Tag Archives: Health System

Asia

Hong Kong plans for a city that’s growing older

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Today, about 16 percent of Hong Kong’s population is age 65 or older. By 2064, that is expected to be 36 percent.
HONG KONG — For decades, this city of more than 7 million has been one of Asia’s most dynamic places, filled with a youthful energy that drove rapid growth in both the population and the local economy.

Planners here still see Hong Kong that way. But they also are looking at the long-term trends, and grappling with a force they cannot stop: Hong Kong is getting older. That’s true of both the city’s people and its built environment — a phenomenon planners here call “double ageing”.

Today, about 16 percent of Hong Kong’s population is age 65 and over. By 2064, that’s expected to be 36 percent — and one in ten residents will be over the age of 85.

Meanwhile, housing stock that appears middle-aged today will become outdated tomorrow. By 2047, some 326,000 private housing units will be more than 70 years old. Many of them feature long flights of stairs unfriendly to older people. More than a third of seniors live in public housing, but the two-year wait list is bound to grow longer as citizens age.

The double-ageing problem is just one issue that Hong Kong’s planners are trying to figure out as they write a comprehensive plan called Hong Kong 2030+. The plan aims to take future demographic and economic trends into account while charting a path for improving quality of life in one of the world’s most densely settled cities.

Phyllis Li Chi Miu, deputy director of the city’s territorial planning department, says buildings, roads, parks and public transport all will need rejuvenation to make the city age-friendly. “It’s a challenging task,” she says.

Alignment with New Urban Agenda

Planners are also looking at how they can align the 2030+ plan with the New Urban Agenda. That’s the 20-year plan for sustainable urbanization that nations agreed to last October at the U. N.’s Habitat III conference in Quito, Ecuador.

Alignment was the main topic of conversation at a recent “Urban Thinkers Campus” conference here. At the event, Li noted that the 2030+ plan already stresses key elements of the New Urban Agenda such as social inclusion and environmental protection.

However, there was some debate about the New Urban Agenda’s relevance in the context of a city-state like Hong Kong. Paul Zimmerman, an environmentalist and elected councilor, said that some notable issues mentioned in the New Urban Agenda, such as increasing numbers of cars on the road, growth of slums and poor utility services, are not problems in Hong Kong.

“Hong Kong is a city and also a country,” Zimmerman said. “It’s a city in which hyper-density and wilderness co-exist. Other mega-cities have no space in their periphery, while Hong Kong has a massive open space in its periphery.”

However, Professor NG Mee Kam of the urban studies programme at the Chinese University of Hong Kong, told Citiscope that the 2030+ plan “needs to strongly align with the New Urban Agenda to plug in crucial policy gaps.” For example, she said, Hong Kong’s plan could take a cue from the New Urban Agenda’s focus on the informal sector and the importance of cultural heritage.

Retrofitting and reclaiming

The 2030+ plan proposes three “building blocks” for implementation — planning for a liveable high-density city, embracing new economic challenges, and creating capacity for sustainable growth.

A major focus, particularly when it comes to dealing with the double-ageing problem, is retrofitting districts with the most old buildings. Tall buildings are likely to be renovated, while many smaller buildings will likely be demolished to make way for new construction and open space. Retrofitting public spaces is also a priority. The city intends to add curb-cuts at sidewalks to make it easier for seniors to walk, and aims to increase the amount of public space from 2 square metres per person to 3.5 square metres.

The plan also aims for compact urban growth that is highly integrated with public transport. Homes and offices are to be within 200 to 300 metres of transit; open spaces within 400 metres; and community facilities, railway stations and educational institutes within a range of 500 metres.

“We are looking at optimum land use through retrofitting,” Li said.

The plan also envisions reclaiming a good bit of land from the sea. That’s a strategy that Hong Kong has long relied on to create room for the city to grow — the city’s airport and Hong Kong Disneyland resort are both located on reclaimed land.

