The Polish senior has dementia, depression and is not on medication. He has a family doctor who, instead of sending him to a geriatrician, because there are no such people in Poland, he refers him to other specialists. And they write tons of drugs that interact with each other, because the cardiologist does not know what the rheumatologist wrote. And seniors? They complain not of the terrible state of health and treatment, but of loneliness, which makes joy a very rare guest in their lives.
- In Poland, there is one geriatrician per 100 inhabitants. More precisely – not one, but 0,8 doctors. This is the lowest rate in Europe (in Sweden there are almost eight geriatricians per 100 inhabitants, 2,2 in Germany, 2,1 in the Czech Republic)
- Statistically, the senior after 77 years of age has the so-called multi-disease and taking multiple medications on a regular basis. They have side effects and often interact with each other. Because patients are treated by various specialists and the effect is that the cardiologist does not check what the rheumatologist wrote and what the nephrologist
- The biggest problem Polish pensioners complain about is loneliness. As doctors say, the feeling of loneliness can not only lead to depression, but also reduces the quality of sleep, increases blood pressure, increases the level of cortisol, and disturbs the expression of genes related to the work of the immune system.
- The subjective feeling of loneliness has a much worse effect than living alone. Seniors really want to feel needed by their family and friends
Two years ago, a model Geriatrics Clinic was established in Białystok, next to the MSW hospital. It has… 20 beds. And it is the only such place for the entire voivodeship. In the neighboring cities: Ełk, Augustów or Łomża, there is not a single bed in any hospital that would be due to an old man who requires, for example, a diagnosis or suffers from dementia or Alzheimer’s. The equipment of the branch in Białystok is quite good, but it is not due to the National Health Fund, but to the Jerzy Owsiak Orchestra.
This clinic is a phenomenon anyway. According to the Supreme Audit Office (data from three years ago), there are 321 geriatricians in Poland, i.e. 0,8 doctors per 100 inhabitants. This is the lowest rate in Europe (7,7 in Sweden, 2,2 in Germany, 2,1 in the Czech Republic). And not much has moved since the last report of the Supreme Audit Office.
In some voivodships the situation is dramatic, in Warmińsko-Mazurskie voivodship there was not a single geriatric hospital bed and not a single geriatric clinic in the period covered by the audit.
– The care in this ward is good. The problem is that there are no such branches throughout Poland and there is no one to work with. As a society, we are aging more and more, so the needs are growing dramatically – said Agnieszka Orłowska, a family medicine specialist who worked in the newly opened Geriatrics Clinic in Białystok, in an interview with Onet.
Another problem is the lack of a holistic approach to elderly patients. Doctors treat the disease, not a man who often heals on his own. A statistical senior citizen takes at least five drugs a day, and one in ten takes ten or more of them. It is estimated that over 30 percent. hospitalization of the elderly is the effect of multi-drug treatment. The effects may be fainting, memory and consciousness disorders, convulsions and impaired coordination of movements. Dietary supplements available in pharmacies without a prescription and herbal preparations are added to the long list of medications.
– Most people in the ward have cognitive impairment, and those over 77 years of age develop multiple diseases. This generates another problem – polypharmacy, i.e. taking many medications on a permanent basis. These preparations have side effects and they also interact with each other. Because patients are treated by various specialists and the effect is that the cardiologist does not check what the rheumatologist and the nephrologist wrote. The treatment must therefore be set so that the patient takes as few reactive medications as possible. And before that, it’s good, comprehensively and as soon as possible to diagnose it – said Dr. Agnieszka Orłowska.
Speed is important because seniors do not like being outside the home, surrounded by strangers, especially since many of them have dementia and sometimes do not even know where they are. There are patients who break out of the examination, jerk with the nurses who are trying to take blood. What features should an ideal geriatrician have? – Patience is important. He must also be able to listen – says Dr. Orłowska.
Beautiful, but on paper
Anyone aged 65+ can go to the geriatric ward. Although 90-year-olds are the most numerous in such departments. Getting a bed in such a place is almost a miracle. Most seniors live in orthopedic wards. Fractures of the femoral neck and, consequently, implantation of a hip prosthesis are classic. Often the scenario is this: the operation was successful, but the patient did not survive. Because there was no rehabilitation after the surgery, the dose of heparin was wrongly selected, a clot formed that caused a stroke. Diagnosed only after a few days, because there is no neurologist at the orthopedic ward. He has to be brought in for a consultation from another hospital, and this continues. Plus, even if she arrives and finds a stroke, she can’t do a CT scan right away to check the condition of the brain. After all, this is an ordinary trauma unit, the equipment is not very numerous.
