Societal Treatment of Aged in Eastern Europe

INTRODUCTION

The ageing of population is becoming a reality in developed and in less developed countries too In EE countries, around 10-12% from general population are over 65, comparatively with Northwest Europe where are 14-16% over 65. In USA 10%, Canada 9%, but in Japan only 7% are over 65 (In India only 2-3%). The increased frequency of mental health problems of the elderly, require re-adaptative approaches of the development of old age psychiatry.
All elderly people in Europe, regardless of sex, race, religion, life conviction, income, disability or sexual preference, have the right to lead valued and independent lives and to participate in social and cultural life.
The rights of the elderly also emphasise their personal responsibility to fellow human beings as well as to the community and future generations.
European society is aging, maturing, greying and becoming more individualistic. People’s life expectancy is increasing. The combination of post-war baby boom with the increase in number of aging immigrants has resulted in a growing number of elderly in Europe. In recent decades, couples are having fewer children and, as a consequence of this, there is increased strain on the working population- (the percentage of people between the ages of 15 and 65) is becoming comparatively smaller.

The standards established in the Universal Declaration of Human Rights and the international agreements about human rights also pertain to all population groups. The United Nations International Plan of Action on Aging (Madrid 2002) also applies to seniors living in Europe. These fundamental human rights remain in effect as people age and apply without limitation to the oldest and most vulnerable group of the elderly and to older persons who are restricted in their ability to function.
As a consequence of the better living conditions, seniors remain healthier longer, even well into old age. However, the increased length of life and the greying of the population also cause the number of vulnerable older people to grow.
At advanced age, the elderly can encounter limitations that result in loss of control over their lives or the threat of such loss. Growing older requires adjustment to changed circumstances and the learning of ways to implement practical solutions. Loss of self-reliance must be as far as possible avoided and quality of life must be safeguarded in all phases of life.

In the vision of EURAG, older persons have a responsibility to the community and to the generations that come after them. The responsibilities of the elderly entail the making of productive contributions to society. This is appropriate to a longer active phase of life, one that involves paid work, as well as voluntary activities and informal care. A positive image of the elderly is important because the way in which the community regards it older members partly determines the manner in which they are treated and the extent to which they are able to participate in society.


LIVING ARRANGEMENTS AMONG THE ELDERLY

There are an increasing number of older people living alone. Because older persons usually have lower incomes, with many living below the poverty line, population aging results in increasing poverty in many countries of Eastern Europe. This is particularly the case for the countries of the former Soviet Union (Russia, Ukraine, Belarus, Moldova) with small pensions, which are generally below the subsistence level. Economic needs may force older people to continue their work beyond the retirement ages. Such data were obtained during a survey conducted by the fund “Public Opinion” in Russia (Vovk 2006). According to this survey, there are no established social norms regarding coresidence of older people with their children in Russia. When asked about benefits of older people coresiding with their children and grandchildren, 40–43 per cent of respondents found more negative than positive aspects in such living arrangements while 34–36 per cent had an opposite opinion.The proportion of older population living in institutions reflects the demand for long-term care but may also reflect constraints related to government ability to provide sufficient funds for this kind of service.


MEDICAL CONDITIONS OF ELDERLY

(1) The Prevalence of Depression Among the Elderly in Bosnia and Herzegovina

Background: Depression among the elderly not only causes distress and suffering but also leads to impairments in physical, mental, and social functioning. Despite being associated with excess morbidity and mortality, depression often goes undiagnosed and untreated.
Depression screening among the elderly in Bosnia and Herzegovina positively revealed depression and depressive symptoms in 34% of undiagnosed patients. These findings demonstrate the usefulness and importance of the depression questionnaire. By using this screening tool, primary care physicians could better diagnose depression and depressive symptoms in their patients, and take appropriate action to treat it, thereby improving the mental health of a great many people in the country.

EFFECTIVE TREATMENTS FOR ELDERLY
(1)
Dr Alberto Zanchetti, Italian cardiologist of the Center of Clinical Physiology and Hypertension of the University of Milan participated at the Congress and said, "The European Hypertension Guidelines published in June, 2007, firmly supported hypertension treatment for the elderly, but recognized that the benefits of this treatment had not yet been proven in patients over 80 years of age. Now the HYVET Trial results will allow the guidelines to do away with this limitation".

- The ADVANCE trial that showed a reduction of 18% in the rate of cardiovascular death, whilst the combination of perindopril and indapamide reduced blood pressure down to 134/75mmHg.

- The ONTARGET trial that compared the effectiveness of the angiotensin converting enzyme inhibitor (ramipril) with the angiotensin receptor blocker (telmisartan) showed that both drugs are similar in terms of their ability to reduce cardiovascular events.

- The ACCOMPLISH trial was the first to find that the combination of an angiotensin converting enzyme inhibitor with a calcium blocker (benazepril /amlodipine, respectively) is significant in reducing cardio-vascular events.
http://www.medicalnewstoday.com/articles/108772.php

(2)
Considerable knowledge has been accumulated in the last decade through retrospective and prospective clinical trials in the various solid tumors and in haematological neoplasias for older patients requiring medical treatment. Further progress has also been made by the establishment of an International Society of Geriatric Oncology (SIOG) with an official journal, working groups and task forces on surgery in the elderly, on chemotherapy dose adaptation, on the use of haematopoietic growth factors to treat anaemia and leukopenia, and on Multidimensional Geriatric Evaluation (MGA).
It is found that some antitumor drugs are ‘elderly friendly’ and that some regimes should be modified to avoid excessive toxicity. Research has also been done on the prevention and treatment of chemotherapy-related complications in older patients. The specific methodology of the MGA has also been applied to evaluate older cancer patients entering clinical trials. For instance, they pay special attention to comorbidity, functional status, depression and mental impairment before deciding on the therapeutic approach.

