Organization of Health Care Services for the Elderly: Russia

1. Organization of Health Care Services for the Elderly: Russia A.M.Clarfield MD, FRCPC Professor of Gerontology Ben Gurion University, Israel

2. The typical “geriatric” patient • chronic disease • multiple disease (co-morbidity) • multiple drugs (polypharmacy) • social isolation and poverty •  physiological function LOSS OF RESERVE

4. An Approach • Caveat:

5. An Approach • education • health promotion • prevention • strengthen primary care • [acute care] • rehabilitation home • long-term care institution

6. Education • medical school - preclinical - clinical • residency – primary care - internal medicine - others (eg. urology, orthopedics) • CME

7. Premature: • mortality in the elderly IHD CVA Influenza (“grippe” ) • morbidity in the elderly Osteoporosis Fractures Influenza (“grippe” )

8. Smoking in Russia (1993) • 67% of men! • 30% of women • Increase in children

9. Accelerated aging

10. Health Promotion (examples) • Smoking in middle age • Exercise (Timur Shaov)

11. Prevention (primary and secondary) • Osteoporosis (Calcium) • Influenza vaccine

12. Prevention (primary and secondary) • Cholesterol (>250 mg%- 20% of population) • treatment of hypertension ( Russia: >140/90 : 60% men, 25% women) • polypill (Wald and Law, BMJ, 2003)

13. Strengthen Primary Care

14. Rehabilitation • post CVA - hospital - home • post hip fracture – hospital • Yad Sarah

15. Long-term care (20% of 65+) • home care (~ 15%) [preferred] • institutional (~ 5%)

16. What is to be done? (next)

17. An Approach • education • health promotion • prevention • strengthen primary care • [acute care] • rehabilitation home • long-term care institution

18. Thank You Спасибо תודה רבה