Pannida Wattanapanom, M.D., FACP. สังคมผู้สูงอายุ : โอกาสที่ สร้างสรรค์

Demographic in Thailand The proportion of older persons (age >60)in Thailand is 14 % in 2014, will increase to 20 % in 2025 and 33% in 2050 Life expectancy in male is 71.1 years and female is 77.8 years The population of older will exceed the population of children in 2020 Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects:

Probabilistic Projections: Population age 65 and over (thousands)

* Dates show the span of years when percent of population age 65 or older rose (or is projected to rise) from 7 percent to 14 percent. Source: K. Kinsella and Y.J. Gist, Older Workers, Retirement, and Pensions: A Comparative International Chartbook (1995) and K. Kinsella and D. Phillips, “The Challenge of Global Aging,” Population Bulletin 60, no. 1 (2005). More developed countriesLess developed countries Speed of Population Aging

Population by age groups and sex

Graph : Potential support ratio in Thailand

Booming business for Aging

What’s in their mind ?

Biggest concerns about life in old age

The needs are being overlooked “ Healthy eating is a top priority for half in Asia- Pacific in retirement, but one in two can’t find foods that meet aging nutritional needs.”

The needs are being overlooked “Finding easy-to-read product labels and easy-to-open product packaging is challenging for more than half in the elderly worldwide”.

The needs are being overlooked

The reality

Living arrangement expectation in old age

Home Sweet Home

Trend of aged care services Nursing home declinedGrowing home care Source : CMMS data

Reconsider care options

Elderly care servicesLong-term care Institutional - Assisted livings - Nursing Home - Retirement home Non-institutional - Day care - Home health care - Residential home Acute care - ACE unit - Geriatric clinic Diagram 1. Elderly care services

Elderly care servicesLong-term care Institutional - Assisted livings - Nursing Home - Retirement home Non-institutional - Day care - Home health care - Residential home Acute care - ACE unit - Geriatric clinic Sub acute care PACE Hospital home Guided care nurse

Sub-acute care for the elderly

Sub-Acute Care Provide continuity of care for patients who no longer require acute care but still need medical care in a rehabilitation facility Maybe offered in a hospital or may be provided in LTC

Conditions for Sub-Acute Care Conditions that may be appropriate for inpatient sub-acute care include but are not limited to : Orthopedic rehabilitation Neurological disorders/CVA Complex wound management Pulmonary and cardiac conditions

How long does a patient stay ? The length of stay is based upon that person’s individual needs varied from a week to months,but average is generally 2 -4 weeks

The Program All-inclusive care for the elderly (PACE) PACE is a care program that provide community –based care and services to the elderly who otherwise need a nursing home level of care Source :

Services provided in PACE Medical services Health and wellness services Assistance with tasks and ADLs Recreation, friends and art

Multiple diseases and polypharmacy Mr. Dan is a 75 y/o man with PMH of DM2, HTN, CHF, CKD, BPH,old cva, COPD in which he’s follow- up with five specialists and taking 20+ medications per day.

Guided care nurse Model of comprehensive heath care for people with several chronic problems, provided physician-nurse teams in primary care practices RN works closely with MD to provide state-of the-art chronic care for patients Source :

Guided care services Assessing Planning care Monitoring Coaching Chronic disease self-management Educating and Supporting Caregivers Coordinating Transitions Between Providers and Sites of care Access to community services Source :

Guided care outcomes Improves the quality of patient care Improves family caregivers’ perception of quality of care Improves physicians’ satisfaction with chronic care Produces high job satisfaction among Guided Care nurses May reduce the use of expensive services Arch Intern Med Mar 14;171(5):460-6

Hospital at home Hospital at Home® provides safe, high- quality, hospital-level care to older adults in the comfort of their own homes. The innovative care model lowers costs by nearly one-third, and reduces complications. It is highly rated by patients and caregivers alike. Health Aff (Millwood) Jun;31(6):

A typical Hospital at Home program steps Staff assesses the patient Physician evaluates the patient and is then transported home The patient receives extended nursing care The patient is evaluated daily by the physician The clinicians use care pathways, clinical outcome evaluations, and specific discharge criteria. The patient can receive diagnostic studies as well as treatments. The patient is treated until stable for discharge Source :

Use technology to deliver healthcare

Make geriatric care a bigger part of training

Reset public mindsets about the elderly

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