ReemLarisa Director of Geriatric and Chronic Diseases

Department of Community Nursing

Treatment of the elderly in the community

Clalit Health Services Israel

The percentage of those aged 65 and over in selected OECD countries

Percentage of 65 yo and older

Country

10.6 Israel

15.1 Average OECD countries

24.1 Japan 20.6 Italy 6.2 Mexico 5.0 South Africa

The increase in age of the population is accompanied by an increase in the percentage of elderly who are limited in their functioning

Growth in demand for support services at home and in the community

Raises various issues for public debate regarding the provision and adoption of policies and services

Need to build innovative models of care

The elderly in Israel

Percentage of 80+ within age 65+. Average age is increasing in Israel.

How is the world coping with the ageing phenomenon

Many Western countries are increasingly engaged in the issue of providing community services to treat the elderly in various medical conditions:

Splitting of services

Successful aging and advancing the functional independence of the elderly

Various approaches are being examined to focus on a consumer-centered / directed customer, tailor-made to the specific dimensions of the patient and the primary caregiver.

An individual treatment plan or individual treatment packages that express flexibility and responsiveness to the specific needs of the elderly and primary caregivers.

(מתוך תכנית לאומית לטיפול בקשישים – 2014אסתר יקוביץ )

Clalit

The largest health organization in Israel and the second largest in the world

Insures about 54% of Israeli citizens

Clalit has 14 hospitals

1500 primary clinics

Ministry of Health

Meuchedet Maccabi Clalit Leumit

Hospital Community

Pathology Geriatric/ Rehabilitation

Institute

Primary care

clinics

Consultant clinics

Call Center

Department of ongoing care, Department of home

care, Department of Geriatrics.

Organizational Structure

ClalitStrategies of

Clalit insures over 600,000 elderly, 66% of the elderly population of Israel

Development of quality, accessible services in the community Focusing on locating and summoning seniors at risk for overall evaluation

Promoting a healthy lifestyle while balancing chronic diseases Development of hospitalization alternatives for patients in situations that can be treated at home, such as: nursing care, rehabilitation, Expanding cooperation with community entities

Complicated cases and house

bound

Chronic disease

Independent

Intervention programs for all levels of illness and Independence

מפת בריאות הקשיש

9

At risk elderly

Functional decline

Cognitive decline Malnutrition

Falls and Balance

issues

Social Issues

Medical Issues

Second Evaluation

ADL, IADL

MMSE

assessment of

emotional distress

MNA Falls

assessment

GET UP AND

GO

Medication assessment

Recommendations for Intervention

Results and Follow-up (Repeat Assessment)

First evaluation

Environm-ental

assessment

Online tools to support health care professionals

Information Websites for Patients and Families

13

“Home Care Units”

20 units across Israel

Replace hospitalization

Specialized multi-disciplinary team

Provide support for Primary care centers

Policy to reduce hospitalizations has led to recent expansion of home care services

The units treat chronic complex patients, respirator patients, oncology patients as well as providing in home rehabilitation, palliative care.

Thousands of patients enjoy the service every year and prefer to be treating at home instead of being hospitalized

14

Reduction5%

Program to reduce hospitalizations of the elderly

Five Wishes

Clalit Dementia Program

0

50

100

150

200

250

300

350

2010' 2015' 2020' 2025' 2030' 2035'

אמדן מספר הזקנים עם ירידה קוגניטיבית בקהילה ובמוסדות , משמעותית ודמנציה

2035 -2010(: באלפים)בישראל

פרס

מ

ה צי

מנ ד

ליחו

X 10

00

Falls Prevention in the Elderly

1/3 of the elderly over the age of 65 fall once a year

20-30% result in minor injury ,5% of the falls result in fracture or require admission for another fall related reason

Half of those admitted due to fall related injury will survive for 1 year

Inviting and assessing fallers with a focus on identifying the cause of the fall

Building an individualized intervention program based upon the cause of the fall

Personal and / or group instruction with the intention of educating on correct health behaviors, maintaining attention, polypharmacy, medications that increase the risk of falls

Encouraging the elderly to continue regular physical activity, including walking and building muscle strength and resistance.

Clalit program

Benzodiazepines

There is a greater risk of falls when patients are taking medications of this type. Even those that have a short half life.

Risk of fracture is higher when the patient is taking high doses of these medications and during the early stages of use of these medications.

Risk of falls is 44% higher in patients taking these medications when compared to patients not taking these medications

Shorter acting medications of these kinds cause an increased risk of falls particularly during sleeping hours

Program

Establishing a team of experts Literature Review Recommendations prepared for

treating teams information booklet prepared for patients Prescribing information to

patients Further training of teams

International Month of the Elderly

Thank You