Your healthcare news library

Posts tagged ‘elderly care’

Sweden ranked first for treatment of elderly in UN report

The report said Sweden was the best country at supporting and helping its elderly population


Sweden is the best place in the world to be old and Afghanistan the worst, according to a UN-backed global study.

The Global AgeWatch Index examined the quality of life of the elderly in 91 countries.

It warns that many countries do not have adequate support in place for their ageing populations.

By 2050, older people will outnumber children under 15 for the first time, with most of the elderly in developing countries, it said.

Elderly care: How countries rank

  • Sweden, Norway and Germany headed the list
  • Britain was rated 13th, one place behind Ireland
  • Afghanistan, Tanzania and Pakistan ranked lowest

Source: Global AgeWatch Index

The Global AgeWatch Index was complied by the UN Population Fund and advocacy group HelpAge International, and released to mark the UN’s Day of Older Persons.

Researchers used 13 different indicators – including income and employment, health provision, education, and environment – in what they said was the first study of kind to be conducted on a global scale.

The study’s authors say countries across the world face an ongoing challenge from the rapidly ageing global population.

“The continual exclusion of ageing from national and global agendas is one of the biggest obstacles to meeting the needs of the world’s ageing population,” says Silvia Stefanoni, the interim chief executive of HelpAge International.

“By giving us a better understanding of the quality of life of women and men as they age, this new index can help us focus our attention on where things are going well and where we have to make improvements.”

While Sweden came top, and Afghanistan was placed last, the top 20 was dominated by countries from Western Europe and North America, along with Japan, Australia and Chile.

Wealth was not the only factor considered, and countries such as Sri Lanka, Bolivia and Mauritius were ranked above several richer nations.

Some large fast-developing countries fared worse than others, with Russia (78), India (73) and Turkey (70) receiving a low rank, while Brazil (31) and China (35) were regarded more favourably by the researchers.

via BBC News – Sweden ranked first for treatment of elderly in UN report.

Elderly care needs ‘set to treble’ by 2050

Care needs can put huge pressure on families


The number of older people needing care is set to nearly treble globally by 2050, campaigners say.

Currently 101 million people require care, but a report from Alzheimer’s Disease International warns the figure will rise to to 277 million.

Many needing care have dementia, and the report warns there will be a “global Alzheimer’s epidemic”.

The report’s author said countries like India and China would be hard hit – and must start planning services now.

Alzheimer’s is the most common cause of dementia. Symptoms include loss of memory, mood changes, and problems with communicating and reasoning.

More than 35 million people live with dementia across the world, according to the World Health Organization. More than half are living in low and middle income countries.

The report reveals that as the world population ages, the traditional system of informal care by family, friends and the community will need much greater support.

Just over one in 10 people aged 60 or over needs long-term care, according to the report. This includes daily help with things like washing, eating, dressing and using the toilet.

It can put huge pressure on families. Carers often have to give up work to look after elderly relatives.

‘Older people left behind’

Treating and caring for people with dementia currently costs the world more than £376bn per year. That includes the cost of health and social care as well as the loss of earnings.

This report is a wake-up call to governments across the world about the immediate need to put in place more care and support”

Alzheimer’s Society UK

Prof Martin Prince, from King’s College London’s Institute of Psychiatry, the author of the report, said lower and middle income countries including India and China need to urgently start planning services to deal with the “epidemic”.

“The social and economic changes happening in those countries are inevitably going to mean that family carers will be less available.

“Things like the decline in fertility rates mean people are going to have fewer children.

“Women are also better educated so are more likely to join the paid workforce and are going to be less likely to be available to provide care.”

And he said an increase in migration between countries, and from rural to urban areas amongst younger people meant there would be a lot of older people “left behind”.

The report makes a range of recommendations including giving paid and unpaid carers “appropriate financial rewards” and monitoring the quality of care both in care homes and in the community.

A spokesperson for the Alzheimer’s Society in the UK said: “Dementia is the biggest health crisis facing the world today.

“This report is a wake-up call to governments across the world about the immediate need to put in place more care and support.

“The UK government’s G8 summit on dementia this year will be a key opportunity to rally support from world leaders to tackle dementia together. We need to see political leadership to avoid a spiralling global crisis,” the spokesperson added.

via BBC News – Elderly care needs ‘set to treble’ by 2050.

