Evolution of the needs of older persons

Most countries in the world experienced a ma'pr increase in life expectancy during the 20th century and a resulting aging of their populations. Further gains in life expectancy are uncertain, particularly in developed countries already characterized by a high longevity, and little is known concerning the health state of future generations of the elderly. But there is no doubt that further population aging will produce larger numbers of older persons both in developed and developing countries. As the prevalence of most chronic diseases is high in old age, population needs change rapidly in health care systems still organized essentially to provide acute care to children and young adults. Old age is heterogeneous, but a large proportion of older persons is affected by multiple chronic diseases, resulting in a wide range of needs. Health systems will have to adapt to this new situation while still providing appropriate responses to acute diseases affecting all ages. Although future needs are difficult to quantify, their nature is already apparent. Providing for these needs will require a major investment in manpower, a diversification of services delivered by health care systems, changes in the training of health professionals and extensive research to define effective treatments for elderly patients with multiple co-morbiditie

Etudier la fragilité : une priorité de santé publique

L'étude de cohorte Lc65+ suit depuis 2004 plusieurs milliers de personnes pour mieux comprendre la fragilisation liée au vieillissement. Que sait-on aujourd'hui de la fragilité ? Peut-on la mesurer ? Pourquoi le faire

Comparability of Health Care Responsiveness in Europe using anchoring vignettes from SHARE

The aim of this paper is to measure and to correct for the potential incomparability of responses to the SHARE survey on health care responsiveness. A parametric approach based on the use of anchoring vignettes is applied to cross-sectional data (2006-07) in ten European countries. More than 6,000 respondents aged 50 years old and over were asked to assess the quality of health care responsiveness in three domains: waiting time for medical treatment, quality of the conditions in visited health facilities, and communication and involvement in decisions about the treatment. Chopit models estimates suggest that reporting heterogenity is influenced by both individual (socio-economic, health) and national characteristics. Although correction for differential item functioning does not considerably modify countries ranking after controlling for the usual covariates, about two thirds of the respondents' self-assessments have been re-scaled in each domain. Our results suggest that reporting heterogenity tends to overestimate health care responsiveness for "time to wait for treatment", whereas it seems to underestimate people's self-assessment in the two other domains.Anchoring Vignettes, Cross-Country Comparison, Chopit Model

Understanding recent trends in Swiss ambulatory care utilization when out-of-pocket payment is minimal

Summary.: Objective:: To examine trends in ambulatory care utilization when individuals face almost no financial barriers to health care. Methods:: Observational study of insurance data. Adults with minimal deductible were included. Ambulatory care visits and costs were measured from 1997 to 2002. Results:: Mean ambulatory care costs/insuree increased from 1 292.- to 1 790.- CHF, corresponding to higher increases in drug costs (+61.7%) than services costs (+24.3%). The proportion of visits to generalists decreased while those to hospital outpatient services increased. Conclusions:: In a demographically stable population of insurees, increases in ambulatory care costs were due neither to growth in physicians' ?visits nor to increasing physicians' fees per act, but to what was included in or prescribed during the visit

The prevalence of rheumatic diseases in the elderly in developed countries and its evolution over time

Summary.: Objectives: This study aims at evaluating the prevalence of rheumatic diseases in the elderly and its evolution over time. Methods: We present a systematic international literature review of the prevalence of rheumatic diseases in the elderly and its evolution over time. Results: The estimated current prevalence of rheumatic diseases among people aged 65 and more varies between 41% and 53%, and is similar to estimated prevalence rates in studies performed before 1990 (35-55%). The prevalence is high and seems to increase rapidly with age. Furthermore, women suffer more frequently from rheumatic diseases than men. Conclusion: The selected studies included a large range of methods, making comparisons difficult. However, estimates of the prevalence of rheumatic diseases in the elderly appear to be homogeneous in different countries and stable since 198