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Geriatric-Palliative Care Units Model for Improvement of Elderly Care

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Geriatric-Palliative Care Units Model for Improvement of Elderly Care Color profile: Disabled Black 150 lpi at 45 degrees Coll. Antropol. 29 (2005) 1: 277–282 UDC 613.98:614.44 Original scientific paper Geriatric-Palliative Care Units Model for Improvement of Elderly Care Nada Tomasovi} Health Center Dubrovnik, Dubrovnik, Croatia ABSTRACT The aim of this research was to indicate the necessity of a new organizational model of health and social care system for the geriatric population in Croatia. Modern geriatrics puts special emphasis on the idea that the care of the elderly should be performed through home care or long-term care institutions, rather than in the acute care hospital depart- ments. The social healthcare of the elderly requires a multidisciplinary approach, as well as teamwork and coordina- tion of institutional and non-institutional departments. Founding of palliative care units is clearly absent from the ex- isting elderly care system. 33% of the total deceased geriatric population within the target area (2000–2002) has passed away in institutions (Dubrovnik General Hospital and nursing homes), what clearly indicates a need for organized palliative care on the stationary level. Nursing homes in Croatia should accept about 4% of the total number of older population (according to the gerontology research). Nevertheless, this research shows that the available capacity of the nursing homes in the Dubrova~ko-Neretvanska County is 50% of the projected percentage. The solution might be set- ting up of palliative-geriatric units in already existing institutions, as shown by the SWOT analysis. Key words: palliative care, geriatric, model of elderly care Introduction Socio-demographic indicators of aging in Croatia age, but it is not a homogenous group. Geriatrics be- clearly show that there are 15.6% of the elderly (age 65 comes relevant in a specific life stage when aging indu- and over) in the entire population1. Due to such demo- ced changes become obvious and start to affect health5. graphic reality and all its implications, the organization Therefore, the notion of a »geriatric patient« will not be of the health and social care system for the elderly is be- strictly confined to age, although it formally refers to coming even more demanding. persons over 65 years of age. History of medicine in ancient Dubrovnik provides a In many European countries geriatrics is an inde- comprehensive overview of how to combine health and pendent field of medicine or a subspecialty of internal social services, especially in regard to the older po- medicine6. The Croatian health care system does not pulation2,3. At the beginning of the 14th century, Dub- foresee organization models that would put sufficient rovnik already had several hospitals, which were used emphasis on geriatrics. However, the number of hospi- as shelters for the elderly and the poor. Famous Dub- talized elderly patients and duration of their hospital- rovnik hospital »Domus Christi« was established in ization compared to younger age groups clearly shows 1347. Later, in 1540, it was transformed into a public the need for new organizational solutions within the state hospital, one of the first in Europe4. Such a re- health care system. The modern trends in the developed spectable tradition in health care culture requires conti- world support treatment of the elderly more often in nuity and integration with all the progressive world their homes or in long-term care institutions, rather trends. than in acute-care hospitals5. Modern medicine is characterized by an all-encom- Average hospitalization duration for persons aged passing and holistic care for older people. It recognizes over 65, compared to the persons below 65, in the their needs, and applies the knowledge from geriatrics Dubrovnik General Hospital was more than 40 % and gerontology. The geriatric population is defined by (2000–2002)7. During the analyzed period, number of Received for publication August 9, 2004 277 U:\coll-antropolo\coll-antro-1-2005\tomasovic.vp 17. lipanj 2005 10:01:23 Plate: 1 of 6 Color profile: Disabled Black 150 lpi at 45 degrees N. Tomasovi}: Geriatric-Palliative Care Units and Elderly Care, Coll. Antropol. 