HEALTH MANAGEMENT FOR OLDER PERSONS WHY WE NEED SOMETHING SPECIAL

Dr. Enrique Vega Regional Advisor in Aging and Health PAHO/WHO [email protected]

POPULATION AGING SOCIAL & PUBLIC HEALTH RESULTS AND … A NEW ISSUE

THE DEMOGRAPHIC TRANSITION: A FAST PROCESS   In 2006, just over 50 million of the Latin American and Caribbean population was 60 or older. In less than 20 years the amount will be more than 100 million. In 2050, 24% of the population—some 200 million people—will be older adults.

In 2006, the life expectancy of people 60 years old was an additional 19 years for men and 23 years for women.

30.0

Aging in Latin America and the Caribbean FAST PROCESS

France Mexico

25.0

20.0

15.0

10.0

5.0

0.0

1700 1750 1800 1850 1900

year

1950 2000 2050 2100

Aging in Latin America and the Caribbean: Aging Population Growth IS NOW Population in Millions

Aging Index: Barbados 2025

LIFE EXPENTANCY INCREASE

The more important increase: in the oldest population

WE HAVE A LOT OF OLDER PERSONS: SO WHAT?

EXPENTANCY OF LIFE AND MORBIDITY SCENARIOS

JF Fries Aging, natural death, and the compression of morbidity. NEJM 1980, Volume 303:130-135 .

John Glenn. 77 years old, 1998 Spatial Mission, Discovery’s

Florence (101 years old ), the oldest Facebook user….

WHAT IS THE REAL AGING CHALLENGE?

EXPENTANCY OF LIFE AND MORBILITY SCENARIOS

JF Fries Aging, natural death, and the compression of morbidity. NEJM 1980, Volume 303:130-135 .

How healthy we will live?

The reality: We are growing old without health

LIFE EXPECTANCY WITHOUT HEATH

LIFE EXPECTANCY WITHOUT HEATH  In the United States only 22.7 percent of people over 65 and only 32.2 percent of those 75 and older report having fair or good health.

 In the Caribbean and in Latin America the majority report having fair or poor health: 58% of women and 51% of men.

 In the Caribbean and in Latin America women reported worse health and poor health status.

3.0

2.0

1.0

HEALTH SELF REPORT AND CHRONIC CONDITIONS IN SENNIORS Bs. Aires (1.84) Montevideo (1.78) Bridgetown (1.64) Havana (1.32) Sao Paulo (1.53) Santiago (1.26) Mexico City (1.21)

0.0

Ex cel ent Ve ry Go od Go od Fa ir Ba d Source: SABE/2000 – PAHO

Seniors with at least one treatable chronic condition 75,0 60,0 45,0 30,0 15,0 0,0

Masculino Femenino Source: SABE/2000 – PAHO

Seniors reporting at least one disabling conditions

75,0 60,0 45,0 30,0 15,0 0,0 Male Female Source: SABE/2000 – PAHO

Heath costs increase with multiple chronic conditions

$18,000 $16,000 $14,000 $12,000 $10,000 $8,000 $6,000 $4,000 $2,000 $0 $1,081 $2,844 $5,074 $7,761 $10,414 $14,768 0 1 2 3 4 Number of Chronic Conditions 5+

Source: Medical Expenditure Panel Survey, 2006; Adapted from Anderson G. Chronic Conditions: Making the Case for Ongoing Care, February 2010, Robert Wood Johnson Foundation.

Chronic Disease and functional status in Seniors. Bridgetown, Barbados 2000

THE DISABILITY BURDEN

SOCIAL DETERMINANTS OF HEALTH

   Around 50% of those surveyed in the SABE study said that they did not have sufficient resources to meet their daily needs.

33% of the elderly in urban areas and 50% in rural areas live in poverty. One-third of persons 65 or older do not have retirement benefits, pensions, or gainful employment.

Older adults have levels of schooling lower than the rest of the population, with very high levels of illiteracy that reach 80% in rural areas in some countries.

THE TOTALLY NEW SCENARIO

• • • • A lot of people are growing old without health High incidence of chronic diseases and conditions, especially multiple chronic conditions.

High influence of several harmful social determinants of health. High impact in functional decline and disability with a consequence of high level of dependency and demand of long term care.

Who cares for older persons and how are we caring for older persons?

WHO CARES FOR ELDERS?

   Health care professionals without training in the medical care of older persons Community health workers without the supervision or the tools to care for older adults Family caregivers without the support of the community

WHO CARES FOR ELDERS?

   In the region, it is families, and especially women (90%), that provide most of the care for older people.

Caregivers, usually over 50, are subject to very high levels of stress, with 60% of them saying that they “cannot do any more”.

More than 80% reporting problems “meeting expenses”.

HEALTH SERVICES AND AGE

 Forty percent of those surveyed by SABE who suffered from hypertension had not had a primary care consultation in the last 12 months.

 Only 27% of women reported having had a mammogram in the last two years.

 80% of respondents reported having unmet dental needs.

 According to the research, 69% of older adults were not vaccinated against influenza.  Only 2% of the countries have health promotion goals for people over 60 years of age.

THERE IS A GREAT DISPARITY IN THE REGION BETWEEN THE AVAILABILITY AND ALLOCATION OF TECHNICAL AND HUMAN RESOURCES BETWEEN AND WITHIN COUNTRIES.

   We are still forming more Pediatricians than Geriatricians.

In the Medical School and in Family Medicine Residence Program, the students receive 24% more learning time in pediatrics than in geriatric issues.

60 % of managers who head aging programs on the National level have not received previous preparation in aging issues and 45% have not received any training in public health.

HAVANA CITY SCENARIOS 2010 BASIC HEALTH TEAM POPULATION OF 600 HABITANTS • Demographic Situation 96 children (0-14 years) 118 elders (60 years and over) Health Situation (SABE) 12 Cognitive Disturbance • 7 births in the years 22 with ABVD limitations • 7 with less than 1 year • 10 with incontinence 29 with falls in a last years 23 with bad hearing 43 with bad seeing • 32 with more than 75 years 9 will live long

AGING SOCIETY PERCEPTION

DEFICIT SITUATION

Few Contributions'

Great Needs High Cost

EXPENTANCY OF LIFE AND MORBILITY SCENARIOS

JF Fries Aging, natural death, and the compression of morbidity. NEJM 1980, Volume 303:130-135 .

Aging Society could balance needs and benefits

Investment

Benefits Challenges/needs

GROWING EVIDENCE

DISABILITY PROJECCION IN SENIORS USA Millions 9.5

9 8.5

8 7.5

7 6.5

6 1982 1989 Cifras Actuales 1994 1996 Cifras Proyectadas 1999 Manton and Gu, 2001

Running against time

WE NEED LEADERSHIP TO TACKLE THE CHALLENGES

TO DO WHAT:     Promote the health of older person as a human right guarantee and transform the issue into a real public policy priority.

Contribute to adapt health systems to population aging challenges and the health needs of older persons especially in the community and in PHC.

Encourage retooling of human resources to meet the health needs of older persons.

Strengthen the capacity to generate evidence based decisions to improve the health of the elderly population in sustainable ways.

A WINDOW OF OPPORTUNITY The next 40 years, the Region’s demographic situation will offer a window of opportunity. Only through adequate social and health investment will it be possible to achieve healthy and active Longevity resulting in a lower economic burden in the future.

PLAN OF ACTION ON THE HEALTH OF OLDER PERSONS, INCLUDING ACTIVE AND HEALTHY AGING. PAHO, 2009