ELTECA experience in long-term care of Central and Eastern ......Katarzyna Wieczorowska-Tobis Poznan...
Transcript of ELTECA experience in long-term care of Central and Eastern ......Katarzyna Wieczorowska-Tobis Poznan...
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Katarzyna Wieczorowska-Tobis
Poznan University of Medical Sciences, PL
ELTECA experience in long-term care of Central and Eastern Europe
Iva Holmerová
Charles University, Prague, CZ
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NO CONFLICT OF INTEREST
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Numerous solutions in Long Term Care (LTC)
are different in CEE than elsewhere
Former „eastern block” countries
Common past
Unified solutions across the block
(Share many issues)
Central and Eastern Europe
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Projected population change, 2014–80 (%)
http://ec.europa.eu/eurostat/statistics-
explained/index.php/People_in_the_EU_%E2%80%93_population_projections
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Healthy life years at age 65 as a share of remaining life expectancy
by sex
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LONG TERM CARE
Social care
sector Health Care
sector
• No co-operation
• No algorithm for assigning the subjects
based on their LTC needs
Central and Eastern Europe
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Medical, psychological, sociological and economic aspects of aging in Poland
Błędowski P. Potrzeby opiekuńcze osób starszych. W: Monografia PolSenior; Warszawa 2012 20
Age (years)
Sources of help (%)
Family members
Others Social workers
Neighbours, friends
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Social care sector DPS (local government, churches, etc)
Home of Social Aid
(2014: 42290 – about 0.1% )
• 26 family DOPS- 166 beds
dependency
and lack of possibility
to organize care at home
DPS ul. Bukowska 27/29, Poznań
dedicated to elderly individuals
439 privat units registrated for 24h care for chronically ill subjects, disabled persons or seniors
Working team – 0.4 workers/inhabinat
(including all staff)
Nurse
Psychologist
PT
OT Social worker
Weekly meetings
Physician
family physician
limit for consultations
DIETITIAN
Nurses – after 5 years lost their certificate
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Table 1: Detailed characteristics of routine pain treatment in analyzed subjects including
MMSE results (only consumed groups of drugs were included) - group A composed of
subjects with MMSE results 24-30 points, group B - 20-23 points, group C - 10-19 points,
group D - 0-9 points; p is only shown when it is statistically significant.
Group A
n=82 Group B
n=67 Group C
n=144 Group D
n=99
No prescribed analgesics 62 (75.6%) 55 (82.1%)
122(84.7%)
89 (89.9%)
p=0.0151 vs. A
Routine step 1 (non-opioids)
Acetaminophen
NSAIDs
0
16(19.5%)
0
12(17.9%)
1(0.7%)
17(11.8%)
1(1.0%)
6(6.1%)
Routine step 2 - tramadol
(weak opioids)
2(2.4%) 0 4(2.8%) 3(3.0%)
Routine step 3 - morphine
(strong opioids)
0 0 0 1(1.0%)
Acetaminophen+tramadol
(one therapeutic formula)
2(2.4%) 0 1(0.7%) 0
MMSE 24-30 20-23 10-19 0-9
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Health care sector
http://www.pcm-nzoz-wieruszow.pl/zol.html
http://domsueryder.org.pl/opieka-medyczna/zaklad-opiekunczo-leczniczy/
ZOL/ZPO Home for nursing and medical care
408 institution
(2014: +9,4% vs. 2010) 8407961 person-day
• Barthel index up to 40 points
(subjects with palliative and psychiatric diagnoses
are excluded BY LAW)
Long term nursing service
obliged by law to employ PTs, OTs, social workers,
yet they do it to the least possible extent
• physisian – consultant:
the institution is charged for any visit
Barthel index
40 points or low
Barthel index
45 points
DISCHARGE Subject at home
with no support
Fast increase
in disability rate
REHABILITATION
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The law
on the older persons
(60+)
The goverment needs to monitor
the situation of older persons
and present it
by the end of October each year
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Healthy live expectancy at the age of 65 y
Live expectancy
Live expectan cy
At birth
At the age of 60 years
At the age of 65 years
M
F
unable to accomplish
able to do with severe difficulties
able to do with some difficulties
transfering eating bathing
Population 80 years and older
58% needs help in self-care
8.0%
11.7%
31.3%
51.0%
3.o%
3.1%
11.5%
17.7%
4.3%
8.7%
33.7%
46.8%
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Long-term care medicine certified training programme (2009)
1 year postgraduate course for all clinical specialists 9 months practical activity (in the LTC-accredited dpt):
1 month geriatrics
2 weeks palliative care
CZ
Holmerova, I, Dementia – a priority problem of long-term care; 2012
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ELTECA: Exchange of Experience in Long Term Care
a platform for exchange of experiences in LTC
with the aim to help open new perspectives for LTC in CEE
Prague (Czech Republic) – Prof. Iva Holmerova
Co-organized by:
• Charles University in Prague - Faculty of Humanities
• Centre of Expertise in Longevity and Long-term Care
• Centre of Gerontology in Prague
• Czech Alzheimer Society,
Alzheimer Europe
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ELTECA Rationale: • Low political priority – law & finances
• Low awareness of problems and syndromes
• Low quality of care in LTC institutions ; lack of quality indicators
• Two sectors of LTC with no co-operation:
• Lack of proper health care in social sector of LTC
• Underdiagnosed and undertreated symptoms (i.e. pain)
• Topic of scandals…
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ELTECA 2011: Exchange of Experience in LTC the ADVISORY BOARD
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Physicians: geriatrics, neurology, psychiatry, GP,
Certified Medical Directors (CMD),
rehabilitation specialists,
long-term care medicine specialists,
public health specialists
Participants - professions
Other members of imultiprofesional team:
nurses,
OTs,
PTs
psychologists,
social workers
Other profesionalists public health, ethics, philosopher,
sociologist, lawyer,
management scientist,
adragogics, econonomist…
Dedicated to all interested people who want to improve LTC
and to build the new face of LTC
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ELTECA: Exchange of Experience
in Long Term Care
DEMENTIA - priority problem of LTC
RATIONALE:
• Persons with without severe CI stay at home as long as possible due to available services and assistive technologies
• Persons with severe cognitive impaiment need more assistance and, in case of no available services, they are institutionalised
The education and training in dementa/dementia care is an urgent need
(GPs, outpatient specialists deal with the specific problems of patients with dementia, physicians in acute care and especially those working in LTC,
other professionals and informal caregivers).
