for delivery of health care with reference to the organizational chart mentioned under Part II, page 6 • Central level
Intermediate level
Community (periphery) level
(g)
Describe the private activities in care of the elderly. Hovdo they compliment and/or back up the government programme,?
- 51/52 Annex 4 cont'd.
(Il)
Manpower for the prograllllJle on care of the elderly (1)
Has training been planned or accomplished for health personnel now engaged in activities in health care for the elderly? yes/no If yes, describe.
(2)
Is additional tra~n~ng of health staff planned for effective functioning of the programme? yes/no If yes, describe.
(3)
Are new catefories of staff to be trained to carry out Ilealth activ~ties for the elderly? yes/no If yes, specify these categories.
(i)
Evaluation of the programme (1)
In terms of attainment of the programme's objectives -
(2)
In terms of toward government's goal of health for all by the year 2000 -
IV.
What type of support can international agencies like WHO provide for the programme for care of the elderly? WHO
----------.-----------------------------------
Other international agencies: UNICEF
UN
Others
---
- 53 -
ANNEX 5 CURRENT STATUS OF WELL-IIEING AND HEALTH CARE OF THE ELDERLY IN COUNTRIES OF THE REGION IntrDductDry Remarks The answers tD the questiDnnaires sent to the tempDrary advisers of the WDrking GrDup Dn Health Care of the Elderly (HCE) were classified where appropriate and possible Dr ordered to Dbtain a quicker insight and overview to provide some basic information. The classification and order are subjective to the consultants and do nDt reflect any standardized or worldwide accepted system. In the field of health care of the elderly, definitions and terms are not yet agreed upon internationally and this is one of the reasons why WHO is now preparing an international glossary on gerontology/ geriatrics and the care of the elderly, to be published before the 1982 World Assembly on Aging. This unclarity of terminology is naturally reflected in the answers tD the questionnaire. An even greater difficulty in assessing certain "replies accurately results from the large differences between the responding countries with regard to socio-cultural (family) factors, religion, tradition, socioeconomic conditions, occupations, climate, health status, etc. Still another problem is the fact that some countries do not as yet have data available pertinent to certain questions. Sometimes only estimations or no information at all could be provided (or data for limited items only, based on a one-time survey, of a merely local character). These facts and others are obvious, but should be kept in mind when considering the tables or attempting to analyse them. They can give only SDme potential for comparison. Yet they provide a certain insight which may be useful as background information for the Working Group in trying to formulate practical and concrete recommendations. This particularly applies to those tables which are generally a classification of citations from the questionnaires. In almost all cases, these citations are direct quotes. A very general, though not surprising, conclusion is that great differences exist between such different countries, as regards for example relative and absolute numbers, (health) status and care of the elderly; extent and kind of formal and informal care; educational possibilities; manpower availability, research potential, etc. But also common patterns of care (e.g. the very import~nt role of the family), common prDblems (e.g. lack of professional interest) and common options
- 54 Annex 5 cont'd.
for solving certain major problems (e.g. increasing the awareness of governments and the public; the need for more information on aging processes and possible services for the elderly; more education) exist. There appears to exist a great demand for support by international organizations, such as WHO. Here and there, concern is expressed as to the future possibilities of support for the elderly at the community and particularly the family level which so far have been of the greatest importance. This seems a matter for serious consideration in the Working Group.
It should be stressed once more that these tables serve only as background material, which generally is not based on research.
7ABlE 1.
~L~RAPP.IC.
SOC!e-ECONOMIC
Ah~
HEALTH SITUATIONS
corllTRY total ~opul.tion (mi 11 ions) population S5(+)
AUSTRALIA
CHIliA 970.9(979)
! , , , I
FIJI
! I
HONG KONG
! ,
JAPAII
!IEII ZEALAMl 3.1(1979)
PHILIPPINES
I
, KOREA :3:~'GAp(lRl
I
I
14.6(980)
: 0.6(1979)
5. H1980)
, , i
i I I , i
I I
I
i 116.1(1979)
I 15.9(1975) 7.0 8.9 17.4(916) 7.9 9.5
.47.7(1980) i
\ 37.6097Q)
I
i :._{lC;E(\l , t !Q.Zf 1980) ,
18.7(1980) 8.5 10.2
: f
~
o
8.2(1979) district) 4.2 4.0
I I 3.4 i 3.4
! 6.8(978)
'
I
, 6.8(1915) 3.3 3.5
i , I
I !
113.0(19S0)
8
C!91S) ,
6.0 , 7.0
3.5 4.5 13.0
, S.C
i
I
::.:
I I I ! I
, ,
population 55(+) (2000) %
i i I I 15.4(980)
I ,
21.0
n.a.
! I .