It is in such departments that the most elderly are, contrary to appearances, not athletes. – The goal of geriatrics is not to cure the disease, the goal of geriatrics is to improve the functional and emotional, cognitive and, above all, physical condition. That is why the doctor, physiotherapist and nursing care are the three “pillars” – says the head of the Geriatrics Clinic of the Medical University of Bialystok, Prof. Barbara Bień. It is in the clinic in Białystok that students will work in interdisciplinary teams and learn how to look after a senior in practice.
– It’s beautiful only on paper, or in selected clinics, but in fact the patient first goes from doctor to doctor, e.g. when he has bedsores, he first goes to nursing care, and if rehabilitation is also needed, because, for example, he has parkinsonism, then he goes elsewhere – so prof. Barbara Bień talks about the situation in Polish geriatrics. The point is that all specialists in various fields can focus on the patient at the same time, that everyone can tell what they see, what indications and contraindications they take.
Prof. Bień emphasizes that geriatrics has only recently become compulsory in medical studies, although such education has been held in Białystok since 1974. He adds that the most important thing is to be active in order to prevent an elderly person from becoming disabled. – This is the most important thing: exercise and be active, first do not let your body become infirm, and when you are sick, do not be stuck to the bed, but try to move around and be independent in terms of self-service activities, e.g. to cook yourself – he says prof. Bień in an interview with PAP. He also points out that the basic activities in a situation where there is a problem are to check whether the patient has well-chosen glasses, whether he needs a cane or crutch to facilitate walking, or whether he or she may require administration of an antidepressant because he does not want to live.
Gray end
Population aging is an inevitable process that affects the whole of Europe. At the moment, seniors account for 20 percent. in general, and according to forecasts, in 2050 a statistical EU citizen will be 60 years old. Italy and Greece have the greatest number of older people. In Poland, 22-year-olds account for over 2050%, in 80 there will be twice as many. The aging process has two main features. On the one hand, we observe the feminization of aging, and on the other hand, the highest rate of increase occurs in people over “XNUMX”.
According to the AAI (Active Aging) ranking, seniors live best in Sweden, Denmark and the Netherlands. In 28, Poland moved up from the last place to the penultimate one out of the 2014 EU countries. The AAI identifies the potential of older people in the area of employment, social life and independent existence. The dramatic situation of Polish seniors meant that in 2013 the Assumptions for the Long-Term Senior Policy (ZDPS) for 2014–2020 were adopted. The goals are to use the potential of people aged 50+ on the labor market, prevent and promote a healthy lifestyle, develop medical and care services and provide a special educational offer. Three years later, seniors are not feeling any better – let’s see what’s bothering them.
Empty wallet
The planned increase in the lowest pensions from PLN 882 and PLN 56 to PLN 1000 will not change much. The more so as electricity bills and food prices will increase in 2017. As a rule, it is at the time of retirement that the elderly decide to take out a loan or a loan to compensate for lower income. The data of the National Debt Register show that Polish retirees are increasingly in the red. Over the last year alone, their debt has increased by 40%. (from PLN 2 billion to PLN 2,87 billion). The average debt of a senior is over twelve thousand zlotys.
The reasons for getting into debt have not changed over the years: insufficient income, expensive drugs, incurring liabilities to other family members and the death of a spouse. Not only children treat seniors as pillars, I am asking their grandchildren without creditworthiness more and more often to take a loan for a console, laptop or smartphone. When retirees are unable to pay their debts, their debts are bought back by securitization funds and debt collection companies. The majority of the indebted are women (62%), living on average eight years longer than men. At the time of her husband’s death, all financial obligations fall on the shoulders of the widow, who is much more difficult to pay on her own.
Loneliness worse than poverty
The greatest problem of seniors is the feeling of loneliness. According to the PolSenior report, 54 percent. people aged 65 and over live alone or with their spouse. Two-generation forms account for 17,1 percent, and three-generation forms account for 20 percent.
Loneliness lowers the quality of sleep, raises blood pressure, increases the level of cortisol, disturbs the expression of genes related to the work of the immune system, increases the risk of depression and generally lowers the general well-being. The subjective feeling of loneliness has a much worse effect than living alone. The senior wants and must feel needed.
Research by psychologist John Cacioppo, a world-renowned loneliness expert, shows that social isolation has a devastating effect on the health of older people. Loneliness is more devastating than poverty and increases the risk of premature death by 14%.
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