WHO report highlights key steps for better and integrated health care for older people in North Macedonia | #healthcare | #elderly | #seniors
Every fourth person in North Macedonia will be over 65 years old in 2050 compared to about 14% currently. While every older person is different, we know that physical and mental capacity tend to decline with increasing age. Poorer health and reduced quality of life for older people will be costly for individuals and for the country.
The report released today by WHO, “Older people and access to health care in North Macedonia”, proposes ways for raising the quality of integrated services for older people in the country.
“This report outlines the nature and scale of the problem, but also offers solutions in the form of evidence-based interventions. It is essential that services for older people are included in universal health care packages. At the same time, there needs to be good coordination between health and social services to provide optimal care as needed,” said Dr Bojan Boskovski, on behalf of the Ministry of Health.
The findings of the report, as well as opportunities for action, were discussed at a round table organized by WHO, which gathered representatives of the key responsible government sectors, international and United Nations partners, patient and professional associations, and civil society organizations. This event has great significance as North Macedonia is rolling out its renewed model of primary health care and particular attention to older people is needed to ensure they are not left behind.
Reducing inequalities and re-establishing safe routines
“The family structures are changing, leaving older people in the country facing a number of health, social and economic challenges, and the current model of care has limited capacity to address emerging needs. Urgent measures are required to tackle this, including activities to help communities adapt to the new reality,” said Dr Jihane Tawilah, WHO Representative in North Macedonia.
“Empowering older people and enabling their full participation and social inclusion are ways to reduce inequalities. Now that we have the evidence documented, we have the vision, the experts and the leaders to drive the process forward. We should make better use of the existing synergies and interconnectedness between the health and social sectors, the different levels of health care, the providers and the community, to achieve better health care,” Dr Tawilah added.
Dr Natasha Azzopardi-Muscat, Director of the Division of Country Health Policies and Systems, WHO/Europe, emphasized the impact of the recent COVID-19 pandemic on the health of the elderly. “In terms of mortality, the COVID-19 pandemic has affected older people more than any other age group. The pandemic has also exacerbated the loneliness experienced by older people and we need to urgently see how, as this cohort becomes vaccinated, we can start to advise upon the safe re-establishment of living routines, bearing in mind that for older people particularly, every week, every month that we delay their ability to socialize with their loved ones is precious time lost.”
Only a third of older people in North Macedonia perceive their health as good or very good, a level substantially lower than the European Union average. In addition, over half of them reported a long-standing illness or health problems, and slightly less than half reported long-standing limitations in their usual activities due to a health problem. This potentially undermines older people’s independence and leads them to require greater assistance in daily activities. Obesity – a risk factor for noncommunicable diseases – particularly affects older people aged 65–74 years.
Reorienting the model of care: a health system supportive of integrated and person-centred care
Older people need long-term, complex care from multiple providers across a variety of settings. Data indicate that services in rural areas are rather limited and there is a lack of community-based services for older people. The coordination of services delivered by multidisciplinary teams in the community should be supported. This would not be possible without developing the capacity of the current and emerging workforce (both paid and unpaid). This can be achieved by evaluating the current capacity of the workforce, specifically their knowledge and skills to deliver appropriate and standardized care, and rolling out training.
Strategies to empower and engage older people and the wider community
Older people, their families and caregivers, as well as civil society, should be actively involved in service delivery. There is a lack of formal mechanisms to involve people, communities and civil society organizations in a systematic way, both at national and local levels.
“Involving older people in decision-making about their care, and helping them feel supported and encouraged regarding their health care are crucial aspects of service delivery, since communication, emotional support and empathy, self-management support and involvement in decision-making directly influence the health outcomes of older people and can contribute to improving health overall,” highlighted Dr Stojance Stefanovski from the Union of Retired People in North Macedonia.
Family members should be offered support and training
“Most of the care for older people is provided by family members, who lack the necessary skills and competencies, as well as lacking support from health and social care services to effectively support and address the needs of care recipients,” said Ljupka Petkovska from the Red Cross in North Macedonia.
Caregivers should be consulted within and across services, to evaluate the acceptability of planned/pilot support or of training initiatives, as well as to assess opportunities for scaling them up. Efforts should be made to ensure that there is available psychological support to appropriately respond to the burden perceived by caregivers; plans for community-based respite care should be initiated, such as community day centres or temporary home-based support.
WHO will continue to support the transition towards better integrated and people-centred care for older people in North Macedonia. “We will facilitate the translation of the data and recommendations into a national plan of action to improve older people’s access to quality care and lifesaving therapies, and to break their physical isolation,” concluded Dr Tawilah.