belarusian association of gerontology and...

BELARUSIAN ASSOCIATION OF GERONTOLOGY AND GERIATRICSPresident Dr. Andrey Ilnitski

BULGARIAN ASSOCIATION ON AGEINGPresident Dr. Ignat Petrov

GERONTOLOGICAL SOCIETY OF THE CZECH REPUBLICPresident Prof. MUDr. Hana Matějovská Kubešová

http://www.cggs.cz/cz/Home/

FINNISH GERONTOLOGICAL SOCIETYPresident Prof. Timo Strandberg

www.gernet.fi

ASSOCIAZIONE GERIATRI EXTRAOSPEDALIERI — AGEPresident Dr. Salvatore Putignano

http://www.associazionegeriatri.it/

ASSOCIATION OF GERONTOLOGISTS OF THE REPUBLIC OF KAZAKHSTANPresident Prof. Valery Benberin

MALTESE ASSOCIATION OF GERONTOLOGY & GERIATRICSPresident Prof. Joseph Troisi

http://soc.um.edu.mt/magg/

NORWEGIAN GERONTOLOGICAL SOCIETYPresident Prof. Börje Bjelke

http://www.aldersforsk.no/Norsk_selskap_for_aldersforskning/Hjem.html

GERONTOLOGICAL SOCIETY OF THE RUSSIAN ACADEMY OF SCIENCESPresident Prof. Vladimir Anisimov

http://www.gersociety.ru/

GERONTOLOGICAL ASSOCIATION OF SLOVENIAPresident Prof. Danica Hrovatičhttp://www.gds.si/

SWISS SOCIETY OF GERONTOLOGY SGG—SSPresident Dr. Stefanie Becker

http://www.sgg-ssg.ch/cms/pages/de/startseite.php

TUNISIAN ASSOCIATION OF GERONTOLOGYPresident Dr. Radhouane Gouiaa

TURKISH GERIATRICS SOCIETYPresident Prof. Yesim Gökçe-Kutsal

http://www.turkgeriatri.org/

UKRAINIAN GERONTOLOGY AND GERIATRICS SOCIETYPresident Prof. Vladislav Bezrukov

УСПЕХИ ГЕРОНТОЛОГИИADVANCES IN GERONTOLOGY

«AESCULAP» • ST. PETERSBURG • 2015

Edited by

Prof. Vladimir Khavinson

Prof. Vladimir Anisimov

Russian Academy of SciencesDivision of Physiological SciencesScientific Council on Physiological SciencesGerontological Society

ADVANCESin GERONTOLOGYV o l u m e 2 8 , № 1 . S u p p l e m e n t

E d i t o r i a l B o a r d :V. N. Anisimov (St. Petersburg) — Editor-in-ChiefV. Kh. Khavinson (St. Petersburg) — Deputy Editor-in-ChiefG. A. Ryzhak (St. Petersburg) — SecretaryV. S. Baranov (St. Petersburg)Yu. P. Nikitin (Novosibirsk)A. D. Nozdrachev (St. Petersburg)A. M. Olovnikov (Moscow)I. G. Popovich (St. Petersburg)

E d i t o r i a l A d v i s o r y B o a r d :

A. L. Azin (Yoshkar-Ola)A. V. Arutjunyan (St. Petersburg)A. L. Ariev (St. Petersburg)V. V. Bezrukov (Kiev, Ukraine)V. V. Benberin (Astana, Kazakhstan)M. Davidovich (Beograd, Serbia)M. I. Davydov (Moscow)C. Francheschi (Bologna, Italy)N. K. Gorshunova (Kursk)A. N. Il’tnitksy (Polotsk, Blarus)V. T. Ivanov (Moscow)A. N. Khokhlov (Moscow)N. N. Kipshidze (Tbilisi, Georgia)T. B. L. Kirkwood (Newcastle, U. K. )N. G. Kolosova (Novosibirsk)V. K. Koltover (Chernogolovka)O. V. Korkushko (Kiev, Ukraine)E. A. Korneva (St. Petersburg)G. P. Kotelnikov (Samara)A. V. Kulikov (Pushchino)

I. M. Kvetnoy (St. Petersburg)A. V. Lysenko (Rostov-on-Don)A. I. Martynov (Moscow)O. N. Mikhailova (St. Petersburg)V. S. Myakotnikh (Ekaterinburg)M. A. Paltsev (Moscow)K. I. Praschayeu (Belgorod)S. I. S. Rattan (Aarhus, Denmark)G. S. Roth (Baltimore, USA)A. V. Sidorenko (Vienna, Austria)V. P. Skulachev (Moscow)G. A. Sofronov (St. Petersburg)J. Troisi (Valetta, Malta)J. Vijg (San Antonio,USA)I. A. Vinogradova (Petrozavodsk)P. A. Vorobiev (Moscow)R. Weindruch (Madison, USA)T. von Zglinicki (Newcastle, U. K. )E. G. Zotkin (St. Petersburg)A. I. Yashin (Durham, USA)

