Transcript Probabilistic Projections: Population age 65 and over (thousands)

สังคมผู้สงู อายุ : โอกาสที่สร้ างสรรค์
Pannida Wattanapanom, M.D., FACP.
Demographic in Thailand
• The proportion of older persons (age >60)in
Thailand is 14 % in 2014 , will increase to 20
% in 2025 and 33% in 2050
• Life expectancy in male is 71.1 years and
female is 77.8 years
• The population of older will exceed the
population of children in 2020
Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat,
World Population Prospects:
Probabilistic Projections: Population age 65
and over (thousands)
Speed of Population Aging
More developed countries
France
1865-1980
Sweden
1890-1975
Australia
1938-2011
United States
1944-2013
Canada
1944-2009
Hungary
1941-1994
Poland
1966-2013
United Kingdom
Less developed countries
115
41
Azerbaijan 2000-2041
Chile 1998-2025
27
China 2000-2026
26
Jamaica 2008-2033
25
Tunisia 2008-2032
24
Sri Lanka 2004-2027
23
47
Thailand 2003-2025
22
1930-1975
45
Brazil 2011-2032
21
Spain
1947-1995
45
Colombia 2017-2037
20
Japan
1970-1996
Singapore 2000-2019
19
85
73
69
65
53
26
* Dates show the span of years when percent of population age 65 or older rose (or is projected to rise) from 7 percent to 14
percent.
Source: K. Kinsella and Y.J. Gist, Older Workers, Retirement, and Pensions: A Comparative International Chartbook (1995) and K.
Kinsella and D. Phillips, “The Challenge of Global Aging,” Population Bulletin 60, no. 1 (2005).
Population by age groups and sex
Graph : Potential support ratio in Thailand
Booming business for Aging
What’s in their mind ?
Biggest concerns about life in old age
The needs are being overlooked
“Healthy
eating is a top
priority for half in AsiaPacific in retirement,
but one in two can’t
find foods that meet
aging nutritional
needs.”
The needs are being overlooked
“Finding easy-to-read
product labels and
easy-to-open product
packaging is
challenging for more
than half in the elderly
worldwide”.
The needs are being overlooked
The reality
Living arrangement expectation in old age
I WILL
LIVE ...
WITH MY
SPOUSE
IN A NURSING HOME
WITH MY
CHILDREN
AT HOME WITH
PROFESSIONAL
IN AN ASSISTED
FACILITY
LIVING
HELP
WITH A FRIEND
3%
3%
3%
2%
3%
• ASIA-PACIFIC
• EUROPE
• MIDDLE
AFRICA
EAST/
• LATIN
AMERICA
•
NORTH
AMERICA
Home Sweet Home
Trend of aged care services
Nursing home declined
Growing home care
Source : CMMS data
Long term care cost per year(U.S. dollar )
100,000
90,000
80,000
70,000
60,000
50,000
40,000
30,000
20,000
10,000
0
87,600
45,188
42,000
Home care
ALF
16,900
Day
services
NH
Long term care cost per
year
Reconsider care options
Elderly care services
Long-term care
Institutional
Acute care
Non-institutional
- Assisted livings
- Day care
- ACE unit
- Nursing Home
- Home health care
- Geriatric clinic
- Retirement home
- Residential home
Diagram 1. Elderly care services
Elderly care services
Long-term care
Institutional
Sub
acute
care
Acute care
Non-institutional
- Assisted livings
- Day care
- ACE unit
- Nursing Home
- Home health care
- Geriatric clinic
- Retirement home
- Residential home
Guided care nurse
PACE
Hospital home
Sub-acute care for the elderly
Sub-Acute Care
• Provide continuity of care for patients who no
longer require acute care but still need
medical care in a rehabilitation facility
• Maybe offered in a hospital or may be
provided in LTC
Conditions for Sub-Acute Care
Conditions that may be appropriate for inpatient
sub-acute care include but are not limited to :
• Orthopedic rehabilitation
• Neurological disorders/CVA
• Complex wound management
• Pulmonary and cardiac conditions
How long does a patient stay ?
• The length of stay is based upon that person’s
individual needs varied from a week to
months ,but average is generally 2 -4 weeks
The Program All-inclusive care for the elderly
(PACE)
PACE is a care program
that provide
community –based
care and services to
the elderly who
otherwise need a
nursing home level of
care
Source : http://www.onlok.org/
Services provided in PACE
• Medical services
• Health and wellness
services
• Assistance with tasks
and ADLs
• Recreation, friends and
art
Multiple diseases and polypharmacy
Mr. Dan is a 75 y/o man
with PMH of DM2, HTN ,
CHF , CKD , BPH ,old cva ,
COPD in which he’s followup with five specialists
and taking 20+
medications per day.
Guided care nurse
• Model of comprehensive
heath care for people
with several chronic
problems, provided
physician-nurse teams in
primary care practices
• RN works closely with MD
to provide state-of the-art
chronic care for 50-60
patients
Source : http://www.hopkinsmedicine.org/institute_nursing/continuing_education/guided_care_nursing.html
Guided care services
•
•
•
•
•
•
•
Assessing
Planning care
Monitoring
Coaching
Chronic disease self-management
Educating and Supporting Caregivers
Coordinating Transitions Between Providers and
Sites of care
• Access to community services
Source : http://www.hopkinsmedicine.org/institute_nursing/continuing_education/guided_care_nursing.html
Guided care outcomes
• Improves the quality of patient care
• Improves family caregivers’ perception of
quality of care
• Improves physicians’ satisfaction with chronic
care
• Produces high job satisfaction among Guided
Care nurses
• May reduce the use of expensive services
Arch Intern Med. 2011 Mar 14;171(5):460-6
Hospital at home
• Hospital at Home®
provides safe, highquality, hospital-level care
to older adults in the
comfort of their own
homes.
• The innovative care
model lowers costs by
nearly one-third, and
reduces complications. It
is highly rated by patients
and caregivers alike.
Health Aff (Millwood). 2012 Jun;31(6):1237-43.
A typical Hospital at Home program steps
• Staff assesses the patient
• Physician evaluates the patient and is then
transported home
• The patient receives extended nursing care
• The patient is evaluated daily by the physician
• The clinicians use care pathways , clinical outcome
evaluations, and specific discharge criteria.
• The patient can receive diagnostic studies as well as
treatments.
• The patient is treated until stable for discharge
Source : http://www.hospitalathome.org/about-us/how-it-works.php
Use technology to deliver healthcare
Make geriatric care a bigger part of training
Reset public mindsets about the elderly
THANK YOU