Under the 2030+ Plan, Hong Kong would add another 4,800 hectares (nearly 12,000 acres) of land — a little less than the area of Manhattan. The land would be used for housing, industry, transport facilities and open space. These would include a few large urban extensions such as the East Lantau Metropolis, which is to be home to as many as 700,000 people.

Work on the 2030+ plan started in 2015 and is in the fourth of six phases of public consultation. The final plan is expected to be released next year.

Europe

The Power of Health Literacy in Later Life

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What is Health Literacy?

Health literacy refers to the ability to access, understand, communicate, and act on information related to health and disease. People who are health literate can find and understand health information, discuss concerns with medical professionals, and act on decisions to improve health and manage conditions. As a social determinant of health, health literacy is related to social factors, such as culture, education, or socioeconomic status.

It is an important factor in public health as health literacy rates affect health systems and the health services they provide. People with high levels of health literacy show healthier lifestyles, have fewer chronic illnesses, are more adherent to treatment, report better health, and live longer lives. In contrast, people with lower levels of health literacy have less use of preventive health services, are at higher risk for misdiagnosis, experience difficulties managing chronic conditions, medications, and treatment adherence, and have poorer health outcomes.

Health literacy affects everyone—even people with good literacy skills can have low health literacy. Most people will have difficulty understanding health terms or information at some point in their lives. Sometimes, people first hear specific medical terms or health information when they or a loved one has a serious health problem.

Health literacy has been shown to affect rates of illness and death, use of health services, and health outcomes. Low health literacy may account for up to five percent of overall healthcare costs. To address this, the European Union (EU) financed the European Health Literacy Survey, which revealed that nearly 50 percent of the population have a poor understanding of healthcare, disease prevention, and health promotion.

Why Does It Matter to Older Adults?

Health literacy is population-focused rather than individual-focused. Like many regions in the world, Europe is experiencing an increase in chronic conditions. It is the leading cause of mortality representing 77 percent of all deaths. When people manage multiple health conditions, they need to understand complex health information and navigate healthcare systems. Research finds that people who have the most difficulty with limited health literacy are older adults, recent immigrants who may not understand the regional language, those with lower levels of education, and ethnic minorities. For some older adults, using the internet to find health information or services is a struggle, and for others using basic math to schedule medications is challenging.

With populations growing older, more people will live with chronic conditions and may not have the skills to access, understand and act on health information. Although Europe has a relatively high socioeconomic status, up to half of its citizens have a poor understanding of their health, which means that health literacy is a crucial factor to active and healthy aging. Improving health literacy supports people in taking responsibility for their own lives, to make better decisions about their personal health, and to have the capacity to live longer lives in better health.

Increasing health literacy means addressing the knowledge and skills of people with low health literacy, their families, and communities. It also requires teaching health professionals how to provide health information that is understandable for individuals and how to help their patients understand what that information means for their own health. Improved health literacy empowers individuals to further engage in their healthcare and take a more active role in their personal health. In turn, this will have positive impacts on health promotion, disease prevention, and better treatment outcomes.

Carrie Peterson is a gerontologist and consultant in eHealth and Innovation.

Europe

Population Aging and Urbanization in Europe

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Cities are seeing a rise in ageing populations. In the European Union (EU), 75 percent of residents live in urban areas. As urban populations continue to rise, more and more people will grow into old age. For instance, the over age 65 group makes up 20-27 percent of the population in cities inside Portugal, Italy, and Spain. Since population aging will influence health, social exchanges, and well-being of older adults, hundreds of cities are designing urban environments to foster active and healthy aging.


Urbanization affects many areas including the health and well-being of society. As a result, many sectors are collaborating to keep populations engaged and healthy. Adapting cities to demographic trends accommodates residents, allowing for independent living and participation in society. The European Commission estimates that over 75 percent of housing in the EU is not suitable for independent living. Other aspects of physical environments including adequate sidewalks, transportation, and functional green spaces can increase physical activity and improve mobility, which reduces the risk and effects of chronic disease. Social issues, such as employment discrimination, negative stereotypes, and ageism, also play a role in the health of aging populations. It is important to involve older adults’ perspectives on urban planning to identify issues and barriers which prevent participation in society.

