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Health and Care in an Aging Society, Jiraporn Kespichayawattana, Chulalongkorn University

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This presentation was part of the ProSPER.Net Leadership Programme 2017 'Building Transformational Leadership Towards the SDGs'

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Health and Care in an Aging Society, Jiraporn Kespichayawattana, Chulalongkorn University

  1. 1. Health and Care in Aging Society: Experience from Thailand Jiraporn Kespichayawattana R.N., APN., Ph.D.(Gerontological Nursing) Faculty of Nursing, Chulalongkorn University Bangkok, Thailand Building Transformational Leadership towards Sustainable Development Goals
  2. 2. Scope of Presentation • Global Aging • Thailand in Transition • Health and care Needs of Thai Older People • Care system and services within the National Context: Thailand’s experience • Conclusion & Challenges
  3. 3. Global Ageing
  4. 4. Source: UNDESA Population division, World population prospects: the 2015 revision, DVD Edition, 2015.
  5. 5. • Ageing population become more concerned especially in developing countries • The well-recognized increase in aged population and increases in chronic disease and disability. • The most important challenge for the aging population is how to increase the lifespan and the quality of life.
  6. 6. Aging Thailand Ten million shades of grey: Plan now for aging Thailand
  7. 7. Thailand: Profile • Population - 66 million • GDP 2015 US$ 13,562 per capita (PPP) • Total Health Expenditure (2010NHA) US$194 per capita, 3.9% GDP Health status • Total fertility rate 1.59 (2017) • Life expectancy at birth 74.1 yrs. • Male 72 yrs. Female 78.8 yrs.
  8. 8. Thailand in Transition 1970 1990 2010 2030
  9. 9. Thailand in Transition • Thailand faces a rapidly growing population of older persons. The population of older persons will exceed the population of children around 2020. • The proportion of older persons in total population will increase from 16.9 % in 2016, 23.8 % in 2025 and nearly 30 % by 2050. • The population of older persons will increase from the current (2017) 10.0 million to 12.9 million in 2025 and exceed 20 million in 2050.
  10. 10. Aged Society Complete aged Society Super aged Society Source : The Situation of the Thai Elderly 2014 > 10 % (2005) > 20 % (2021) > 28 % (2031) 16.9 % (2016) Thailand Rapid Ageing Society
  11. 11. Ageing population are approximately 10 million or about 16.9% Average age 75 years Men 72 years Women 78 years Source : NESDB : 2016 SITUATION OF THAI ELDERLY 13.61% 56.5% 29.9% Young-old = 60-69 years Middle-Old = 70-79 years Old-Old = 80 years or older
  12. 12. Living Alone or with Spouse is increasing Source: 2014 Survey of Older Persons in Thailand
  13. 13. Male 2.2 yrs16.4 yrs 1.7 yrs Female 18.2 Yrs 2.9 yrs 2.6 Yrs Age 60 ปี LE = 80.3 ปี (+20.3 yrs) LE = 83.9 ปี (+23.9 yrs) Active Ageing: Independent Living Passive Ageing: Assisted Living ( Home bound) Dependent Living (Frail /Bed Bound) Ref:Sutthichai Jittapankun, 2010
  14. 14. Limitations in ADL and IADL Source: 2014 Survey of Older Persons in Thailand
  15. 15. Burden of Diseases : DALY 2014 Top 10 cause of DALY in 60+ years old Male Female Rank Disease Disease Stroke (CVD) COPD IHD Diabetes Cancer (Liver) Cancer (Lung / Bronchus) Dementia Diabetes Dementia Arthritis Cataract CKD
  16. 16. RAPID INCREASING OF ELDERLY POPULATION: THAILAND REACTIONS How to maintain these elderly population to be A POWER not A BURDEN?
  17. 17. What we gonna face in the future?
  18. 18. Healthy Aging Successful Aging Productive Aging
  19. 19. Active Ageing: A Policy Framework (2002)
  20. 20. Ageing Challenges Active Ageing Demand of Care (Health & Social Care) Better elderly living for longevity (Income, Re-employment, welfare services environment, engagement & connection) HR Development (Prof, para, non-prof, volunteer caregivers) R & D Innovation (Smart gadgets for smart elder) Well preparedness for Active Ageing (Health, Income Security, Housing, Participation)
  21. 21. Thailand Strategies for Active Ageing 1. Preparedness and readiness for quality aging 2. Promotion and development of the elderly 3. Social protection for the elderly 4. Creating a national comprehensive system for integrative implementation 5. Processing and disseminating knowledge on the elderly and monitoring
  22. 22. National Policy For Healthy Aging Integration & Collaboration : 4 Ministries Ministry of Public Health Ministry of Social Development and Human Security Ministry of Interior Ministry of Education Source : Health Dept. MOPH
  23. 23. Thai Active and Healthy Ageing 2. Strong (Health) The elderly have good health 1. Social Participation Families and communities as a strong institution 3. Security The welfare system and support services with quality, standards, access. Source : Health Dept. MOPH