10.0
!17.2 16.9(1980)
26.6
18.6
8.0
10.3(60-:)
crude hirth
~ate
I I i , I i
17.9(1979)
: 28.3C!978)
14.2(979)
16.3(978)
31.0(980)
23.7(978)
~7.J(1980)
I , i i I , , ~
;
crude death rate life expec::ancy I
7.4(980)
6.2(1979)
~ ,
4.2(978)
I 5.0(980) ! I
.
6.0(979)
7.9(1978)
8.2(980)
6.2(1978 )
~.2(1980)
: , i
I , I
at birth \y~ars)
I I
74.0(approx. 1979) 86.~(j976)
6S.0(1978)
. i '61.6C!976) : 74.0(approx) , I
76.0(approx)
72.0(approx. 1976)
62.0(980)
70.1(1980)
: 67.3(1970) , ,
, i
urban population % urban population 55(+) in % of
15
; 37.2(1976)
i 88.009S1) 87.2(976)
75.9(1975) 68.9
IS3.0(976) 87.5(65-:)
IS.0(1980)
52
(1975 )
?
n.a.
! 42.6(1976)
!
! , urba::n area I ~
i I
52 .,prox.? (1975-1980)
35
(1975 )
urban area
I i
I
total population 55(+)
: yes yes yes
.igration to cities
(controlled) average (nuclear) f_ily lize auclear fail,. pattern % 3.1(979) (j
I
yea (to new city) 4.2(1976)
yes
?
yes
yeo
5.4(1970 ,
! ,
, 6.0(976) 3.5(975) 3.7(971) 5.7(975) 5.6(1914)
i ! household) ?
4.47(979)
dis tric t) 1 ?(35%) (979)
, (80 (urried couples Qr one parent iaea. group with depeudent child (ron)(1979) I ------
I I
around 40 (rough •• ti. .tioa)
84
(88 in 1976)
78
(iucl.1
69
72
per.oa boulehold)
I I
i
I
I
'CrNTRY
Al'STRALIA \ 1 ,
CHIMA
FIJI •
!!QIIC
lWIIG ,
JAPAII ;
NEW ZEALA/ID
,
PlIILIPPIlIES I
~otIEA
I
SIIICAPORE ,
family p~·tern ch8r.gin~
I I
probably yel (more 55+ living aloae)
I I I ,
yes
,
, ,
I ,
I I I !
.. 'ties
i,
~es(slowly)
, yes to smal! ler family
i
? yes
! i
: households
I "
I
I
I population "l+} living with child~eD
! I. , I I
LUI"! I
I living in inatitutions\ changing of living ~rrangement pattern
4.7
i
?
I I ,
I ! \
,
I lY lbO+! J
I , I !
I I Y2
I
yes
"
i ,
I I
, ?
I , i
7
tb.)+!)
\l~l~J survey)
I , ! , , , I I
I
, '!
I , I
I
i
1.3(&0+:)
probably yes
?
I
?
ii
,
yes(.lowly)
I ,
I
6.6<65+:)
,
~1 ?
!
1
, ? I
I literacy rate of popuhtion I
I
I , 1~
\ (1976) 83(10+)
i
i ,
yes (more to \ hosl'itah, : alone. or : with spouse ~ only) \ 100(15+;
slightly
I \
I
, 92-97(1975)
,
I
, I I , I I
varies but high (95%) yes
8O(rough esti.ate) yeo
I i
99
(1970)
! 1976) i
89
!71<10+)
equal opportunity feaale education? .ain economic base
i I I
I I
?
~.
, . 1ture,~. agrlcu Lndustry
, ; i , I ,
\
ye.
I I I
~.
I I I
yes
yes
i I I
:0"'.
I !
!
: agriculture, , industry t , service
I agriculture! I 60
, I i
, i
industry
Iagriculture I I ,
, I agriculture
Z population ecoaoaically active averap aDIlual per capital inca-!
I I I !
61 30
I , agriculture iI 58
I
i
i industry
!~ i I , f I
I
i
64
64
39
35(83)
56 I
I US"300 (<>1'ti .....1) 65(60) 60(55)
US$415 (worker.) I 60
US*1100 (979)
US$4100 (974)
U5$4480
us$46oo
; ,
US*39O
US*1280
1ll5S3100
I
,
I
reti.-ent age -
_0. -_n . .
I
55
55 ?
55 55
-
57-60 lover than
60-65 60-65
(60) (60)
55-65
I !
i I I
IiO 60
I 8.5 f
I I
popul.tin ....rIti... after retir...at I
6.lli.. l.b....r foRe)
....'Y few
!
J8
.
.
.p_.50% tor MIl 6-5+ appro.. 15% for_ 65+ Uab""r fore. participatiOll rate 1975)
£.10
?