To help cities adjust to demographic trends and support healthy ageing, the World Health Organization (WHO) created a Global Network of Age Friendly Cities and Communities and Affiliated Programs, as well as a guide for policy and action in fostering age-friendly urban environments. Over 300 cities in 33 countries are currently involved in the Global Network, including 19 Member States in the European Region. The WHO guide advises on eight areas¹ considered the most influential, which also reflect the UN Principles for Older Persons. Through the work of the European Innovation Partnership on Healthy and Active Ageing (which has a dedicated Action Group on Innovation for age friendly buildings, cities and environments) the European Commission has published a guide on innovation for aging, with examples from 12 countries in Europe.

EuroHealthNet’s Healthy Ageing website also highlights examples of initiatives and key resources on healthy and active aging throughout the European Union. Arup, Help Age International, Intel, and Systematica have produced an overview² of aging in 10 European cities with comparative data on both urbanization and aging. AGE Platform Europe published a guide³ aimed at helping European cities to use the Urban Agenda to become more age-friendly and as a repository of innovative solutions for age-friendly environments. These networks and initiatives encourage cities to be health-promoting environments as they adjust to population aging, and share innovative ideas, experiences, and lessons learned along the way.

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By 2020, more than 50 percent of the global population over 60 years old will be living in urban areas. Planning now can stimulate active and healthy aging both for current and future generations.

1. The WHO guide addresses: outdoor spaces and buildings; transportation; housing; social participation; respect and social inclusion; civic participation and employment; communication and information; and community support and health services.
2. The ”Shaping Ageing Cities” publication examines: society; mobility; built and digital environments; politics; planning; and aging.
3. The AGE Platform Europe guide addresses the eight areas in the WHO guide as well as eight themes corresponding to the Urban Agenda: inclusion of migrants and refugees; jobs and skills in the local economy; urban poverty; housing; air quality; urban mobility; digital transition; and innovative and responsible public procurement.

Carrie Peterson covers Europe for Global Health Aging. She is a Gerontologist and Consultant in eHealth and Innovation.

Africa

Under-Diagnosed and Often Overlooked: Elder Abuse in South Africa

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This article is the first part of a two-part series on elder abuse in South Africa. Click here to read Part 2.


This year marks the tenth anniversary of World Elder Abuse Awareness Day (WEAAD). The United Nations established WEAAD to bring communities around the globe together in raising awareness about elder abuse. Although this problem is considered a public health issue, the World Health Organization has recognized that elder abuse remains a taboo which is often underestimated and ignored by many societies. This problem is perpetuated by societal attitudes and a lack of public knowledge about elder abuse. The abuse of older people is often viewed as a personal matter – it is not openly discussed. As a result, the prevalence of elder abuse is under-reported worldwide.

In South Africa, organizations like the Saartje Baartman Centre in Cape Town are helping those affected by elder abuse.  Dorothy Gertse the head Social Worker at the center reports that a growing number of elderly women are seeking assistance due to abuse by younger relatives. Elder abuse is a broad term that is comprised of various acts such as physical, sexual, emotional, and verbal abuse, neglect, exploitation, abandonment, and financial/economic abuse.

South Africa is currently experiencing a rise in economic abuse– individuals are seeking access to financial resources such as pensions and the homes of vulnerable older adults. Gertse states that family members are escorting the elderly to pension pay points and confiscating their finances. The rate of abuse has increased within the last 6 years; Femada Shamam, Chief Operating Officer for the Association for the Aged reports that in the 2010-2011 there were 1458 reported cases; this rose to 2497 cases in the 2012-2013 financial year.

