Medical care of elderly persons [experts panel]

NIK has invited specialists in geriatrics to debate. The panel was organised with regard to the audit (currently being worked on) called Medical care of elderly persons. NIK wants to use the knowledge and experience of outstanding medical practitioners to develop the audit programme. “We would like to hear your opinions on what questions we should ask during this audit and which of them are most important” – NIK Vice-President Jacek Uczkiewicz has addressed the experts.

Vice-President of the Central Statistical Office (GUS), Grażyna Marciniak, PhD, presented forecasts concerning the population 65 and over in Poland and Europe. The whole European Union is getting old but this process is particularly dynamic in Poland. Vice-Minister of Health Igor Radziewicz-Winnicki talked about the Ministry’s proposals to broaden access to geriatricians and geriatric consultations.“ We have to use the enormous potential of internal wards” – he said. He also mentioned changes in regulations which are going to entrust the function of the general practitioner to internists. He also said that the Ministry is now developing a concept of the new national healthcare plan which will also comprise the healthy ageing programme.

Prof. Tomasz Grodzicki, PhD, National Geriatrics Consultant and Head of the Department and Clinic of Internal Diseases at the Medical College of the Jagiellonian University, presented the concept of geriatrics and the way it functions in the Polish healthcare system. “The role of geriatrics is to coordinate medical care and comprehensive treatment of elderly persons. In Poland no such system is in place yet” – he said.

Another issue is the deficit of geriatricians and geriatric nurses. For two years vocational training programmes have been organised by the Ministry of Health but the number of specialists in this area is still very small. The question is who should teach proper care of elderly persons. “There are approximately 300 geriatricians in Poland. Part of them do not work in their profession as it is not profitable for them” – argued prof. Grodzicki. Most universities in Poland do not have separate geriatric subjects. According to the National Geriatrics Consultant this subject has to be part of the syllabus if a given medical university wants to be accredited. Grodzicki also mentioned the issue of integration between healthcare and social welfare. Other debate participants raised that issue several times during the meeting.

Prof. Barbara Bień, PhD, Head of the Geriatrics Clinic of the Medical University in Białystok, posed a few difficult questions. Why is there no day geriatric care in Poland? Why are there no full-time jobs for geriatric consultants in hospitals? Why no system changes have been made despite the fact that geriatrics is announced as a healthcare priority? “We shouldn't waste money on sending elderly persons to numerous specialists. Let's think through the prism of their needs. The answer is geriatrics with a complex approach to the patient”- said prof. Bień.

Jarosław Derejczyk, PhD, Director of the John Paul II Geriatric Hospital in Katowice presented advantages of geriatric care from the practitioner's perspective. He underlined that geriatrics makes it possible to see the patient as a whole. It enables limiting the number of medicines, so willingly taken by elderly persons. Nearly one fifth of hospital admissions of the elderly is caused by overdose or bad medicine combinations. “The presence of a geriatrician in hospital or outpatient clinic will help prevent such situations. But it is also important for every doctor to know how to diagnose diseases of the elderly and how to treat them” - said Derejczyk confirming the postulate of prof. Grodzicki about geriatrics as a separate subject in medical schools.

Prof. Katarzyna Wieczorowska-Tobis, Head of the Department and Clinic of Palliative Medicine of the Medical University in Poznań, mentioned model examples of geriatric care, particularly the Belgian and the British ones. In Belgium, which also has ageing population, a spike of interest in geriatrics can be observed since 2005. Each patient over 75 years of age who goes to hospital is subject to assessment after which he or she is sent to a standard or geriatric ward. In the latter case a special team takes care of that person. This allows holistic treatment of the patient. Also, the elderly person does not have to go from one specialist to another, exposed to great stress. At the same time, in Great Britain geriatricians take care of elderly persons already in admission rooms. People of over 80 years of age do not have to wait long hours in queues, risking rapid deterioration of their health which would also stand for additional costs for the system.

The experts' debate shows that a properly implemented geriatric system is a response to the aging society issue. It reduces stress and problems of patients and also minimises the costs of their treatment. The issue of aging communities is a reality in nearly all European countries. Some of them already have systems in place adjusted to the needs of their citizens. In case of Poland it seems to be a final call to realise that the issue of medical care for the elderly may not be put aside for later.