Chi, I

Lam, TP

HKU Scholars Hub

Title Health care services for the elderly: integrated or fragmented?Author(s) Lam, TP; Chi, ICitation Hong Kong Practitioner, 1995, v. 17 n. 3, p. 97-99Issued Date 1995URL http://hdl.handle.net/10722/45102Rights Creative Commons: Attribution 3.0 Hong Kong LicenseEDITORIALEDITORDr.. Lam Tai PongDEPUTY EDITORSDr. John T.N. ChungDr. Wong Hung WaiBOARD MEMBERSD. Eddie I Chan D. Peter C.Y. LetDr David VK Chao Dr, Glenn K.L. LeeDr. Betty K.M. Kwan Dr. John MackayDr. Cindy L. K. Lam Dr. David OwensD n i \y/ L/ |Dr. Bernard W. K. LauBUSINESS MANAGERDr. Ip Kit KuenADMINISTRATIVE MANAGERMs Teresa LeeHONORARY CONTRIBUTING EDITORIALCONSULTANTSDr. Cindy S.T. Aun - Anaesthesia & Intensive CareDr. Augustine F Cheng- MicrobiologyProf. Tony Dixon - Family MedicineProf, Wes Fabb - Family Medicine~ Surgery~ Community Medicine- Medicine- Community Medicine- Orthopaedic Surgery- Psychiatry- Pharmacology- Obstetrics & Gynaecology~ OphthalmologyProf. S.T. FanProf. A. HedleyDr. Walter W.K King - SurgeryProf. C.R. Kumana - Clinical PharmacologyDr. C.P. LaUProf. S. H. LeeProf. P.C. LeungDr. Mak Ki YanProf C.W. OgleDr. Grace TangProf. Marie TsoProf. C.A. van Hasselt - OtothinolaryngologyDr. C.K.Wong -PsychiatryProf. Jean Woo - MedicineProf. C.Y Yeung - PaediatricsProf. R.T.T. Young -MedicineThe Hong Kong College of General PractitionersTel: 2528 661 8 (2 lines) Fax: 2866 061 68th Floor, Duke of Windsor Building,1 5 Hennessy Road, Hong Kong.Printed & Designed byPrinthouse Production CenterHONG KONGHealth Care Services For TheElderly: Integrated OrFragmented?In the Governor's 1994 Annual Policy Address, Mr. ChrisPatten stated, "At the top of our social priorities come theelderly." This is a reflection of the urgency of the problemawaiting us as our senior citizens will number over one millionby 2000. In Hong Kong, an elderly normally refers to a personaged 60 or over (although the Government appears to want toraise it to 65 or over). However, the elderly population isheterogeneous and can be further divided into different sub-groups - the young-old, the old-old and the oldest-old,arbitrarily defined as the age groups 60-69, 70-79 and 80+.The older age groups constitute more rapidly growingsegments of the population. In Hong Kong, the old-oldpopulation aged 70 years or over will increase between 1981 and1999, from 38% to 50% of the elderly population. The healthand social needs of these different sub-groups are quitedifferent. For instance, the old-old and oldest-old peopleconsume an amount of services far out of proportion to theirnumbers'. Since their increase in the percentage of the totalpopulation will be more than that of the young-old, this willcompound the demand on health care and social services of theelderly.Recognising the magnitude of the problem, in the Reportof the Working Group on Care for the Elderly released by theHong Kong Government in August 1994, the concept of "carein the community" by providing appropriate support for olderpersons and their families to allow old people to grow old intheir home environment with minimal disruption was consideredpivotal to the provision of services for elderly people2. This isconsistent with the opinion around the world where it isgenerally agreed that elderly citizens should be encouraged tolive in the community3"5.Based on the concept of care in the community,Government's Department of Health is establishing ElderlyHealth Centres to promote the health and well-being ofelderly persons in the community. These Centres' main tasksare to provide screening and other primary health care services97Editorialfor the elderly. Altogether, seven of thesecentres are planned. In general, studies haveshown the elderly participants of healthpromotion programmes are healthier than theircounterparts6'7. A local study evaluating theeffectiveness of adult health promotion indicatedthat the participants self-rated their physicalhealth significantly better than the non-participants. In particular, they were moreknowledgeable and conscientious about theirhealth, and they complied more with healthhabits8.Unfortunately, these Centres' services willnever likely to reach many of the elderly who liveall over the territory and who may have mobilityproblems preventing them from attending theseElderly Health Centres. They may also duplicatethe services provided to the elderly e.g. preventionprogrammes, health education and lab tests, in theexisting General Out-Patients Departments(GOPDs) which are expected to provide qualityprimary