A revolução do envelhecimento

Abstract

The aging of the population brings with it major changes in the relative importance of illnesses. From the situation that prevailed in the last century, when acute illnesses were preponderant, we are now moving to an era when chronic diseases are becoming increasingly prevalent. The hospital-centered healthcare system of the 19th and 20th centuries that was created to deal with acute and especially infectious diseases is inappropriate for responding to the long-term, ongoing treatment needs of the chronically ill. We must revamp the healthcare system and centre it on the place where people live, i.e., their home. The health care system should thus shift from a hospital-centered to a community-centered model.Since most chronic diseases are preventable, health promotion and disease prevention should be prioritized. Promoting healthy life habits is critical to decrease the future burden of chronic diseases. Tobacco cessation, healthy nutrition, regular physical exercise and good sexual habits are key issues. But health promotion should go beyond in targeting also lodging, employment, education, revenue and environmental issues which are strong determinants of health.Primary care is essential to ensure adequate follow-up of patients with chronic diseases to monitor disease evolution, adjust treatment, and prevent deterioration and undue emergency room and hospital utilization. Physicians and other health professionals should be supported by geriatric teams to provide specialized care to the frail older people suffering from functional decline and acute deterioration. Geriatric services must be available not only in institutions (geriatric assessment unit, rehabilitation unit), but also in the community (day hospital, day center, outpatient clinic, memory clinic).Patient engagement in their own care is part of the Chronic care model aiming to improve the productive interactions between a well-informed and activated patient with a prepared pro-active inter professional team. The era of almighty physicians prescribing to passive patients is over. Physicians should now work with other professionals; patients together with their family should take part in the decisions and be responsible for their own health.The care and services required by people suffering from chronic diseases go beyond medical treatment, which will consequently have a more marginal role to play. People's disabilities due to chronic illnesses are now the main driver for health care and services utilization. Our objective should be to optimize the autonomy of individuals by reducing their disabilities and supplying the support needed to mitigate them.Current healthcare systems area long way from completing this refocusing process. Access to coordinated services is lacking. Integration of health and social services and coordinating the multiple providers involved in care of older frail people are important challenges. Models of full integration like PACE in the USA or coordination like PRISMA which we developed, validated and implemented in Quebec are p...

Prevalence of and factors associated with polypharmacy among elderly persons resident in the community

“…Aging also brings an exponential increase in the prevalence of chronic diseases and medication use 1 , often with negative consequences for health.…”

Saúde sexual do idoso: prevenção de infecções sexualmente transmissíveis

“…Apesar de todas as transformações que a sociedade moderna tem passado, a longevidade sendo uma realidade mundial, a vulnerabilidade do idoso frente às ISTs é relacionada a: invisibilidade do sexo na velhice, o idoso é frequentemente visto como assexuado; a ampliação do acesso a medicamentos para disfunção erétil é associada a sexualidade na terceira idade; a participação do idoso em grupos da terceira idade; a falta de diálogo com médicos e outros profissionais de saúde e; a falta de informações para os idosos (de Albuquerque Melo et al, 2012;de Mattos Santos & de Assis, 2011;Lindau et al, 2007;Minichiello et al, 2012); além do aumento da prevalência das DCNT (Doenças Crônicas não Transmissíveis) características com o avanço da idade e debilitam ainda mais o organismo dos seres humanos (Confortin et al, 2017;Hebert, 2015;Ramos et al, 1993).…”