By scoring these MGA items, a distinction can be made between older, fit patients who can be treated as adult patients; frail patients handled mostly with palliation only; and patients in an intermediate state, or the vulnerable, treated with reduced or adjusted chemotherapy regimens. In 2005, a grant of a total of 25 million dollars was provided to the National Institute of Cancer and the National Institute of Aging for studies in age-integrated aspects.
In Europe, the French ‘Institute National du Cancer’ has established a Special Research Program on Geriatric Oncology and nine Programs of Geriatric Oncology have been funded with a global grant of 1 273 000 Euros
At present, specific activities for cancer in the elderly worldwide (mainly in USA and Europe) are carried out in some medical oncology departments of general hospitals but also in some cancer institutes, as well as, but to a minor extent, in geriatric departments.


MEDICAL SERVICES

(1) Services for Elderly Care in Turkey, Wednesday, 20 August 2003

In 2000, the Department of Social Work and Care developed a project under the title "taking care of the elderly at their homes". According to this project,the public who would like to care for the elderly at their home will be trained. 3% of the old age population in Turkey are in need of protection and permanent care in an institution.There are few nursing homes for these elderly people.10% of the beds in old age homes run by the the Health Ministry and Municipalities are spared for demented and physically debilitated patients.The staff working with this population is well trained. There are few specialist psychogeriatric services in Turkey. 5% of the psychiatric beds in teaching hospitals are occupied by elderly 60 years and older.The elderly with psychiatric problems are placed in general psychiatry departments and are treated by general psychiatrists.The interest of the general psychiatrists in geriatric psychiatry has increased in recent years. Geriatric psychiatry is one of the main topic in national symposium and congress.


INEQUAL ACCESS TO MEDICAL SERVICES

With regard to people with dementia, this means, that no one shall be treated differently from other people on the grounds of disability or age. They have a right to human dignity and those who cannot obtain the necessary means for a dignified life have the right to receive indispensable subsistence and care. Everyone is guaranteed by an Act the right to basic subsistence in the event of illness and disability.
In the Social Welfare Decree (607/1983), §9, the way that home-help services are organised is defined: 1) assistance, personal attendance and support provided at home by a trained home helper for house aid for an individual or a family and 2) auxiliary services (meals on wheels, maintenance of clothes, bathing, cleaning, transportation and services promoting social interaction).
In Finland, all inhabitants are legally obliged to have social insurance. This obligatory social insurance is intended to cover everyone for the financial impact resulting from old age, work disability, sickness, unemployment and death of dependents.
However, there is inequality in access to services. Concerning people with dementia, this inequality means that getting first-hand information and adaptation training, for example, depends heavily on which municipality the patient with dementia lives in. The role of service providers from the private sector has therefore become more important and expectations for the future of this sector are high. However, this places people with dementia on an unequal footing due to higher expenses. Private services don’t exist in all municipalities. The use of service vouchers is an option for people who need home services. Municipalities can offer these vouchers to their inhabitants in order to buy services from the private sector.
The Six State Provincial Office creates the conditions for the implementation of social and health care services in the province. It also steers and monitors the delivery of these services.


CAMPAIGN TO INFORM ELDERLY PEOPLE

The aim of this campaign is to get more elderly people and people with chronic diseases to get a vaccination against the flu. The target group is elderly people (+ 65 years of age) and people with chronic diseases like diabetes. The campaign is communicated through TV, posters, prints and articles in local and national papers and magazines. A central part of the campaign is to give the local municipalities information of the free vaccinate and ensure that Danish citizens are offered free vaccination against the flu. It is the second time the National
Board of Health has carried out a flu campaign. The first campaign was in October and November 2007. The price for the campaign is 160.000 Euros.


OLD AGE BENEFITS

(1) Amendments to the Act on Social Pension – The Jobplan.

In order to remedy the lack of manpower the Government concluded an agreement on a Jobplan. The aim of which is to increase the supply of manpower and create better financial conditions for seniors who wish to stay on the labour market beyond the age of 65.
The amendment introduced by the Minister for Social Welfare on 28 March 2008 is aimed at seniors who have already retired, those who receive social pension and who wish to increase the income from pensions by an additional earned income, and at seniors who wish to defer the pension.

(2) Income adjustment

Entitlement to pension allowance and personal allowances is calculated on the basis of all taxable income, inclusive of pension. Under the new provision the first 30,000 of earned income by old age pensioners shall not be taken into consideration in the calculation of personal allowances (as e.g. the means-tested personal allowance, pension allowance, supplementary pension allowance and health allowance).

(3) Deferred pension

For persons who meet the requirements for deferred social pension, the number of compulsory annual working hours shall be reduced from 1,500 hours to 1,000 per year in order to favour a more flexible transition from working life to retirement. The provisions entered into force on 1 July 2008.

(4) Supplementary pension allowance.

On 1 July 2008 the Danish Folketing adopted an amendment to the Social Pension Act to the effect that the supplementary pension allowance was increased to a maximum of DKK 10,000 with effect as at 1 January 2009. The allowance is means-tested.

Social pension (old age) per month in DKK, January 2008
Non-single persons:
Basic amount 5,096
Pension supplement 2,396
Total 7,492
Single persons:
Basic amount 5,096
Pension supplement 5,130
Total 10,226
Citizens are entitled to home-help services irrespective of whether they live in their own house/flat or in, for example, assisted living accommodation. The local authority decides whether the elderly person is entitled to receive home-help services. The local authority’s decision as to the assistance required by each person must be based on a specific and individual assessment of the need for assistance.