Treatment of the elderly in the community Clalit Health Services Israel. Director of Geriatric and Chronic Diseases Department of Community Nursing

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1 Treatment of the elderly in the community Clalit Health Services Israel Larisa Reem Director of Geriatric and Chronic Diseases Department of Community Nursing

2 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

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

4 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. )אסתר יקוביץ 2014 מתוך תכנית לאומית לטיפול בקשישים(

5 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

6 Organizational Structure Ministry of Health Meuchedet Maccabi Clalit Leumit Pathology Call Center Department of ongoing care, Department of home care, Department of Geriatrics. Community Consultant clinics Geriatric/ Rehabilitation Institute Primary care clinics Hospital

7 Strategies of Clalit 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

8 Intervention programs for all levels of illness and Independence Complicated cases and house bound Chronic disease Independent

9 Results and Follow-up (Repeat Assessment) מפת בריאות הקשיש First evaluation At risk elderly Medical Issues Social Issues Falls and Balance issues Malnutrit ion Cognitive decline Functiona l decline Second Evaluation Environmental assessment Medication assessment Falls assessment GET UP AND GO MNA MMSE assessme nt of emotional distress ADL, IADL Recommendations for Intervention

10 Online tools to support health care professionals

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12 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 13

14 Program to reduce hospitalizations of the elderly 5%Reduction 14

15 Five Wishes

16 מספר חולי דמנציה 1000 X אמדן מספר הזקנים עם ירידה קוגניטיבית משמעותית ודמנציה, בקהילה ובמוסדות בישראל )באלפים(: Clalit Dementia Program ' 2015' 2020' 2025' 2030' 2035'

17 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 Clalit program 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.

18 Benzodiazepines Program 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 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

19 International Month of the Elderly

20 Thank You