The Older Person’s Act exists within South Africa’s Constitution and outlines the government’s obligation to protect the rights and uphold the safety of older persons. However, Shamam reports that many are unfamiliar with the act, and their role in upholding it. He states, “If you go to the police to report an incident, they wouldn’t know they have the authority to remove the alleged perpetrators.” Thankfully organizations like the Saartje Baartman Centre and The Go Turquoise for the Elderly are creating awareness surrounding issues faced by older persons in South Africa.

Andria Reta covers Africa for Global Health Aging. She is a Gerontologist and Professor of Health Administration.

South America

The Impact of the Chavez Government on Pensions and Health Systems

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This is Part 2 of a two-part series on Venezuela’s economic crisis. In Part 1, the main focus was food shortages. In Part 2, pension programs and health systems are emphasized.

On the surface, the status of older adults in Venezuelan society should have been secure. The Chavez government had expanded pensions to cover all older adults regardless of work history in 2011. The program was particularly beneficial to women who often participate in the informal economy or are self employed. The government also subsidized home repairs and gave older adults preferential access to food, allowing them to skip the lines at grocery stores. These new programs were termed the most generous social programs in Latin America.

Photo Credit: Globovisión
Photo Credit: Globovisión

By 2014, at the very beginning of the economic downturn, older adults were already at heightened vulnerability. The Global AgeWatch Index noted that the health system was showing signs of dysfunction. Older adults had problems accessing doctors or medications, infectious diseases were spiking, and there were signs of difficultly in accessing basic care. By 2015, the Index ranked Venezuela 76th out of 96 nations in security for older adults. Despite the “generous” pension program, the nation ranked 66th out of 96 countries for income security. Safety was most concerning since Venezuela scored only 17 percent in this category. As the economic condition deteriorates through the year, the country is likely to perform even worse in 2016.

The health system has also collapsed, leaving older adults without necessary medications and treatment for chronic or acute diseases. Moreover, the Venezuelan government nationalized the pharmaceutical industry, but is still unable to keep up with demand. While news has focused on the Zika virus, other infectious diseases such as malaria and dengue are also reappearing. These diseases can be more deadly for older adults who may have other chronic illnesses. Human Rights Watch recently found a “shortage of medications to treat pain, asthma, hypertension…”, all conditions that impact older adults.

The shortage of doctors and nurses is a long time in the making, and not solely because of low wages. According to the Wall Street Journal, over 13,000 doctors left Venezuela between 2000-2003, and current treatments are often outdated. Women do not have access to radiation, and breast cancer is often treated with radical mastectomy compared to more modern treatments. Finally, as of April 2015, only about 35 percent of hospital beds were operational in Venezuelan hospitals.

Older adults are more likely to be poor, and the poor are less likely to be able to access medical care or pay for food on the black market. The combination of food and medical shortages, and safety threats leaves older adults vulnerable to the resurgence of diseases, creating an unfortunate cycle of dependency. Life expectancy fell after the collapse of the Soviet Union, and it is likely that a similar impact may be felt in Venezuela.

Many of the bloggers and commentators on the Venezuelan imminent collapse are pro-democracy advocates who place blame on the socialist nature of the government. While the socialist nature may be the underlying cause of Venezuela’s current crisis, stable democracies can collapse when faced with economic threats. For example, the University of Michigan Retirement Research Center noted that older adults in the U.S. faced housing insecurity, and were required to work longer in order to recover from the 2007-2009 recession. In an economic collapse, work is scarce and older adults who are already near or below the poverty line become destitute.

Grace Mandel is pursuing a Master of Public Health in Health Systems and Policy at the Johns Hopkins University Bloomberg School of Public Health.

 

 

 

 

Africa

The African Age Wave – The Future is Now

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Photo Credit: Pixabay
Photo Credit: Pixabay

“As we get older, our rights do not change. As we get older, we are no less human and should not become invisible.” These powerful words by 84-year-old South African Archbishop Desmond Tutu illustrate the necessary social, economic, and political shift that needs to occur in order for global sustainability to be achieved. He is in fact a living testament of what the world can expect to see, as the age wave extends itself far beyond geographical borders. In the foreword of the 2015 Global AgeWatch Index, Tutu goes on to say that “No future development goals can be legitimate or sustainable unless they include people of all ages and leave no one behind.” According to the National Institute on Health, “In 2010, an estimated 524 million people were aged 65 or older – eight percent of the world’s population. By 2050, this number is expected to nearly triple to about 1.5 billion, representing 16 percent of the world’s population.” This phenomenon is unprecedented, pervasive, enduring, and has profound implications around the world, especially in Africa where the age wave has gone virtually unnoticed.