,
I . I .
I
I
I , I
COl>N!dY
I ACSTRALIA , I
, CHINA no
F!J: ~
'HO:;G KOliG
JAPAN
NEIl
ZE~1)
PH~LlPPIN£S yes (espei cial1y in
l
KOREA
S~SC,A?'::::
is retirement an economic crisis for the :mily? i
yes (class, I house-owner-
~o
no
no (l@% of the elderlv
I often
'0
I dent)
ship depen-
have
SORe I
rural areas for those without :'ixeC. iDcOIIIe)
difficul ties)
retired persons totally dependent financially r.
not applicable (govt.
10
•
pet)sion, etc.)
% of totally dependent is unknown ': of part-
,
• !
50
not arp i
ica~:
e
! , ! I I
!
: I I
,
I I ,
,
I I :
I i I i , I
I
i I
I
! , I
i
i , I retired persons' source of income % pensions
I _ 90 i
I
I cable not apph(61%
, ;
~
! gove. pension ! main source) , I
i
, ;
I ! ,
I "0 old heads ' of householes I , I I
I I
"
I i I ,
?
!
-
~:)t
ap~!i,:a:'le
. .-
, : 4.
savings family
second job
I grain, meat rice, wheat maize
I
to
, ,
~ 60
~
! country's sta~le
i vegetab les
I
, :
35 (aU jobs)
I I
I ,
I , , I
Ie
food
Irice. wheat I rice. j flour I
rice, wheat
I meat, dai" I products, I I
I
problem of malnutrition in people 55+ proble. of obesity in. people 55+
no
no
!
, ,
no
I
I
! wheat ,
rice, COTll, wheat., sveet potato
I I rice, .eat. I vegetables I
:-:or.e
I ne ".,
no
no
yes
yes
no
DO
no
yes
I
--
____1
__ J
i
I ,
I
aot. for thoa. living below poverty Hae I which i. ' appro•• 60% of the total ! population I ,
-
, I
~o
I , I
,
I
- 59/60 -
TABLE 2.2 RANGE OF SCHOOLCHILDRENS' ATTITUDES AND PERCEPTIONS OF AGING AS MENTIONED IN COUNTRY QUESTIONNAIRES
Country Singapore Hong Kong New Zealand Japan Korea, Philippines, New Zealand
Childrens • reported perceptions necessary event - end of life
handicapped or sick, but revered
Philippines, Korea Phi lippines Korea, Philip-
elderly are emotional
adviser, superior
pines Fiji Hong Kong Singapore Australia Australia Korea, Philippines, Hong Kong
all elderly need respect
fall ill easily, handicapped, failing health rigidity, argumentative should help elderly in physical need children educated since early age to respect and help the elderly
Fiji China
.lMLt.
L.",>
ULU n:.. U.t'Lr.',::,
C'£.,1\.\.OL,.C'.i.J.. U ... U
Vi
~~·~.ii::i.."L.3,
'in.r...iK 1."t.t.U~
rt.:.,;U S£LCJ::£J:\: i!\OBLENS AS
MENTIONED IN COUNTRY QUESTIONNAIRES
Perception of old age 1.
Awareness of specific needs fully aware: Hong Kong Singapore New Zealand Philippines Fiji partially aware:
Specific problems They believe they don't do any good in terms of productivity for others - Korea Loss of income (job) Philippines Korea III health Japan Singapore Philippines Korea Fiji ..... a.
As a group: They take for granted that their unwell-being are mainly due to old age and disabilities are unavoidable; accept physical and mental degeneration - Hong Kong Sick, need to be looked after Fiji No common identity and emergence of a unified group (grey power) unlikely - Australia
"not enough" - Japan of: financial and indepenent living - Australia
2.