29 (2005) 1: 277–282 beds available for hospitalization (without pediatrics, The methods used in the survey were SWOT analysis neonatology and birth centers) at the Dubrovnik Gen- and descriptive statistics, i.e. average population growth eral Hospital was 225 (source: Institute for Public rate in population over 65 years of age for the area of the Health of the Dubrova~ko-Neretvanska County). At the Dubrova~ko-Neretvanska County (1991–2001), the ra- same time, persons older than 65 years accounted for tio of deceased people over 65 years of age in institutions 32.6 % of all hospitalized persons in the Dubrovnik Gen- (nursing homes, Dubrovnik General Hospital) and out- eral Hospital7. For comparison purposes, the statistical side institutions, and percentage of geriatric population information for Croatia indicates that persons aged over situated in nursing homes of Dubrova~ko-Neretvanska 1 65 accounted for 30.7 % of all hospitalized in 2001 . The County (2003). Croatian long-term elderly care model is based on nurs- SWOT is a situation analysis used for defining mar- ing homes. In 2003, total number of nursing home beds keting strategies and business management quality rec- in Dubrova~ko-Neretvanska County was only 381 (Source: nursing homes and Institute of Public Health ommendations. In this survey, SWOT analysis was per- in Dubrova~ko-Neretvanska County), with stable aver- formed by means of a brainstorming procedure by target age occupancy rate of 100%, due to permanently open expert groups. An overview report with the collected waiting lists. According to requirements of the Rules, data enables comparison between the external opportu- the nursing homes are grouped in three categories. If a nities and threats and the internal advantages and nursing home fails to fulfill the envisaged requirements weaknesses (in this case creation of geriatric–palliative even for the third category, it should adjust within the unit models)16. period of 5 years8. In the year 2003, there were four nursing homes throughout the area of the Dubro- va~ko-Neretvanska County: two in the City of Dub- Results rovnik and two on the Island of Kor~ula. The health care Average population growth rate in population over practice in these nursing homes relies exclusively on the 65 years of age, for the area of the Dubrova~ko-Ne- responsibility of a family physician (urgent medical as- retvanska County, in period of 1991–2001 was 2.09% sistance or transport for specialized examinations are (2.78% male and 1.66% female) (Table 1). organized when necessary). Geriatric population is rec- The results showed that out of the total deceased in ognized as a special interest group for palliative care, geriatric population (Dubrova~ko-Neretvanska County, especially due to their quantitative presence as poten- tial users of palliative medicine9. The palliative care 2000–2002), the proportion of those deceased in institu- unit programs primarily involve cancer patients, AIDS tions was 0.33 (Figure 1, Table 2). infected persons, patients with neurodegenerative dis- According to data, the nursing home capacities in the orders, geriatrics and pediatrics groups. The palliative Dubrova~ko-Neretvanska County (2003) enable accom- medicine provides an optimal quality of life for patients modation of 1.95% of the total geriatric population of with diseases in advanced stage and limited progno- that area (Table 3). sis10. The health care systems in many Western coun- tries give the palliative care a firm position11. Under the Health Protection Act the palliative care is integrated TABLE 1 with the primary health care, whereas real possibilities AVERAGE POPULATION GROWTH RATE FOR POPULATION OVER 65 YEARS OF AGE FOR THE AREA OF THE of practical use of palliative medicine exist especially on DUBROVA^KO-NERETVANSKA COUNTY (1991–2001) this level12. The nursing homes quite clearly belong to the sphere of primary medicine, which implies the possi- Census Total Men over Women over bility of organization of in-patient palliative care units population 65 (N) 65 (N) in institutions13. A nursing home in Netherlands has over 65 (N) started a specific palliative care project in the year 1991 15902 5965 9937 1970; where due to a traditional emphasis on home care 2001 19564 7851 11713 induces investments in education and general practice Average 2.09 2.78 1.66% support14. Establishing of palliative–geriatric units in growth rate Croatia would allow that the said model be applied to other mentioned groups, foreseen by the palliative med- icine program as in-patient hospice units. The aim of this study was to explain the need and possibilities for introducing the new model of elderly care in Croatia. in institutions outside institutions Methods Source of the data were nursing homes in the Dub- rova~ko-Neretvanska County, and Institute for Public Fig. 1. Deceased population over 65 years of age in/out of insti- Health of the Dubrova~ko-Neretvanska County. tutions in the dubrova~ko-neretvanska county (2000–2002). 278 U:\coll-antropolo\coll-antro-1-2005\tomasovic.vp 17. lipanj 2005 10:01:24 Plate: 2 of 6 Color profile: Disabled Black 150 lpi at 45 degrees N. Tomasovi}: Geriatric-Palliative Care Units and Elderly Care, Coll. Antropol. 29 (2005) 1: 277–282 SWOT analysis clearly shows internal advantages Discussion and Conclusion (strength) and favorable external opportunities of set- ting up geriatric-palliative care
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