The Global AgeWatch Index provides insight on the state of older people in various regions around the world. The Index measures four key domains that affect the welfare of older adults which include, income security, health status, capability and the enabling environment. According to the report, “Despite Africa’s rapid economic growth, poor social and economic wellbeing for older people means most countries continue to rank in the bottom quarter of the Index.” Mauritius ranked 42nd, which was the highest ranking of the region. This was followed by South Africa which ranked 78th, Ghana 81st, Tanzania 91st, Mozambique 94th and Malawi 95th. Although the index sheds light on the disparities that older adults are faced with, it does not tell the entire story for the African continent. Due to lack of data, only 11 of the 54 countries were evaluated.

While this report offers an empirical snapshot of the challenges faced by older adults in Africa, 65-year-old Dominic Ologi of Nairobi, Kenya personifies the plight of income security, one of the four key domains. His story parallels others throughout Africa. Ologi spent 30 years working in both private and public sectors, and when he retired nearly 10 years ago, he was faced with a harsh realization – he could not afford to remain without employment. His circumstance required that he goes back to work, and now at 65, Ologi is running a tap water kiosk. He is unable to enjoy his golden years just yet. Analogous to many Kenyans, Ologi is without savings and receives 7,500 shillings ($75) a month from his state pension. According to the South African financial services firm, Alexander Forbes, more than 40 percent of Kenyans cannot afford to retire and must continue working, and another 40 percent rely on family for support. Ologi’s story is not the exception, but in fact the rule. Based on this data, eight out of 10 Kenyans will experience similar hardships.

Conclusions about the Index can be drawn from what it states as well as from what it is missing. On the one hand, Africa is on its way to ratifying a charter on human rights that will outline specific obligations to older people. This effort signifies a more serious commitment to the urgent need for improvement that Africa now seeks to address. On the other hand, I could not help but think about the unquantifiable elements that would show Africa and the treatment of its elders in a more positive light. From firsthand experience, I have witnessed the level of respect given to elders in Africa remains unmatched. Elders continue to be the nucleus of entire communities, and are often sought after for wisdom and guidance. The African proverb, “A village without the elderly is like a well without water” illustrates the value placed on their contributions. Although Africa has a long journey towards developing an infrastructure that supports the needs of its older people, in some ways, it is miles ahead of the rest.

Andria Reta is a Gerontologist and Health Administration Professor.

 

Australia

Dementia Among the Aging in Australia

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For Australians aged 65 and older, dementia has been identified as the third leading cause of disability and its prevalence is expected to rise as the population ages. Among this age group, roughly nine percent are living with dementia and among those aged 85 and older, the percentage increases to nearly 30 percent. As a disorder, the risk for dementia increases as an individual ages and it is expected that cases may increase to as many as 900,000 among older adults in Australia by the year 2050.

Photo Credit: Pixabay
                                                                                 Photo Credit: Pixabay

Dementia is not considered a single specific disease, but rather describes a series of symptoms associated with more than 100 different diseases.The symptom most commonly associated with dementia is impaired brain function, which often manifests as problems with language, memory, perception, personality, and/or cognitive skills. Typically, the decline in brain function that is the hallmark of dementia is significant enough to create challenges in daily living.

In Australia in 2010, dementia was the third leading cause of death overall and among adults aged 65 and over, it was the leading cause of morbidity. From a structural perspective, there are many barriers to the provision of quality care for older adults living with dementia in Australia. It has been estimated that by the year 2029, there could be a shortage of more than 150,000 caregivers for those living with this disorder – a bleak prospect when considering the projected rise in those diagnosed. Additionally, it is estimated that the costs of care to the healthcare system associated with dementia will arise and reach nearly one percent of Australia’s GDP in the next 20 years.