As individuals: Independent - classify self as unusual, other aged as frail - Australia welcome relaxed pace and what they can do for family and society Singapore increasingly insecure and dread to be a burden due to absence of income as the result of retirement - Philippines as burden Hong Kong, New Zealand Korea, Singapore
Lack of health services Korea Lack of respect of younger generation/community members Philippines Hong Kong need for comprehensive services to enable family to take care of the aged - Hong Kong institutional care last resort Hong Kong problems of a home when family finds them a burden/nuisance or unable to cope with elderly sick when family members working - Singapore
unaware:
"passive" Australia
dislike consideration of self as recipient of services - Australia
Perception of old age
Awareness of specific needs
Specific problems
Limited social participation due to physical limitations Philippines Loneliness - New Zealand Singapore Japan Unwanted - Singapore Failing memory - New Zealand Nothing to do - New Zealand Lack of preparation - Philippines Relative taking advantage of inheritance - division of property Philippines aN
•
- 63/64 -
TABLE 3. RATIOS OF GENERAL HOSPITAL BEDS TO POPULATION, SEPARATE ACUTE GERIATRIC FACILITIES AND PERCENTAGE OF BEDS IN GENERAL HOSPITALS OCCUPIED BY THE ELDERLY
€OUNTRY
BED RATIO IN GENERAL HOSPITALS Government Pr1vate
SEPARATE GERIATRIC FACILITIES Government rr1vate several hospitals have separate geriatric facilities; a few specialist. geriatric hospitals exist
lUSTRALIA
·
% OF BEDS IN GENERAL HOSPITAL OCCUPIED BY ELDERLY
1:204 _.-
1:748
- -----
many private getie- estimated ral hos50-60% pitals -. have geriatric patients not separated usually
CHINA FIJI • HONG KONG
Not available 1:363 1:395
Not availab Ie 20 beds 1: 2077 6 hospitals with geriatric specialty 206 beds 3 hospitals with geriatric specialty 59 beds very few 2831 beds 16 Lfacil;~;D"
· JAPAN NEW ZEALAND PHILIPPINES REPUBLIC OF KOREA SINGAPORE 1:282 (1978) 1:119 1:3233 1:2815 1: 301 1:295 (1978) 1:549 1:1654 1: 1677 1:1619
1 hospitiLl 750 beds. 2922 beds 94.7& occupied 2 facilities none none
32.2% 23.9%
65+ 70+
none none
approx. 13% 55 14.2%
- 65 -
TABLE 4. CHARACTERISTICS OF DAY CARE AND LONG-TERM INSTITUTIONAL CARE
COUNTRY
DAY CARE
LONG TERM INSTITUTIONAL CARE
AUSTRALIA
growing, but no comprehensive data available, medical care, physiotherapy, chiropody, occupational therapy, .podiatry, dietician, craft work, etc.
142 government (14790 places) 98-100% occ¥paacy full nursing care 1157 private (50499 places) 98-100% occupancy full nursing care
CHINA FIJI HONG KONG
none
3 private homes (A) Hostel (self care) 930 places 100% occupancy re.idential accommodation (B) Home for the Aged 4570 places 100% occupancy meals, laundry, cleaning, escorting for medical advice, limited assistance in personal care, general supervision of health care, recreation (C) Care and Attention Homes 375 places 100% occupancy general personal care, limited nurling cara (A), (B), (C) government 8ubvented feee increasing from (A) to (C)
2 centers 40 each, faa charged recreation, personal care. limitad nursing supervision
- 66 ------------~:------------------------~----------------------
COUNTRY
DAY CARE
LONG TERM INSTITUTIONAL CARE
-----------~----------------------~~----------------------JAPAN still at demonstration stage . (Al Nursing homes 60 places (totally financed by (seriously impaired, r,overnmental subsidy (1980). The 1902 <i non profi t) capacity of each centre is 25 places i ,(8) Homes for aged (home persons a day. for slightly impaired, nominal fee lower income) nursing care, rehabilitation, reactivation, recreation, 142 611 beds socialization, education, etc. nursing care, medical care, In addition to these government rehabilitation, recreation, supported day care centres, there socialization, education, etc. are a few small scale day care 100% occupancy except for centres run and financed by volun ordinary-type home for the tary or ganizations. aged fee depends on kind of institution and financial capability of client; often no charge NEW ZEALAND (A)
- provlslon of day wards for assessment and rehabilitation attached to hospitals - development of day care
Old People's Homes and dependent flats 976 government 10559 private, religious + welfare organizations housing 12390 government 578 private, religious and welfare organizations
(B) Rental flats - independent
PHILIPPINES community centres available for normal persons and the aging
fO%
2 government (250 places)
occupancy
free; rehabilitative and therapeutic 2 private (100 places}and 14 others social service, home life, education, health, religion, productivity
REPUBLIC
OF KOREA
no formal day care, but most villages have special places for the aged, where they can rest, talk,play chess, etc. "NOINJEONG" public and private no fees
''Homes· for the Aged" 2756 } 3 80vernment places 43 private lodging and boarding answers 33.6% of need for this kind of accommodation 2 government 726 beds, 85.4% occupancy rate residential care, b •• ic nursing care,
no charge no .charge
SINGAPORE
1 private 22 places rehabilitative, counselling, supportive, simple medical treatment nominal fee
free 47 private 2239 beds 82.3% occupancy residential care, basic nursing care
."-
41 free, 6 paying .
--T-~
,---~
--~-~-
,--
• • " I
•
,
• • i
-1 ~ • II
• ----I---~
J.~
• c.
o ~ • c
.
