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1
Projected number of people 65 with chronic
illness in United Kingdom, 1996-2066, based on
reported prevalences in 1989
Khew KT, 1999
2

• Population ageing has also been projected to
  aggravate the magnitude of mental health
  problems. This will happen because of the
  increasing life expectancy of those with mental
  disorders and an ever-growing number of people
  reaching the age at which the risk of such
  disorders is high.
• Estimated at 29 million today, the number of
  people affected by senile dementia in Africa,
  Asia and Latin America may exceed 55 million in
  2020.

WHO, 1998
3
Ageing and dementia
Estimated number of people aged over 60 with
dementia in United Kingdom, 1996-2066
Khew KT, 1999
4
Visual problems and ageing

• Visual impairment and vision loss increase
  dramatically with age. One striking example is
  cataract mostly related to the ageing process.
• Cataract is responsible for 19 million cases of
  blindness worldwide. In most countries of Asia
  and Africa, it accounts for over 40 of all
  blindness.

• Usually, ageing-related cataract can be treated
  with a relatively simple operation to remove the
  opaque lens. Increasingly, cataract surgery
  includes the use of intraocular lens
  implantation, which requires sophisticated
  technology and adequately trained personnel.
• In the US alone, there are some 1.35 million
  cataract operations performed each year at a cost
  of US 3.4 billion.

WHO, 1998
5
Hip fractures and ageing
Need of rehabilitation
Estimated numbers of hip fractures in people gt
60 in United Kingdom, 1996-2066, based on rates
from 1983 and 1956
Khew KT, 1999
6
Functional and social consequences of chronic
disorders raise the issues of quality of life of
disabled persons and of implementation and
financing an integrated system of long term care
including tertiary prrevention or prevention of
handicap.
Needs and perspectives
Henrard JC, 1999
7
Ageing and health care costs

• Elderly people are the greatest consumers of
  health services (linear rise with age)
• Inflation in health care expenditure is due to
  overuse of costly techniques (medico-technical
  solutions)
• The health expenditure of elderly people raise
  with acuteness the issue of effectiveness of the
  health policy
• Effort to promote health among elderly people
  through life style risk factor reduction
  (stopping smoking, healthy diet, exercise) are
  the domain of controversy

Henrard JC, 1999
8

• Long term care includes
• nursing homes,
• old people's homes, institutional care for
  disabled people,
• appliances to assist disabled people.

Total and per capita healthcare costs by age and
sex for hospital and long term care in the
Netherlands, 1994.
Meerding WJ, 1998
9
Social and medico-social sector

• There is a general agreement that older people
  should be able to live in their own homes for as
  long as possible
• Most EU countries have developed supportive
  services for the elderly, particularly for those
  frail and disabled
• There is very limited data on the extensiveness
  of delivery of long-term care outside residential
  care
• The only available comparative indicator of the
  home services as a whole is the extent of home
  help service, which varies widely between
  countries

Henrard JC, 1999
10
Proportion of elderly people receiving home help

Henrard JC, 1999
11
Social centres

• In the context of domiciliary services the
  assessment process tends to assess suitability
  for service as defined by professionals rather
  than clarifying a persons needs
• Another issue is the choice left to older people
  in the definition of their social needs
• In some EU countries social centres provide a
  point of access to various professional services
  and form a base for home-care
• This model appears to promote the rights and
  self-administration of older people for defining
  social needs

Henrard JC, 1999
12
Residential provisions

• Ageing of the istitutionalized population
  results in an increase in those involved by
  cognitive impairment and/or difficulties from
  performing the ADL (Activity of Daily Life)
• In the case of large institutions there is the
  risk of loss of personal identity, together with
  a loss of contact with social networks when the
  catchment area is wide
• Residential provision, including long term care
  facilities, are more or less developed among EU
  countries

Henrard JC, 1999
13
Proportion of elderly people residing in
institutions

Henrard JC, 1999
14
Alternatives to institutional care

• Small units of group housing, able to call on
  existing domiciliary care services in case of
  need
• In Denmark a policy of elderly-frendly
  housingcoupled with services delivered to people
  according to needs
• In Scandinavian countries rights, services and
  benefits are available to all and emancipate from
  the traditional family thus personal care is
  financed by public funds
• In countries with National Insurance Schemes,
  rights are related to contribution during
  employment and are limited to the recognised
  risks (e.i. sickness and old age). This regime is
  committed to the preservation of traditional
  family relationship and thus to the principle of
  subsidiarity

Henrard JC, 1999
15
Proposal for further actions

• To improve the knowledge on the health situation
  of the very old people
• To add quality of life through increasing the
  capacity of independent living
• To identify and evaluate the impact of effects
  of conceivable intervention on reversible
  disabilities
• To assess alternative programmes among elderly
  people with reduced capacities
• To improve the knowledge of care systems for the
  elderly
• To improve the skills and knowledge of health
  and social professionals and scientists

Henrard JC, 1999
16
Health perception of old people

• Presence of diseases and even disabilities does
  not always mean that oldest old people feel in
  poor health.
• Their perceived health seems strongly related
  to the feeling of social utility and sufficient
  social exchanges which are essential to maintain
  feeling of good health and an acceptable quality
  of life.

Bury M, 1991
17

• An italian example of how the elderly
• can feel in good health and enjoy an
• acceptable quality of life

18
Association Prof senectute, founded 1974 in
Verbania, Lake Maggiore

• A large group of people, all in their third age,
  volunteered for programs in favour of the local
  community, offering themselves as a resource and
  not as a problem. With the financial help of city
  authorities, they managed the schoolbus service,
  opened schools at no cost for music and theatre
  open to everybody, created an orchestra, built a
  life trail.
• The impact on such a small, traditional community
  from such an unexpected initiative was impressive

19
Association Pro senectute (1974) in Verbania,
Lake Maggiore, Northern Itly

• Compared to other age-matched elderly groups, the
  Pro senectute people showed a lesser dependency
  ratio, a greater subjective health and a marked
  feeling of being socially appreciated

20
Youth is a defect which is corrected by elapsing
time. Good luck for your future!
21
And now ...

• Time for recreation
• See You next Monday!