Among Australia’s indigenous groups, the risk for dementia is higher than the general population. Research has suggested that the prevalence of dementia among “remote and rural indigenous people” could be nearly four to five times higher than the general population. For individuals aged 45 and older among indigenous groups, dementia prevalence was 12.4 percent compared to 2.6 percent compared to 2.6% in the broader Australian population. Research has also shown that among indigenous groups, dementia tends to be higher among males while the rate is generally higher among females in the overall population.

The Australian government has recognized the importance of addressing dementia risk among the aging population. In 2012, the Australian Health Ministers included dementia as the ninth National Health Priority Area and it is the newest health issue to be added. By including dementia as a priority area, it is recognized as a significant issue of concern for the Australian population and allows for more concerted, focused efforts to combat its effects. Continued efforts and prioritization will be necessary to ensure older adults in Australia, particularly those living with dementia, may continue to age while experiencing improved quality of life.

Diana Kingsbury is a PhD student and graduate assistant in prevention science at the Kent State University College of Public Health.

North America

Aquatic Therapy Marketplace

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In honor of National Physical Therapy Month, Global Health Aging is presenting a weekly four-part article series on water aerobics. This is Part 1 in this series. Click here to read Part 2.

Welcome to the 21st century and a new American Healthcare System. The advent of the Affordable Care Act (ACA) and its gaining foothold of functional acceptance in America presents an interesting opportunity for citizens who are making a paradigm shift: movement from managed health care to managed self care. Who will be making this shift? Citizens are moving into a realm of do-it-yourself healthcare management through many fields of allied health.

Photo Credit: OakleyOriginals
nPhoto Credit: OakleyOriginals

One such allied healthcare service is becoming more commonly prescribed and sought after: Aquatic Therapy. National collegiate teams and professional franchises have led the way as it is most commonly used in sports medicine. Patrons in private and public clubs, especially non-profits like YMCAs, are blazing new trails in aquatic practices, catching up with other countries around the world.

Whether it is prescribed or not, many patrons now choose to seek services outside the coverage of their insurance. In the 21st century, aquatic exercise and therapies are steadily growing with the aging of the baby boomer population. The trend is growing more rapidly in younger populations where an overuse injury from a favorite sport may occur. The younger “weekend warriors” are aware of the conditioning and rehabilitative outcomes from employing aquatic exercise and therapies in support of their favorite sport.

In today’s aquatic marketplace, how can new patrons, of any generation or experience, determine what is desirable in an aquatic program, facility or instructor? The industry is so new that standardization in practice is far from being established and even farther from being commonly known or accepted. Insurance regulations governing those who may be reimbursed for services are sorely misaligned. This means that many aquatic therapy participants can get insurance coverage for “aquatic therapy” but it may not be the best available instruction and care.

Knowing this about the industry now, three questions come to mind: What do you look for in an aquatic facility or program? And thirdly, who or what kind of person with what skill-set or credentials is most important when becoming a patron of aquatic therapy?

Since university degree programs and licensing in physical therapy do not instruct or test students in this aquatic modality, aquatic patrons need be guarded in their pursuit of care. Water exercise can be performed anywhere between high impact and totally suspended, meaning no contact with the pool floor. This variance assures that there is some effective form of aquatic therapy for all ages, most types of injuries, and almost any physical condition a person may need to address. Even speech pathologists are gaining advancements through aquatic environments.

Water therapies can be passive or active. An active therapy is something the patron does in response to the therapist’s instruction and it may ultimately become an exercise. A passive therapy is a physical maneuver or manipulation that the therapist does to the patron’s trunk, limb or extremity. More often than not, passive therapies are practiced only by those aquatic professionals specifically trained in aquatic therapies. They may or may not hold a degree or license in physical therapy.