Published since 1997Indexed in Index Medicus / MEDLINE & Index Copernicus & SCOPUS

S t . P E T E R S B U R G • 2 0 1 5

С А Н К Т - П Е Т Е Р Б У Р Г • 2 0 1 5

Выходит с 1997 г.Индексируется Index Medicus / MEDLINE, Index Copernicus и SCOPUS

A. Л. Азин (Йошкар-Ола)А. В. Арутюнян (Санкт-Петербург)А. Л. Арьев (Санкт-Петербург)В. В. Безруков (Киев, Украина)В. В. Бенберин (Астана, Казахстан)Р. Вейндрук (Мэдисон, США)Я. Вийг (Сан-Антонио, США)И. А. Виноградова (Петрозаводск)П. А. Воробьёв (Москва)Н. К. Горшунова (Курск)М. Давидович (Белград, Сербия)М. И. Давыдов (Москва)Т. Фон Зглиницкий (Ньюкасл, Великобритания)Е. Г. Зоткин (Санкт-Петербург)В. Т. Иванов (Москва)А. Н. Ильницкий (Полоцк, Белоруссия)И. М. Кветной (Санкт-Петербург)Н. Н. Кипшидзе (Тбилиси, Грузия)Т. Б. Л. Кирквуд (Ньюкасл, Великобритания)Н. Г. Колосова (Новосибирск)

В. К. Кольтовер (Черноголовка)О. В. Коркушко (Киев, Украина)Е. А. Корнева (Санкт-Петербург)Г. П. Котельников (Самара)А. В. Куликов (Пущино)А. В. Лысенко (Ростов-на-Дону)А. И. Мартынов (Москва)О. Н. Михайлова (Санкт-Петербург)В. С. Мякотных (Екатеринбург)М. А. Пальцев (Москва)К. И. Прощаев (Белгород)С. И. С. Раттан (Орхус, Дания)Дж. С. Рот (Балтимор, США)А. В. Сидоренко (Вена, Австрия)В. П. Скулачёв (Москва)Г. А. Софронов (Санкт-Петербург)Дж. Троизи (Валетта, Мальта)К. Франчески (Болонья, Италия)А. Н. Хохлов (Москва)А. И. Яшин (Северная Каролина, США)

Pоссийская академия наук Отделение физиологических наук

Научный совет по физиологическим наукамГеpонтологическое общество

У С П Е Х ИГЕРОНТОЛОГИИТ о м 2 8 , № 1 . П р и л о ж е н и е

Р е д а к ц и о н н а я к о л л е г и я :В. Н. Анисимов (Санкт-Петербург) — главный редакторВ. Х. Хавинсон (Санкт-Петербург) — заместитель

главного редактораГ. А. Рыжак (Санкт-Петербург) — ответственный секретарьВ. С. Баранов (Санкт-Петербург)Ю. П. Никитин (Новосибирск)А. Д. Ноздрачёв (Санкт-Петербург)А. М. Оловников (Москва)И. Г. Попович (Санкт-Петербург)

Р е д а к ц и о н н ы й с о в е т :

Успехи геронтологии. Санкт-Петербург: Эскулап, 2015. Т. 28. № 1 (Прилож. «Энциклопедия: геронто-логия в Европе», Ч. I). 106 с., ил.

Издается при поддержке Санкт-Петербургского института биорегуляции и геронтологии и Северо-Западного государственного медицинского университета им. И. И. Мечникова

С 2011 г. издательство PLEIADES PUBLISHING (МАИК «НАУКА / INTERPERIODICA») публикует журнал «ADVANCES IN GERONTOLOGY» (English Translations of «Uspekhi Gerontologii»), ISSN 2079-0570. Издание распространяет издательство SPRINGER

Журнал входит в Перечень ведущих научных журналов и изданий ВАК,в которых должны быть опубликованы основные результаты диссертацийна соискание ученой степени доктора наук

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Главный редактор В. Н. Анисимов

Редакционная обрабо тка Т. К. Кудрявцева

Адре с редакции : 197758 Санкт-Петербург, Песочный-2, ул. Ленинградская, 68,НИИ онкологии им. Н. Н. Петрова, чл.-кор. РАН В. Н. Анисимову.Тел. (812) 439 9534; факс (812) 436 9567e-mail: [email protected], [email protected]

197110 Санкт-Петербург, Левашовский пр., 12, издательство «Эскулап»Лицензия ИД № 04402 от 29.03.2001 г.