-~
--
~--
~-
--- -
-----~--
---------1f----+---+--+----- -- -!'.~ • > ......... ~ .~·~~I~"" tIl_O' .... ~~~
~~
· ..
8.~
ok V
e" o :
· k
!: i
•
----+---iH----- ----
·" 1 J Q
ic= ...... • " tI _ G
.• ~,~.~-+------+---~----+----~--~~----~---i c "~
1 •
o ~ o •• ¥ ." o
lit
-g,!
~ ..:;
::;::
:.
j
:
-Hr---------_r----+-----r_--~----r_-r~~-_r_1 ,~
1
I,g·:::: ."lu~.= tII ..
WI_ . . . . ·... & " ,
.~~a.=!~~
le:;':'~~_ lcu.1I
" ! •
.; l
'•••. j _~
---~,--- ------+-----+----t---t----t~___Ir_++_-_+___i
•
~ pi. C G
H ......... " ~ S c:
" ... c; u ..,
,=, .. ul~
1 j
---------
----------~--+----
i~ !
----+-----r-----r--+--+-I------+-~
i.1 .=
i
1 ~
-----------------
Wi ..........
j..!!::tl
• .• .. Q
• .. = re I 0" •
,
.
l ~ • • ,3'- ~ --l---'-~
!
c:
t ,~ -~----_1---+--~--
::J "
-----~----
~
•
" 'I
.,-,
· -, t: ~ .. '" Iii
. , ~.~ ~
0· ... " z ,~
." "
·. .• •
N
• : • I.
----!--4Ii I.. 'l.
i
\ e ::
,
------
• • • ~ ~
-
1 •
.! u
! --
" I
: 1 , i
•
, ,II
· - -J ~~ o
.M ~~
.. ... o. i; 0" .~
!!
'II· ...
.' . ~1 ... '; :ric
------
--~---
--~~
--~~-H-'--+_--
I~ ,
~-!
J • ~
-~ o
·-
I'
J
•
E.• l.
I
~-----,,-
1 --I - • •. l ---
l
i
,~
-E.!
~'
f
c
~
- 69/70 -
TABLE 6.
RATIOS OF MEDICAL DOCTORS, REGISTERED NURSES AND OTHER NURS INC PERSONNEL
.
Country
Ratios of medical doctors 1:558 (1981)
Ratio of registered nurses
Rat10 of other nurs1ng personnel 1:536 (1978) nurse aids 1:5000 (1979) home help
A~stralia
1:165 (1978)
China Fij i Hong Kong
1:899 1:1964 1: 1395 (1980)
1:2306 1:509 1:455 (1980) including psychiatric nurses
1:1451 enrolled nurses, including psychiatric 1:8783 (1980) home help in non-profit service 1: 1135 (1979) enrolled nurses 1:722 (1979) nurse aids
J!lpan
1:812 (1979) including those not working as physicians 1: 719 (1978)
1:244 (1979) actually working, including public health nurses 1: 346 (1979)
-'-
Ne.'
Zealand
-Phi lippines -Republic of Korea , Singapore
1:14264 otl1~ fIDs in government serV1C 1: 1614 (1978) 1:1230 ( 1980)
1:25,000 (?) 1: 1300 (1975) 1:322 (1980) 1:1134 (1975) nurse aids
.
TABLE 7.
NIOOIEIlS OF MEDICAL SCHOOLS, IiUllSIBG SCHOOLS
(lIEGISTEIIED, ASSISTANT, AIDS) AND THEIR AIIJI1IAL 00lPOl'
RUllber
Country
of Mediaal Annual output Schaols
......er of llursing Schoo Is (R. N. ) 275 approxiBlate1y 700 schools for all nursing categories
Amrual output
Nullber of Schoo Is for Assistant
..AuRqal"Clutput of AIIab'bint Kunes and Aids
.