As the aquatic industry continues to evolve, it can very well become its own discipline in colleges. Presently, there needs to be a lot more work put toward the effort of standardizing practices, quantifying outcomes and modifying insurance coverages. This will allow certified professionals even without degrees in physical therapy to be compensated or reimbursed for their services.

When practitioners universally understand and consistently use the properties of water to their fullest potential, then best outcomes for patrons will emerge.  Aquatic therapies will then become a first line application for preventative and restorative allied healthcare. For instance, physicians will prescribe pre-operative aquatic conditioning to keep the muscles, ligaments and tendons surrounding a surgical site as strong and healthy as possible. Doctors will also place post-op patients in water before commencing land- or weight-bearing exercises so that the supporting muscles, tendons and ligaments can begin moving sooner and speed the healing and recovery process from the surgery performed. The efficacy of aquatic therapy is growing exponentially, thanks to the wisdom of experience; once relegated to senior citizens. The positive experiences of seniors may now be shared by all ages with varying abilities and health constraints.

Felecia Fischell is an Aquatic Specialist with twenty-three years experience in aquatics. She leads aquatic classes and consults as an aquatic personal trainer and a swim instructor at the Franklin County Family YMCA in Virginia. Formerly the Founder of FunLife Aquatics Consulting in Maryland, Felecia presents at health fairs and has given aquatic presentations to high schools, Howard County Board of Education, Howard County General Hospital and Howard County Community College.

Australia

Australia: Integrating Mental Health Services at the Primary Care Level

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Health-hospital-indoors
In many developed countries, the aging populations are on the rise and Australia is no exception. Currently, 13% of Australia’s population is over 65 years and this is projected to grow 19-21% by 2031 and 26% by 2051. The experience of aging can range from a positive, fulfilling one to an anxiety filled, negative experience. In Australia, mental health disorders are highly prevalent among the elderly.

Existing mental health services are provided at the primary care level, with the general practitioner. In 1992, Australia changed its mental health services policy from an institutional to a community-oriented set up. When it comes to health, one’s General Practitioner (GP) is usually the first point of contact for an elderly patient. By integrating mental health services at the primary care level, the Australian government places mental health as a mainstream agenda in the health system.

An example of a model is the case of St. Vincent’s District in the inner city of Sydney. This district had a heterogeneous elderly population, comprising of Holocaust survivors, people who are homeless, or in hostels among others. Less than 1% of the population surveyed went directly to a hospital for mental health services, and a significantly larger proportion went to their GP. Since the elderly have the freedom to choose their GP, they place a high level of trust with these health professionals. The model encouraged collaboration across primary care, community services and specialist services such as geriatric medicine and geriatric psychiatry. An impact evaluation of this program suggested that general practitioners and other primary health care workers became more skilled in assessing and managing elderly mental health, requiring less support. Additionally, there has been better outcomes with regards to maintaining continuity of care.

This model was applauded for not only improving access to mental health services, but also in the collaboration it achieved. However, stigma against mental health issues is a concern. Elderly patients are often victims of the existing stigma around mental health and this is a significant barrier to engaging in dialogue on mental health issues with one’s General Practitioner. Another critique of this program is that care and treatment can be ‘fragmented, piece meal and sometimes non-existent,’ and that there is no nationally consistent protocol.

It is estimated that 10-15% of the elderly population have experienced depression. If one looks specifically at the elderly population in residential care homes, this population has more than twice the rate of the depression, at 35%. Additionally, about 10% have experienced problems with anxiety. Suicide rates among the elderly are also a cause for concern as men over 85 years have the highest likelihood of dying by suicide than any other age group. This age group’s suicide rate  is three times higher than the national rate, at 37.6 deaths per 100,000 people. Some of the key reasons for depression include loss of a partner and deterioration of health.

These figures look grim. Perhaps there is a need for the re-evaluation of this model, looking at health systems factors as well as sociocultural factors affecting access and use of mental health services.

Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health.