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© Успехи геронтологии, 2015© Геронтологическое общество, 2015

CONTENTS

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

The Belarusian Association of Gerontology and Geriatrics . . . . . . . . . . . . . . . . . 11

Notes on the gerontology research in Bulgaria . . . . . . . . . . . . . . . . . . . . . . 14

Milestones of Czech gerontology and geriatrics . . . . . . . . . . . . . . . . . . . . . . 20

Gerontology and geriatrics in Finland . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Out-of-hospital geriatrics in Italy: defi ning it and searching for tools and strategies . . . . . . . . . . . . . . . . . . . . . 34

Gerontology in the Republic of Kazakhstan . . . . . . . . . . . . . . . . . . . . . . . . 37

The development of gerontology and geriatrics in Malta . . . . . . . . . . . . . . . . . 40

The Norwegian Society for Age Research — the walk towards old age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Gerontology in Russia: Milestones and perspectives of development. . . . . . . . . . . . . . . . . . . . . . . 52

Gerontological association of Slovenia (GDS) . . . . . . . . . . . . . . . . . . . . . . . 63

The Swiss Society of Gerontology and the development of gerontology in Switzerland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

Development of gerontology in Tunisia . . . . . . . . . . . . . . . . . . . . . . . . . 73

Gerontology in Turkey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80

Gerontology in Ukraine: past, present and future . . . . . . . . . . . . . . . . . . . . 100

As the current President of the International Association of Gerontology and Geriatrics, European Region (IAGG-ER), and the Editor-in Chief of ADVANCES IN GERONTOLOGY respectively, we are delighted to present this special issue of the Journal on the occasion of the 8th IAGG European Congress in Dublin, Ireland, provid-ing an overview of the state of gerontological research in various countries in Europe.

Diff erent countries have diff erent priority areas for research, which keep on chang-ing and evolving in accordance with the changing social, political and economic trends.

There are 42 national gerontological research societies in Europe, and they are expected to maintain databases with respect to all aspects of ageing research, includ-ing biological, sociological, psychological, and clinical. From about mid-2012, we ap-proached them with an invitation to present a brief overview of the state of gerontolog-ical research in their respective countries. The fi rst series of such reports from Belarus, Bulgaria, Czech Republic, Finland, Italy, Kazakhstan, Malta, Norway, Russia, Slovenia, Switzerland, Tunisia, Turkey and Ukraine have been presented in this issue of Advances in Gerontology. Since 2011, Pleades Publishing has issued it in the English lan-guage for distribution by SPRINGER VERLAG. The journal has been published since 1997 and is indexed in Index Medicus/Medline & Index Copernicus & Scopus. Its edi-torial board includes many internationally renowned scientists from Austria, Belarus, Denmark, Georgia, Italy, Malta, Serbia, UK, Ukraine, US. We hope that similar re-ports from the other countries will be published in the future issues.

Good practices collected together may give new impulse to promoting healthy life, create physical and social environments to physical and mental frailties, develop holistic lifetime health and education strategies, provide fi nancial and social security to senior generation. It is for this purpose that the IAGG-ER Executive Board launched the project «Encyclopedia: Gerontology in Europe». We believe this vast store of informa-tion will be adequately evaluated by all stake-holders and made available for policy and opinion makers.

Prof. Vladimir Khavinson Prof. Vladimir Anisimov

INTRODUCTION

ADVANCES IN GERONTOLOGY • 2015 • Т. 28 • № 1 (Suppl.)

11

The roots of the Belarusian Association of Gerontology and Geriatrics:

history of Belarusian gerontology

The recognized beginner of Belarusian Geron-tology is academician Vasilii F. Kuprevich.

He graduated from the Institute of advanced training of public education in Moscow (1931), in 1934–1938 was the senior researcher of Institute of biological Sciences of the Academy of Sciences of the Belarus, in 1938–1949 — the head of labora-tory, in 1949–1952 — the Director of the Botanical Institute of the Academy of Sciences of the USSR. In 1952–1969 Kuprevich was the President of the Academy of Sciences of the Belarus, simultane-ously with 1953 — the head of Department of the Institute of biology of the Academy of Sciences of the Belarus. In 1954–1969 he was the Deputy of the Supreme Soviet of the USSR, the chief editor of «Reports of the Academy of Sciences of Belarus» (1952–1969), «Mikologiya i Fitopatologiya» (1967–1969) and «Botanical magazine» (1959–1966). The scientifi c interests of Kuprevich were in the sphere of physiology of diseased plants, he found the extracellu-lar secretion of enzymes in obligate parasites and put forward the hypothesis of the progressive reduction and specialization of enzymatic apparatus of parasit-ic fungi in the process of their evolution. In the same time Kuprevich was the fi losov and his activity in this sphere was dedicated to the gerontology.