': AllSTllALIA
10
12100-1300
8500
382 includes training aids
2100 5267
aids a8sistaat nurses and aida I
atlNA YLJI BONG KONG JAPAN
116 1 1 79 (19801 2 15-21 150 82&0
5 I\)
,
1 8
50-60 578 33940 (entrance) 1473 6000 3000 8
30 aids 248 assistant 33907 (entrance) assistant nurses
829 (1979) 29 132 52
716 (1979) 26 none
(entrance) !lEW ZEALAlilD
240 2000
1145 enrolled nurses
PBILIPPllCES UPUBLIC or KOREA
22
1300
_ny hospi tab and private institutions train aids (1)
approx. 5000 aids
I I 200-400 assistant nurses
SIJIGAPORE
1
9')-130
1
100-200
TABLE 8. COUNTRY gerontology taught separately medical school nursing school with one except on yes no (little) yes (little) no
PROFESSIONAL EDUCATION IN GERONTOLOGY* FIJI HONG KONG JAPAN NEW ZEALAND PHILIPPINES REPUBLIC OF KOREA SINGAPORE
AUSTRALIA
CHINA
no no
yes yes
yes (not always) yes (not always)
yes some
no no
yes yes
no no
gerontology integrated into curricula medical school nursing school pub Ii cat ions yes (li ttle) yes (little) 4-5 cited yes yes no no no no 3 cited yes yes a very great number 3 cited yes yes not available? yes yes 3 ci ted yes yes 3 cited
~ ~
-.1
3 cited none
*questionnaire p. 6, questions 4,6
- 75 -
TABLE 9.1
COUNTRIES' OVERALL POLICY AND OBJECTIVES IN CARE FOR THE AGED AND PLAN FOR IMPLEMENTATION
AUSTRALIA There is no official programme for the aged. However, the Australian (Federal) and State Governments provide or finance., for the general public, a wide variety of services such as inpatient and outpatient hospital care, and care at community health centres. These are heavily used by the elderly • Income maintenance, provision of health care. In latter area, concerned to change balance of expenditure from institutional care to development of community services. Implementation: Expansion of community care programmes.
•
FIJI To provide good care for the elderly. To meet the demands for the care of the elderly with available resources to prolong and make life as comfortable and useful as far as possible. Implementation: Old peoples home - Government and Private Special hospitals for the whole nation Home visits and district nursing services
HONG KONG
To promote the well being of the elderly in all respects of their living by providing services that will enable them to remain members of the community for as long as possible; and to the extent necessary, to provide residential care suited to the varying needs of the elderly. To. sustain elderly people in the medical and health services including rehabilitstion, and for those who are being fit to be reintegrated into the care and attention. community through a range of prevention, treatment, and not recovered to the extent of community, to provide continuing
- 76 -
HONG KONG (cont'd.) Implementation: A programme plan for the elderly is designed to coordinating elderly services amongst Government Departments and Voluntary Agency. The Programme Plan is reviewed constantly to identify needs and evaluate services. JAPAN There are nO officially proclaimed policies/objectives. The importance of the programmes for care of the elderly is taken for granted. No overall plan is made. NEW ZEALAND Provision of adequate assessment and rehabilitation facilities. Development of community services. Provision of continuing care, residential, where necessary. PHILIPPINES 1. 2. 3.
To provide health care for the aged. To prevent accident and its resultant effects among the aged patient. To restore ability/skill necessary to their basic daily personal action and personal hygiene. To provide rehabilitation services for the disabled and special groups including the elderly.
4.
The rehabilitation programme for the older citizens consist of the following services: custodial, residential, medical, social, educational, economic or employment opportunities, grantsin-aid, social security and housin~. Implementation:
1. 2.
Encourage community service organization to provide geriatric services. Training of health manpower with skill relevant to the needs of the aged people.
REPUBLIC OF KOREA Improving welfare of the aged including health services. Implementation: 1.
Enacting Welfare Law for the Aged. Increasing the number of Homes for the Aged. Providing the aged comprehensive health care.
2. 3.
- 77/78 -
SINGAPORE 1. 2. 3. Provide free home nursing care for the elderly indigent sick through the Home Nursing Foundation (HNF). Encourage and motivate relatives to keep elderly chronic sick in their own homes with support provided by HNF nurses. Encourage voluntary organizations to run homes for the aged sick.
Implementation: Expand the existing Home Nursing Foundation. The Home Nursing Foundation which provides health care for the elderly is institutionalized through the Primary Health Care Service, Ministry of Health.