Elderly care: The other options

Elderly hand holding coins
There is disagreement over how reform of social care should be paid for

There is now a growing consensus that elderly care needs reform.

Councils are increasingly having to ration the support they provided in people’s homes and the care home places they fund.

But the big unsolved question is how to pay for change.

In 2011 the government-appointed Dilnot Commission recommended an individual’s lifetime costs be capped at £35,000 in England.

But this would cost £1.7bn a year – a figure which would rise in the future.

Ministers have spent the best part of two years discussing how to proceed, but have yet to reach agreement.

In many ways that is not surprising. Reform of social care has actually been on the agenda since Tony Blair came to power in 1997, but a combination of cost and complexity has meant that no government has felt able to push ahead with reform.

Lib Dem MP Paul Burstow has waded into the debate by suggesting the winter fuel allowance should be means-tested to pay for a cap on costs.

But this has caused controversy among some and, what is more, David Cameron has always promised the payment – worth between £200 and £300 for the over 60s – would not be cut.

So how else could it be paid for?

Setting the cap at a higher level

The Dilnot Commission actually suggested a level of between £25,000 and £50,000 with £35,000 being the favoured amount.

The thinking was that this was a sum that was affordable enough to get people engaged with planning for old age, but low enough not to be a drain on the public purse.

The hope was the insurance industry would start to develop products safe in the knowledge that the catastrophic costs – one in 10 face bills of over £100,000 – would be covered by the state.

However, ministers are known to have being discussing whether it would be feasible to set the cap at a higher level, perhaps even as much as £75,000.

This, of course, would be cheaper for the government. However, some have expressed concern that setting it so high would discourage people from planning for old age.

Raiding other benefits and budgets

Since the Dilnot recommendations were published a variety of other funding sources have been put forward to pay for it.

Who gets what care

social care promo image

Last summer the Nuffield Trust think tank highlighted a range of benefits that could be targeted.

These included the free TV licences and travel concessions that older people are entitled to as well as the winter fuel allowance.

It also suggested the NHS surplus – which stood at £2bn last year – could also be used.

Others have looked at some of the tax-related benefits the elderly are entitled to, such as relief on capital gains tax at death and those related to pensions.

Get everyone to pay

This was actually proposed by the Labour government in its final months before the 2010 election.

The then health secretary Andy Burnham, who is now the shadow health secretary, called for a universal levy that everyone but the poorest would have to pay.

The figure put forward at the time was £20,000, which was thought to be enough to cover the costs of everyone who needs care.

One of the options floated was allowing people to defer the payment until after they die, prompting the Tories to dub it a death tax.

The idea was soon put on the backburner as the election campaign got into full swing, but many within the sector thought it was an excellent idea.

Pool budgets with the NHS

The NHS budget tops £100bn – six times what is spent on social care.

If just a fraction of health spending was diverted to social care, councils argue it could make a big difference to the services they could provide.

Even just a little more collaboration could make a difference as there is a great deal of cross over between the two sectors – particularly within NHS community services such as district nursing.

Such moves benefit the NHS as well. When vulnerable elderly people do not get support from councils their conditions can worsen, leading to hospital admissions.

To some extent this has already been recognised by ministers – by 2015 £1bn of NHS money will be reserved for supporting social care.

But some believe there needs to be a much more radical approach. In Labour circles there is talk of merging the two budgets.

How this would work in practice and whether it would negate the need for a cap on care costs remain to be seen.


Care for the elderly

Older people often suffer from a multitude of illnesses that pose a challenge to organ-specific specialists. Geriatricians can help identify and prioritise their patients’ ailments.

STROKING her thighs as a senior physiotherapist straps on a pair of striking pink sand weights onto her ankles, Bong Fah Heong shows no signs of exhaustion as she prepares to repeat a series of physiotherapy exercises.

Once the sand-filled weights are firmly wrapped around Bong’s slim ankles, Universiti Malaya Medical Centre’s Lokman Abdul Majid helps her to work on strengthening exercises which include calf raises, knee extensions and standing knee flexions.

Lokman gives her a few words of encouragement and eventually, the 83-year-old grandmother of seven rises to the challenge and completes the low impact exercises without breaking a sweat at the gym housed in UMCC’s geriatrics division, in Petaling Jaya, Selangor.