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YES: PL, Cz, A, DE, Israel, USA
NO; Sk, H, Alb, LT, SLo
Holmerova, I, Dementia – a priority problem of long-term care; 2012
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ELTECA: AIMS
• To compare the LTC (dementia care) in different countries including CEE
• To compare the interprofessional perspectives
• To promote co-operation and exchange of information among
professionals, patients and the community
• To support development of long-term care policies and services with
special focus on the Central Eastern Europe
• To share of the best practices
• To describe the unique challengers and common challenges in various
countries
• To develop the education opportunities in dementia for variuos
professionals (especially physicians) and caregivers
• To create the research initiatives & outline the succesful research in LTC
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LTC modules of ELTECA
Geriatric assessment
Communication
Management of geriatric syndromes
Management of care
in different care settings
Coordination of the multidisciplinary team
Dignity Quality of care
...
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• 1st ETECA - 2012
• 2nd ELTECA - 2013
• 3rd ELTECA - 2014
• 4th ELTECA - 2014
P
R
A
Q
U
E
Cz
Common Speaking Experts
(Budapest, H)
(2013-2017)
Interprofesional Geriatric Training
Ft. Loudadaile, Fl, USA)
ERASMUS project on dementia education
(Glasgow, – 2013-2015) -Paliare
EUGMS:
SIG on LTC
• Venice, IT – 2-12;
I. Holmerova
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recorded
and
available as streaming media
Time Lecture Speaker
09:00 Opening ceremony Iva Holmerová (CZ)
Dementia from different points of view
09:10 Dementia and its impact Charles Scerri (MT)
09:40 Diagnosis of Alzheimer´s disease, differential
diagnosis
Robert Rusina (CZ)
10:10 Alzheimer´s disease – therapeutic possibilities Jakub Hort (CZ)
10:40 Needs of persons with dementia – geriatric point of
view
Iva Holmerová (CZ)
11:10 Coffee break
11:30 Collaboration of Alzheimer Scotland and
university, education on dementia
Debbie Tolson (UK)
12:00 Behavioral and psychological symptoms of
dementia and their management
Deborah Sturdy (UK)
12:30 Patient with dementia and emergency. János Rádnai (H,A)
13:00 Lunch
Dementia Management : Similarities and
Differences
Panel Discussion on Case Studies
14:00
14:30
Care for persons with dementia: What we can do
after diagnosis – experience of Scotland
Case Study 1 – First signs of dementia, diagnosis,
disclosure of diagnosis, support .
Panel Discussion :The importance of coordination
(Alzheimer Plan) and case management. The role
of physicians.
Kate Fearnley (UK)
Presentation
Panel: Charles Scerri, Debbie
Tolson, Kate Fearnley and
others
15:30 Coffee break
16:00 Case study 2 – Management of BPSD,
psychosocial interventions
Panel Discussion – management of dementia and
BPSD
Presentation
Deborah Sturdy, Iva
Holmerová and others
17.00
17:30
LTC and palliative care for persons with dementia
Wrap-up of the day
Ladislav Kabelka (CZ)
WORKSHOPS
PANEL DISSCUSSION
with the feedback from participants
and ongoing e-mail communication
Various types of activities
PLENARY LECTURES
2014
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• 1st ETECA - 2012
• 2nd ELTECA - 2013
• 3rd ELTECA - 2014
• 4th ELTECA - 2014
P
R
A
Q
U
E
Cz
Common Speaking Experts
(Budapest, H)
(2013-2017)
Interprofesional Geriatric Training
Ft. Loudadaile, Fl, USA)
ERASMUS project on dementia education
PALIARE (Glasgow: 2013-2015)
EUGMS:
SIG on LTC
DEMDATA: Austrian-Czech institutional
LTC project + Poland (2016-2018)
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SWOT analysis
Strengths
Opportunities
Weaknesses
Threats
1. International collaboration
2. Group of experts from various fields, interested in LTC
3. Interprofessional approach
4. Collaboration with international organisations
(SIG EUGMS, AMDA)
1. Building a collaboration network
2. Spreading out the idea of LTC
3. Innovative educational opptions
4. Best practices exchange
5. Growing importance of LTC
1. Lack of formal organization and management
2. Incidental activity
3. Not a sexy topic
1. Not of academic interest
2. Unclear futute
3. Lack of systematic funding
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Thank you! [email protected]