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2. Healthy Aging Adapting Health Care Services for Older Adults: The Prevention Model of Health Care
We have moved from living only to the end of reproduction and dying of acute illnesses to much greater life spans, with attendant chronic illnesses. In the Americas and the Caribbean there are approximately 94 million people are 60 years of age or older of which 44% live in the Americas and the Caribbean. By 2025, the total number of people who are 60 years and older is expected to reach 194 million of which 98 million (1 out of every 7 people) will live in the Americas and the Caribbean. With the exception of pockets of unrelenting poverty and/or inaccessibility, the majority of the population will survive infections and parasitic diseases only to develop chronic ailments.
Increased life expectancy is one of the major gains achieved by public health, yet, longer life does not necessary coincide with higher quality of life. Disabling conditions and decreased health status plague many people as they grow older. In some urban areas in the Americas and the Caribbean, an average of 70% of women 60 years and older have at least one disability such as low vision, arthritis, or urinary incontinence. In a survey of self-reported health status, only 42% of older women and 49% of older men reported having very good or excellent health. Despite their pervasiveness, these diseases and other disabilities are not an inevitable result of aging. Modifiable risk factors such as poor nutrition, physical activity, smoking, and failure to use preventive and screening services cause almost 70% of physical decline in older people including hypertension, cancer, blindness, cardiovascular disease, chronic pain, and mental health issues (National Center for Chronic Disease Prevention and Health Promotion, 1999).
Evolution of the healthcare sector is needed to meet the changing needs of its clients. In the Americas and the Caribbean, the public health community has focused the majority of its resources on infants, youth, and women of childbearing age. Some progress has been made in the areas of maternal/child health as well as the reduction of infant mortality. These efforts are still necessary and important, but the campaigns and consideration must now extend to the healthcare needs of older adults.
The current generation of older adults enjoyed the benefit of antibiotics, vaccines, and access to healthcare services throughout life, and they survived in part through reliance on the public health system for modern medicine and treatment. As they age and stop working, many can no longer pay for healthcare services, life-saving medications, or treatment regimens that increase quality of life. Moreover, the healthcare infrastructure is not built to accommodate their needs, and health professionals are not trained in the diseases or chronic conditions that predominate in older populations. These realities further compromise the quality of care that older adults receive.
Older adults require and deserve a health system adapted to their needs, and actions can be taken that are both cost-effective and of high quality. We need to ensure that the continuum of care begins at infancy and continues through old age without large gaps in service between the end of child-bearing years and the last years of life. To create an equitable and high quality healthcare system for older adults, the public health community must act now to develop, test, and refine healthcare systems and programs.
As the number of older people increases, the healthcare system must evolve to meet the changing needs of its clients. Action must be taken now to adapt the healthcare sector and train health care providers to ensure that older adults are able to access health promotion, risk assessment, screening, preventive advice and services plus quality treatment needed as they age. They must also include gender-specific strategies. This describes the transition from predominance of the Treatment Model of Healthcare to the Prevention Model. PAHEF wishes to foster this transition.
Building the Foundations for Quality of Care for Older Adults: What is needed?
There is still limited data from developing countries about risk factors for disability and diseases, and there are few interventions on which to build. We must create evidence and disseminate lessons learned for adaptation and replication in the near future. Best Practices in developing countries for care of the elderly must be discovered and developed, and operations research on effective and appropriate interventions must be well documented and disseminated.
Work is needed in three specific areas:
- Education and training of service providers, families and older adults;
- Tools and methodology to ‘adapt’ the environment and procedures of the health center in order to meet the health needs of older adults; and
- Research on how to conduct successful health promotion and screening activities with older adults in order to obtain behavioral changes leading to active aging.
While we recognize that chronic disease have their antecedents in younger years, the program seeks proposals that focus on innovative prevention programs, the development of public health protocols, and/or operations research focused on individuals 50 plus. Grants will not be made to launch new or to broaden existing service operations.
Examples of problems/topics that will enhance the quality of health care for older adults:
- Cigarette smoking is not discouraged sufficiently
- Health centers do not exam older adults periodically using gender and age-specific, evidence-based screening protocols, for example, post-menopausal women do not receive gynecological screenings and mammograms and men do not receive prostate-specific antigen tests. Screening endoscopies are reserved for the wealthy
- Stool guaiac and rectal exams are not often done for screening purposes
- There is a general ignorance of the impact of small increases of blood pressure on cardiovascular morbidity and mortality, and a failure to act to maintain low systolic pressures
- Older adults with co-morbidities are treated with disease-specific protocols
- Health promoters fail to take responsibility for the health of older persons in their geographical area
- Low coverage of mental health treatment and high rates of depression and suicide
- The incidence of diabetes and hypertension increases with old age yet behavior changes related to these conditions are not consistent with need
- Health centers fail to educate families of the proper care of people with dementia
- Older men and women do not use health services in a timely manner
- The health system does not have quality indicators of care from an older person perspective
Examples of projects that will promote changes in life-style in order to improve the health and well-being of older adults as well as adherence to treatments:
- Increase the number of older adults who receive an annual health exam at a health center using a protocol based on models of preventive medicine for older adults
- Develop a self-care group for older people designed on a behavior change model that is age and gender appropriate
- Chronic disease management targeting older adults with multiple chronic conditions