“Although the exercises seem mah fun (inconvenient), I need to do them diligently in order to walk independently,” says the former machine operator who lives with her daughter – one of her eight children – in PJ.

The octogenarian is among 300 respondentsents of the Malaysian Falls Assessment And Intervention Trial (MyFAIT), a study conducted by the division to determine the common causes of falls in older adults and ascertain effective treatment options for this debilitating condition. Respondents are 65 years and above, who have been treated for fall injuries in the last 12 months at UMMC.

Cheering Bong on is the Associate Professor Dr Tan Maw Pin, the geriatrician conducting the research.

Based on historical data by Tinetti et al published over 20 years ago, 30% of people over the age of 65 fall at least once a year, says Dr Tan, 37. There’s a misconception that instability is a common problem among senior citizens.

“Older people are prone to falling due to factors such as instability, medication, poor eyesight, heart conditions and memory problems. We want to identify specific issues that are relevant to elderly Malaysians and work towards solving this problem,” she explains.

The division has also conducted clinical and laboratory studies on dementia, Frailty Among Inpatient Geriatric Medicine (FIG), and the Malaysian Elders Longitudinal Research (Melor, a long-term study on older people).

While it maybe relatively unknown to many, it plays a vital role in identifying and treating medical problems among elderly people. These include geriatric syndromes and conditions, prevention of various health issues such as instability, immobility, incontinence and intellectual impairment, and psycho-social and ethical issues.

Specific needs

UMMC’s geriatrics division, formed in 1998, has four arms – research, clinical services, administration and development, and teaching. Clinical services is sub-divided into three specialised areas – the general geriatric clinic (which caters to patients 65 years above), memory clinic (tackles memory-related issues such as dementia) and falls (handles patients at risk of falling).

Heading the division is Professor Dr Philip Poi, who works with a team of geriatricians: Associate Professor Dr Shahrul Bahyah Kamaruzzaman, Associate Professor Dr Chin AiVyrn and Dr Tan, who specialise in specific areas such as frailty, memory and falls, in addition to handling general geriatrics.

Dr Poi considers geriatricians “case managers” who identify medical problems of elderly folk and provide solutions to enable them to function better in society.

“The elderly suffer a multitude of illnesses ranging from heart disease to stomach complications to arthritis. It is a challenge for organ specific specialists (such as cardiologists and gastroenterologists) to handle these complex issues in a holistic way. Geriatricians need to identify and prioritise issues at hand to enable senior citizens to live in a comfortable manner,” he says.

Dr Shahrul concurs: “As we grow older, we tend to accumulate multiple health specific problems, including dementia, delirium, incontinence, osteoporosis and hearing and visual impairment. The elderly need specialised care as some complications require immediate attention.”

For example, falls can lead to fractures and other injuries, which can be prevented through early detection.

“Older people have age specific conditions that affect various body functions, which include memory, stability and continence,” adds Dr Chin. We also concentrate on iatrogenesis – complications that occur in patients due to medical treatment by a physician or surgeon. “Often, we have patients who face side effects after taking medication for a problem. We need to rationalise the medicine to deter-determine what’s needed. It is important to nip the problem in the bud before there is a cascading series of problems.”

On average, Dr Poi and his team consult over 200 outpatients monthly. Daily at the geriatric ward located on the 13th floor of UMMC, a team of dedicated nurses tend to about 30 patients hospitalised for various health problems. In a month, the ward can house over 100 patients.

It’s not wrong to say that their efforts have given a new lease of life to the elderly.

“Since the mid-1950s, life expectancy has increased and, on average, people are living into their 70s. This has resulted in a need to improve the quality of health care for the elderly,” explains Poi, who is part of The Star’s Health and Ageing Panel. Members of the panel have wide experience in medical health education for the public.

Besides tackling medical conditions, geriatricians also work closely with occupational therapists to look into emotional and social issues that impact the lives of their patients.

“Arthritis curbs one’s mobility and often results in social isolation. Sadly, some pedestrian walkways or public transportation aren’t conducive for the elderly and disabled. Part of our job is to identify obstacles and team up with occupational therapists to come up with ‘environment-friendly’ solutions,” he adds.

Growing demand

While better healthcare services has contributed to a longer lifespan, it has also resulted in a growing number of older patients in need of consultation and admission to hospitals.