- 79 •
TABLE 9.2 MINISTRIES AND GOVERNMENT AGENCIES IN CARE OF THE ELDERLY AND LEVELS OF RESPONSIBILITY
CENTRAL LEVEL RESPONSIBILITY Australia Commonwealth: Social Security - pension prOV1S10n, general benefits, social welfare. Health - pensioner medical service, pharmaceutical benefits, nursing home benefits. Housing - provision of low cost housing Numerous special programmes grants to state and voluntary organization Health,Welfare and Housing authorities administer specific p~o~rammes
State:
social and Welfare Hong Kong
Social Welfare Department, Housing Department, Home Affairs Department, Urban Services Department The Government Secretariat is the coordinator and policy making branch. Japan The main part of the responsibility for the care of the elderly is taken by the Ministry of Health and Welfare. But the following ministries are also involved in the'provision of services for the elderly: Ministry of Labor, Ministry of Education, Ministry of Agriculture and Fishing, Ministry of Construction (housing), Ministry of Finance (tax deduction), Office of the Prime Minister Totally responsible for public pension and health insurance for employees. Planning, financing (partly), supervision and control of most of the important services related to the health needs of the elderly. (Moat of the important services are subsidized by the national government.) New Zealand Department of Social Welfare
- 80 -
Philippines Minhtry "I' Social Services and Development, Lualhatt ng MaynllA and the Reception and Action Center Hospieio de San Jose (not a F,overnment agency) Republic of Korea Ministry of Internal Affairs (for Homes for the Aged), Bureau of Social Affairs Singapore Ministry of Social Affairs, Housing & Development Board and People's Association INTERMEDIATE LEVEL RESPONSIBILITY Australia State Government responsible for planning and administration of major programmes. These governments provide or fund non-profit community groups or Local Governments to provide a number of services which are used primarily by the aged - nursing homes, hostels, independent living units for the aged, home nursing, home helps, meals on wheels, day care centres, senior citizens centres and hearing services. Hong Kong Social Welfare Department, Medical and Health Department, Housing Department, Home Affairs Department and Urban Services Department PhilippInes Local governments Japan Planning, financing (partly), superv1s1on and control of moat of the important services related to the health care of the elderly. Republic of Korea Urban health centres + Bureau of Health and Social Affairs
• •
- 81 -
TABLE 9.3
PRIVATE ACTIVITIES IN CARE OF THE ELDERLY
AUSTRALIA Mainly in the prOV1S10n of private nursing homes, but patients in these homes receive government benefit. Private enterprise provides about 55% of Australia's nursing home beds. Patients in these beds receive from the Australian Government a nursing home benefit which meets most of the cost of nursing home care. Private enterprise also provides some nursing and has a small involvement in home health aide services. It is also starting to provide accommodation along the lines of the independent living units for the aged. Provision of private pensions through occupational super-annuation schemes to which some (about 40%) of employees contribute. FIJI Home boarding and care. Care for the elderly.
HONG KONG Mainly VOluntary organizations with the Hong Kong Council of Social Services playing a liaison role. Private Sector is the main provider of Social Welfare Services for the elderly. Majority of t?e.agenc~es is supported by Government Subvention. Agencies also part1c1pate 1n the Review of Elderly Programme Plan.
JAPAN
. Except.f?r informal support systems of family members and relatives pr1vate act1v1~y for the elderly is very weak in Japan. Though quite a ' number of nUrS1?g h?mes and homes for the aged are established and run b voluntary organ1zat10ns, they are 100% financed by the government. y
- 82 -
NEW ZEALAND The private activities are mainly involved with the provision of residential care either in residential homes or hospitals. Subsidies are available through the hospital schools and through the Department of Social Welfare in both types of institutions. There is a need to involve the private sector in the provision of community services also. PHILIPPINES Provide Home for the Elderly with nominal fee (Chinese Home), Hospicio de San Jose also providing home for the elderly. Other private institutions providing institutional care and rehabilitation services for the aging. REPUBLIC OF KOREA 1. 2. 3. Running private Homes for the Aged Providing hospital beds Giving free medical services for the poor aged people
In proportion, more than 80% of all the services for the aged in Korea is being done by private institutions. SINGAPORE 1. 2. 3. 4. Residential care in Homes for the Aged Supportive and rehabilitative care in Day Care Centre Home Nursing Care in patient's own home Community Participation in voluntary nursing and supportive service
•
•
•
TABLE 10.
~PO~~R
DEVELOPMENT AND COUNTRY GOALS FOR THE YEAR 2000
COtnmrl
'lRAlJIDIG
NEED lOR KEW STAFF CATEGORIES
lVJI 2000 (GOALS)
AUSTRALIA
formal courses exist In geriatrics for both .edical practitioners aDd nurses training opportunities have expanded in all are.. , but coverage still in~lete. Much in-service training is needed to reaeh tbose already working in care of aged. the develo~nt of formal courses bave only ~cent:Qo been deve loped. It 11 l1ke:Qo tbat the DUllber and range ot eourses viII be increased. training bas not been planned as part of an integral prograand this i8 one of the problem areas. Lack of planning of Mnpower needs of prograllllles bas inhibited their expanSion, but training now expanding.
health aides to give persons 1 care to supplement trained nurses it is likely that acute health care services Will continue to be provided by existing occupational groups. New groups \1liiy emerge to provide home services
Will requi~ considerable expansion of reaources to achieve geels in community ca~
I
& I
CJUl(A
Barefoot doctors are given short courses on geriatrics to enable them to deal with some of the ailments of the aged in rural areas
COUlfl'RY
'I'IAIII1fG
NEED FOR IIIW STAFF CA'fJIIOORIES
YEAR 2000 (GOALS) cont:rol and Ilurveillance of cbronic illness ani! the evaluation of heal th care
fiJI
training hoBpital aids tor the care of elderly and training of doctors in geriatrics
has pi tal aidll
11)'- IroJIG
1.