health care services to their patients.Furthermore, they may hinder the provision ofcontinuous care which is of prime importance inthe overall provision of primary health care.It is therefore encouraging to learn from theReport of the Working Group on Care for theElderly that it is proposed to integrate thesehealth centres with GOPDs2 which are attendedby a significant number of elderly people all overHong Kong. If the recommendation ofintegration is accepted by the Government, theintegration will hopefully involve the completerange of primary health care services to theelderly, rather than the physical premises alone.In fact, well co-ordinated programmes for theelderly should be established in all GOPDs whereelderly persons constitute about 30% of theirpatients, so that the services will become easilyaccessible to those of our senior citizens whochoose to attend government clinics. It is alsolikely to be more efficient and cost-effective tohave these services based in GOPDs, rather thansetting up separate Elderly Health Centres. Atthe very least, the pace of introducing theseservices should be a lot faster than it has been, asthere is only one Elderly Health Centreestablished so far. It will also make the servicesreadily accessible since there are almost 60GOPDs established all over Hong Kong.By the same token, general practitioners inprivate practice should also providecomprehensive and continuous primary healthcare services for the elderly, with strong emphasison prevention and health education. As a matterof fact, countries with well developed primaryhealth care system, e.g. United Kingdom,Australia and Canada have not needed toestablish clinics similar to our Elderly HealthCentres. General practitioners in these countriestake up the role of providing preventive,comprehensive, continuous and community-basedprimary health care to all their citizens, includingthe elderly.In conclusion, community-based generalpractitioners are indeed central to the care of theelderly, be they in public or private service. Theymust play an active role in the care of the elderly,managing their chronic illnesses and arrangingappropriate community support. This will resultin better care for the elderly and will provideprofessional satisfaction for their doctors in thecare of the elderly. Easily accessible ElderlyHealth Centres may help achieve these aims.However, establishing Elderly Health Centresshould not reduce the Government's commitmentto providing a wide range of primary health careto those in need of such public services in HongKong. Furthermore, given the importance ofcontinuous care in primary care setting, seriousconsideration must be given to where and howthese health services should be provided. IReferences1. Chi I & Boey KW. A Mental Health and Social Support Study of the Old-old in Hong Kong. Resource Paper Series No.22. Department of SocialWork and Social Administration, The University of Hong Kong. 1994.98Hong Kong Practitioner 17 (3) March 1995Hong Kong Government. Report of the Working Group on Care for theElderly. August 1994.Cohen L. Ottawa's Geriatric Assessment Program: "Better care is lessexpensive care" Canadian Medical Association Journal 1989; 140: 710-713.Lindsey AM & Hughes EM. Social Support and Alternative toInctitutionalization for the At-Risk Elderly. Journal of the AmericanGeriatrics Society 1981; 26(7): 308-315.OECD Social Policy Studies No. 14. Caring for Frail Elderly People: NewDirections in Care. 1994.Dyahtwald K. (ed) Wellness and Health Promotion for the Elderly.Aspen Publications, Rockville. 1986.Lubben JE, Weiler PG & Chi I. Effectiveness of Health Promotion forthe Ageing: An Evaluation of an United States Program. Hong KongJournal of Gerontology. 1988; 2(2): 13-18.Chi I & Leung EMF. An Evaluation Study of the Health PromotionProgram for the Elderly in Hong Kong. Department of Social Work &Social Administration. The University of Hong Kong. 1992.Dr. Lam Tai PongEditorDr. Iris ChiLecturerDepartment of Social Workand Social AdministrationThe University of Hong Kong**** **** **** ****NEXT ISSUE1. Update On Osteoarthritis2. Reasons For Screening And Methods Of Diagnosing Type II DiabetesMellitus3. Oxygen Therapy4. Report Of The Lunch Seminar On Cervical Smear Screening AndEndometrial Biopsy

Health care services for the elderly: integrated or fragmented?

http://hub.hku.hk/bitstream/10722/45102/1/5531.pdf

Health care services for the elderly: integrated or fragmented?

Abstract

Similar works

Full text

Available Versions

HKU Scholars Hub