  24. 24. Health • More focus on Health Prevention & Promotion through elderly group/ club • Promoting geriatric/ health screening, assessment in community • Launch several projects related to health and well-being of the elderly such as cataract screening & treatment, dental hygiene, free dentures, flu vaccine • Develop primary care system for the elderly, LTC system, health volunteers in community
  25. 25. Security • Monthly allowance for all Thai elders • Encourage and support ageing friendly environment/ universal design • Encourage local government to be more active in improving well-being of the elderly • National Policy for Saving Funds
  26. 26. Participation • In Thai society, older persons generally are respected and valued as resources for cultural and traditional Thai customs and knowledge • Encourage social participation of the elderly through elderly club, Brain Bank Project, Volunteering • Many elderly clubs in regional parts are very active and well-known for active participation of the elderly
  27. 27. School for Older Persons
  28. 28. Care system and services within the National Context: Thailand Experience
  29. 29. Acute Care Long-term Care Paradigm Shift Home & Community Based Services and Care
  30. 30. Paradigm Shift in Care Services • Acute Care -> Community Care -> Home Health Care • Primary Care Unit (PCU) – Family Nurse • Continuity of Care (COC) • Home Ward • Family Care Team
  31. 31. Continuityofcare Long Term Care Acute Care Intermediate Care Palliative care End of Life Care
  32. 32. Geriatric Hospital
  33. 33. Private Nursing Home *** ***
  34. 34. Paid caregiver
  35. 35. BMA Geriatric Hospital
  36. 36. • Training and Capacity Building in Geriatric Care for Health Personnel • Geriatric Clinic in all Level of Public Hospitals (800+ hospitals)
  37. 37. Intensive education Geriatric assessment Rehabilitation
  38. 38. Fast Lane / Green Tract for Older Persons OPD - Public Hospital ๏
  39. 39. Age-friendly Health Care settings
  40. 40. Long term Care System •National Long Term Care Action Plan 2014 •Focusing on strengthening community based care for older persons/ disability •Several models were developed all over the country during past five years •Now moving towards System Based LTC not Project Based LTC •National Health Security Office (NHSO) launched the National LTC project last year
  41. 41. Ministry of Public Health Permanent Secretary Cluster of Medical Service Development Cluster of Public Health Development Cluster of Health Service Support  Office of Permanent Secretary • Area Health Board 1 – 12 • Provincial Administration • Provincial Public Health Offices • District Health offices • Subdistrict = SHPH • Department of Health Family Care Team Health Volunteer (1,000,000+ ) Training course : - Care Manager - Caregiver • Department of Health Service Support LTC team Care Plan Community Board
  42. 42. Care personnel Family Care Team -Consult/Give an advice -Joint plan of care for the elderly Care manager Caregiver Family Volunteers -Assessment -Make Elderly Care Plan -CM 1 person : 35 – 40 elderly people. -Assessment/Care for the elderly -care of the dependent group -CG 1 person : 5 – 10 elderly people. -Care for family members. Source : Health Dept. MOPH
  43. 43. Primary care Team/ Home health care services Family Care Team
  44. 44. Older Person Health Record Booklet
  45. 45. Older Person Grouping Group 1: Healthy and Independent Group 2: Partially dependent (Home bound) Group 3: Totally dependent (Bed bound)
  46. 46. Healthy/ Independent Partially dependent/ Homebound Totally Dependent/ Bedbound • Health prevention • Health Promotion • Social participation • Volunteering • Active & Contribution to family/ society • Secondary health prevention • Maintain functional activities ADL, support IADL • Home & environment modification • Support caregiver & family • Rehabilitation •Complication prevention •Symptom control •Support caregiver & family •Support ADL & IADL •Palliative care
  47. 47. Conclusion & Challenge Care for All…
  48. 48. Challenges • Demographic changes put challenging on preparation for all sectors to improve health, care system • As Thailand becomes ageing society, health services and proper care systems especially for OPs need to be well- established and improving • Services oriented toward geriatric and long term care need to be more focused
  49. 49. https://link.springer.com/ content/pdf/10.1007/s12 126-009-9028-5.pdf
  50. 50. For more information: contact wattanaj@yahoo.com
  51. 51. Lumsonthi Model •The rural district located 120 km. from the province • District hospital collaborate with the Local administration organization •Established care-team including family member, semi-volunteer care worker, HC staff, Hospital staff (medical doctor, nurse practitioner, mental health nurse, physiotherapist) •The local administration organization funds the salary for care worker
  52. 52. รูปแบบการดูแลผู้สูงอายุระยะยาวลําสนธิโมเดล ลพบุรี

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