One of the biggest challenges faced by the Health Ministry is the lack of geriatricians to meet the needs of seniors, who make up seven per cent of the country’s population of 28 million. Currently, there are only 16 such doctors in Malaysia – nine in Selangor and Wilayah Persekutuan, three in Perak, and one each in Penang, Malacca, Sabah and Sarawak.

In Services For Older People In Malaysia: Issues and Challenges, an academic paper co-authored by Dr Poi and published in the British Geriatrics Society’s Age And Ageing in 2004, he noted that geriatric medicine needs to be firmly embedded in undergraduate and postgraduate curricula (medicine, nursing and therapy).

This will enable Malaysia’s current and future generations of healthcare professionals to develop skills to access and manage the older patient, and recognise atypical presentations of common diseases in those aged 65 and above.

“Health Ministry director-general Datuk Seri Dr Hasan Abdul Rahman has tirelessly proposed this issue to all medical schools. The biggest challenge is these institutions don’t have geriatricians at hand to teach medical undergraduates,” explains Dr Poi, adding that there are currently six geriatric trainees in the country. They undergo attachments in various hospitals, including a nine- to 12-month clinical fellowship/attachment at UMMC.

Dr Chin says he did not have any reservations about joining this niche profession, which he finds exciting and challenging.

“The best part of the job is being able to care for the physical, emotional and social circumstance of elderly patients. Although it is a challenge to deal with many co-morbid diseases simultaneously, it is incredibly satisfying to help them get on their feet again.”

Dr Shahrul explains that it is important to educate schoolchildren on elderly care.

“Schoolchildren have a faint idea of what growing old is all about. There is a disregard for elders and a growing gap between the generations due to modern technology. It is important to bridge the gap by introducing more activities between young and old in the community. Education from a young age is key,” she adds.

The Star

Councils putting stricter time limits on elderly care

By Jane Hughes Health correspondent, BBC News

Jane Hughes reports on time limits imposed by councils on elderly care.

Most councils are imposing unreasonably short time limits on care for the elderly at home, according to the UK Homecare Association.

In a survey, it found that an estimated 75% of councils expected carers to complete visits to elderly people in less than half an hour.

Ten per cent imposed time limits of 15 minutes.

The Association of Directors of Adult Social Services said it illustrated the financial pressures on the system.

Around 640,000 carers visit people in their homes across the UK on a daily basis, helping them with basic tasks like dressing, washing, and heating up meals.

But as budgets tighten, increasing numbers are being told to clockwatch; having time limits set on visits.

In its survey, the UK Homecare Association heard from 739 companies providing care at people’s homes, representing 90% of all local authority areas.

Dignity compromised

Many said even when staff were carrying out the most intimate of personal care, they were given such strict time limits that it became difficult to protect people’s dignity; a third had issued formal warnings about the problem to councils.

And six per cent said carers were sometimes under so much pressure that they feared people’s safety could be compromised.

Many companies providing home care complained of councils driving down the prices they were prepared to pay for care, to the point where quality was affected and some carers were leaving the profession.

The UK Homecare Association suggested that excessively short time limits on visits might amount to institutional abuse.

Its chief executive, Bridget Warr, called on governments across the UK to ensure that everyone was able to get high quality care, and that enough funding was available.

“We need to consign visit times that risk the dignity and safety of elderly and vulnerable people to the past,” she said.

The UK’s largest home care provider, Saga, said the findings highlighted the need to change the way social care is paid for in the UK.

“Care is not just about old people – it’s about families and loved ones,” said Ros Altmann, Saga’s director general.

“At the moment all these people are being let down.”

The Association of Directors of Adult Social Services said until a sustainable funding solution was found things were unlikely to change.

Their president, Sarah Pickup, denied that price was the overriding priority.

“Inevitably in the current climate, commissioners are concerned about price,” she said, “but that is not the same as saying it is general practice to put price above quality.

The government is expected to announce its plans for the system of providing care for elderly people and other vulnerable adults in England in the next few days.

The Department of Health said it had provided £7.2bn extra for adult social care services over the next three years.

“Commissioning care by the minute is unacceptable,” said the Care Services Minister, Paul Burstow.

“The focus must always be on providing high quality, timely and dignified care – not on the time it takes to deliver it.”


Tag Cloud