Elderly in Ukraine

All countries are currently experiencing the growing problem of the demands that the elderly place on health care systems. The elderly are becoming an increasing percentage of the population - seen now by a post-war boom in birthrates followed by current limitation of family size. Also as medical science impacts on many disease processes the elderly live longer to suffer from more complex and expensive diseases and to consume a larger amount of social care as they eventually loose their independence. Added to this is the impact and the add-on cost of constantly improving medical science - the USA is currently worried about the huge social cost of successful stem cell therapy.

Whilst some forty years ago many patients at the end of their lives died at home or in hospital from simple yet fatal diseases such as stroke, heart attack or pneumonia medical science now salvages them from these potentially terminal illnesses. The result is a growing population of increasingly elderly people who have often lost their independence and spend the last few years of life in an old person’s home, their existence punctuated by further admissions to hospital and discharges back to their place of care.

Two factors have exacerbated this problem, the first is the reticence of doctor’s to let people die at the end of their natural lives - a relatively new phenomenon driven by the fear of medico-legal litigation, and the second the huge growth of obesity which quite simply robs the elderly of the physical power to move themselves as their decreased muscles are unable to power their weight.

I paint this rather bleak picture of growing old in western and american society because both its existence and development should be recognised by Ukraine as reference points.

The current picture in Ukraine is very different and indeed somewhat different to what it was in Soviet times. There are however some similarities that have to be recognised. Firstly there is also an increasing population of elderly in Ukraine supported by a decreasing number of tax-payers; immigration and population decay have increased this trend, which would doubtless be accelerated if Ukraine joined the EU. Secondly some relatively inexpensive medical and social interventions could markedly decrease the numbers dying prematurely but leave them to consume more expensive health care.  In Soviet times an equitable standard of health care was guaranteed for the elderly, as indeed were reasonable pensions and housing - small surprise that many pensioners still bemoan the collapse of communism.

Today’s picture is a sad reflection of how care for the elderly has become something of a cinderella service. Still many old people in slavic culture are looked after and indeed expect to be looked after by their children - or as is the norm more often their single child. Their children often have to cope with this care without medical or nursing help and from their own resources. Relatively common occurrences such as leg fractures in icy weather are often treated with bed rest hoping the fracture will mend rather than modern interventional orthopaedic surgery, which of course comes at a price. The result is either death from pneumonia or pulmonary embolus or a life of disability stranded in a fourth floor apartment. These anecdotal stories abound and many are doubtless true and amongst them also exist stories of excellent care.

Not all medical problems of the elderly are either life threatening or complex but they do impact seriously on the quality of life, simple conditions such as anaemia and thyroid dysfunction are all too common, anaemia the more so with a historically poor diet and pensioners afraid to spend money on meat. Depression also is common in the elderly and very easily treated, but sadly is often not recognised or diagnosed due to stigma, and is self treated with increasing shots of vodka.

In western europe and america there has been a huge growth in the medical science of the elderly and alongside that of gerontologists or geriatricians who are essentially generalists who specialise in the care of the elderly. This growth has not been mirrored in Ukraine where elderly care is still fragmented into the normal medical specialities and there are few gerontologists and even fewer psychiatrists with expertise in the elderly - psychogeriatricians - who deal with the conditions of depression, anxiety, memory loss and dementia. Strangely the individual and family respect that is normally shown to the elderly is in no way mirrored by their health care.

So where must Ukraine turn to cope with its growing problem. Firstly is the matter of human resource, medical schools need to increase the curricular content and training of doctors in elderly medicine and postgraduate academies need to create attractive training schemes in this speciality. The European Union needs to back its talk of European integration with firm policies for integrating Ukrainian doctors into the wider medical establishment and supporting their training and development.

All doctors need to be able to recognise and treat common conditions in the elderly and simple tests should be made available. Support should be available in the community for those who are looking after invalid elderly relatives. Whilst the medical budget remains small, cost effective interventions need to be studied to prevent some illnesses causing dependence and further fiscal or social expense. This requires realistic fiscal planning, many countries, the UK is a good example, have already raised the expectation of the elderly vis a vis healthcare and are unable to deliver.

The problems of obesity, which impact hugely on the health of the elderly, and of diabetes which is increasingly prevalent in Ukraine and brings major problems especially to the elderly, need urgent attention and a multi-sectoral approach from government, health, schools and the food industry itself.

Ukraine needs to act now to ensure that the children of its Independence have a standard of equitable and european healthcare in their latter years and that the respect normally paid to the elderly also exists in their healthcare, at such point Ukraine will be a happier place to grow old gracefully.

 

Friday, 07 October 2011

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