1. Organization of Health Care Services for the Elderly: Russia A.M.Clarfield MD, FRCPC Professor of Gerontology Ben Gurion University, Israel

2. The typical “geriatric” patient chronic disease multiple disease (co-morbidity) multiple drugs (polypharmacy) social isolation and poverty  physiological function LOSS OF RESERVE

4. An Approach Caveat:

5. An Approach education health promotion prevention strengthen primary care [acute care] rehabilitation home long-term care institution

6. Education medical school - preclinical - clinical residency – primary care - internal medicine - others (eg. urology, orthopedics) CME

7. mortality in the elderly IHD CVA Influenza (“grippe” ) morbidity in the elderly Osteoporosis Fractures Influenza (“grippe” ) Premature:

8. Smoking in Russia (1993) 67% of men! 30% of women Increase in children

9. Accelerated aging

10. Health Promotion (examples) Smoking in middle age Exercise (Timur Shaov)

11. Prevention (primary and secondary) Osteoporosis (Calcium) Influenza vaccine

12. Cholesterol (>250 mg%- 20% of population) treatment of hypertension ( Russia: >140/90 : 60% men, 25% women) polypill (Wald and Law, BMJ, 2003) Prevention (primary and secondary)

13. Strengthen Primary Care

14. Rehabilitation post CVA - hospital - home post hip fracture – hospital Yad Sarah

15. Long-term care (20% of 65+) home care (~ 15%) [preferred] institutional (~ 5%)

16. What is to be done? (next)

17. An Approach education health promotion prevention strengthen primary care [acute care] rehabilitation home long-term care institution

18. Thank You Спасибо תודה רבה