Overseas training for doctors &ad nurses in Geriatric Medicine. Limited in-service training 1'or doctorll and nurlleS in Geriatric IlePllrtment. Ltaited training for voluntary workers in the care of the elderly.
no
provision of servicell and facilities for the elderly evaluation of 1977 Programme Plan
2.
,. i I
IX> ....
I
JAPAJI
often topics on ge:rontology/ geriatrics are included in in-service training
"we don 't think it necessary "
"we are afraid that the present efforts of the governments at all levels are not enough in terms of the health related needs of the elderly in the year 2000"
,
IIIW 2'EALAlfD
training i8 available with each of the profe..io_l groups concerned with care of the elderly
no
•
•
•
COUNTRY
TRAINING
NEED FOR NEW STAFF CATEGORIES
YEAR 2000 (GOALS)
PHILIPPINES
specialized training opportunities such as seminars, workshops and development of continuing education for professionals - prov1s1on of scholarships and fellowships grants to train abroad (including cross posting schemes in ASEAN or PP Regions)
(More social workers, nursing home aides, community workers)
- community based care, home nursing services, apartments (for those who can afford) - more comprehensive health and social welfare plans (multi-disciplinary collaboration)
REPUBLIC OF KOREA
none
special nurses for the aged (for both physical and mental health), physio-therapists
health services and a welfare plan
~
SINGAPORE
1 week home nursing experience in care of elderly included in nurse training
no
develop home nursing to minimize need for building homes/hospitals for the sick aged
•
•
•
~
•
TABLE 11.
SUGGESTIONS FOR SUPPORT FROM INTElUIATIONAL AGENCIES (e.g. WHO)
IDOlIIA'!'IC,JII EXCHAltG! + AWAREl'IESS Exchange of ideas and
R!SBARCH Fund a ponaored for
MAJll'OWdi IJ!NELOPMKIft'
+ KWCATIO.
1II!AlInI SERVICES 01lGQIZATI01l'
SPBCInC SERVICES
experiencea - Japan Philippines (crossposting prograaaes for multidisciplinary workers) Spreaj or iDrorwation - reg~onal and global Ne--v Zeele!"..:t
research OD health statu. or elderq is highly deBirable. Thill detill1tely vtll give. better satde11 ne on fllture ulanning of aerT1cea. - Hong ICOIII
Information - curri~la and IIBter1al.e - for education prO@l"8I1l1!1eE in all fields - Australl.a
laidelinea ror national pIaunlng - Australia Ittrorwation of models of eare an:! prograaae delivery - Australia
Equi.-nt. - Fiji
yelii~les
Progra..es for Yiatting health workers in .arioue countries - Australia SPecialize1 manpower training (DOte: they have to be fro. private iest1tutioM beeaWle in Korea, for e-xpwpl.e, .ore than of tbe health lIervtcee are bet. off'ered by prtftte lIealth inatitution&) - Iaree
st!'c~!.y advising
all
the countries (governments) to provide health and social welfare services for the aced people Korea
Research on aeeaa or the elderly - Philippines
Medical subaidies in hospital; Meals ou ~eIa; Rotary: reereational progrll_S f'or elderly; financial IIUpport; _ttage tDd1tatr1el! not neeesea" Tilv froa ODD. but from Rotary Arms (wives of Rotarians) and UNICEF I - Philinptnes
ss
Developing co.parative information - AnBtral1a Sponsoring of trNect1ve statistical studies - Australia TraininQ of research! workers. 9tatisticiansChina
801>
AvveneSB progT8IIIIIeS re: elderly - Fiji, Australia e!:ptasts on paychc:ogi;,al health of el~er:y - Australia Gre~te=
Sponeor workshops for medical, ~sing and me-dlesl-secial workers on topics relevant to health eare for the elderly - Singapore
DmlIlIPaoI . , . , . . +
RI8IAlICI!
JWIPOWER IE'fEWPMEIft + EOOCATION
DAImI SZIInCBS ORGAlUZATION
51'11>'_ll'"lC SERVICES
Fellowshio, scholarship spoosored for staff like. doctors, social vo~kers, managers of c~ntres. etc. working in the field of Geriatric Medicine and Health Care of the Elderlv to have experience ia other S.E. Asia countries or elsewhere - Hong Kong ·Training of staff (to help them motivate and develop familv and communitv network of health and social services) - Philippinet. fiji Oocupational Therapy Schools - Philippines Training of technical personnel including research workers, social workers and statisticians - China Opportunity of study tour ia other countries, both developed and developing - China
8l