The main idea of Kuprevich was «Death is un-natural for human nature... Obviously, people in-tuitively understand that century, during which con-tinued to evolve, lost in vain if his life is only 50–70 years... which implies that each creature destined to die? Usually say, from observation, from experience. But the daily experience convinces us that the Sun re-volves around the Earth...». Kuprevich supposed that simple organisms have lost the ability to update the broken cells as a result of natural selection and life

hypothetically immortal person has fallen by exactly one period, after which it is no longer useful mind.

«Not in the world of the material structure, which could compete in stability with protoplasts carrier of life», such a conclusion was made by Kuprevich. «Death is a historic event,» he said, «she has not al-ways existed, and appeared at a certain stage of de-velopment of life and immediately became the main engine of evolution: the change of generations has led to the possibility of the emergence (and fi xing the result of natural selection) those organisms that were better adapted to the environment. Mors creator vi-tae est — Creator of life is death. If it weren’t for our animal ancestors’d never become men. However, creating a new species, death marked them «natural» lives. But with the emergence of a society man slipped out from under the power of natural selection. The body was formed in the distant past, and probably for a long time. And death? It has become a historical anachronism. As a factor contributing to the improve-ment of human nature, it is no longer needed. From the point of view of society it is harmful. Based on those problems that society faces, it’s ridiculous. Who wants to leave this nonsense forever?»

The main conclusion made by Kuprevich: mecha nism of death arose in the process of evolution. Surely, today such position seems us to be mistaken, but in 1960–1970 they promoted the organizing in Belarus a special laboratory for exploring the prob-lems of longevity and gerontology.

In the sphere of medicine most actives professors in gerontology were G. Vecherski and V. Sytii. They were the beginners of Belarussian geriatrics in 1970–1990 years. Due to their activity the Ministry of health of the Republic of Belarus created the Department of gerontology and geriatrics in Belarusian medi-cal Academy of postgraduate education in order to increase the eff ectiveness of postgraduate train-

Adv. geront. 2015. Vol. 28. № 1 (Suppl.). P. 11–13

THE BELARUSIAN ASSOCIATION OF GERONTOLOGY AND GERIATRICS

Andrei N. Ilnitski

Belarusian Association of Gerontology and Geriatrics

12

ENCYCLOPEDIA: GERONTOLOGY IN EUROPE • PART I

ing of physicians. This Department is the center of Belarusian gerontology.

The Belarusian Association of Gerontology and Geriatrics

The Belarusian Association of Gerontology and Geriatrics was organized in October, 2011 on the ba-sis of common interests of citizens and presents itself as a voluntary scientifi c and public organization, spe-cializing in gerontology and other related sciences. It operates according to the Charter, confi rming it as a legal body.

The main goals of the Association are as follows: facilitation of information awareness, promotion of civil society’s and state’s participation in the geron-tology and other related sciences agree with the ones of the International Association of Gerontology and Geriatrics.

On a par with the global ageing trend the age structure of Belarus doesn’t look optimistic: 61,6 % of the population are adults capable of working, 15,9 % are children and 22,5 % are elderly people. The life du-ration in 2010 amounted 70,9 years on ave rage, 65,3 for men and 76,9 for women to be exact. However the demographical and medical situation in Belarus is characterized by growth of early deaths, rapid age-ing of the population, decrease of population, labor potential defi cit caused by emigration in the market economy development circumstances. The main re-source for liquidating of the abovementioned gap is a professionally developed, qualifi ed and experienced grown-up generation.

Demographical ageing poses new challenges, but at the same time creates new opportunities for im-proving quality of life and establishment of a new social economic and cultural environment involving aged people into political process in order to tackle the ageing problem with their participation.

Hence, one of the major directions of activity of the association of gerontologists is to elaborate and formulate a program of social and scientifi c develop-ment in the matters related to the demographical age-ing.

The major purposes and objectives of the Asso-cia tion are the following: a) implementation and promotion of methods and principles of gerontolo-gy and geriatrics in social and cultural life of the country; b) promotion of achievements of national gerontology and geriatrics in the country and abroad; c) assistance in uniting eff orts of physicians, social workers, biologists, teachers of educational institu-

tions, representatives of mass media to gain respect for problems of ageing and old age from all members of the society, which eventually will aid in providing high life quality of older and oldest people, off ering them equal opportunities in social, professional and cultural life; d) making and maintaining contacts with scientifi c organizations in the fi eld of gerontol-ogy of the CIS and other foreign countries, with in-ternational non-governmental scientifi c institutions. Arrangement of meetings of scientists for exchange of scientifi c data and discussion of issues arising in the course of scientifi c studies; e) assistance to mem-bers of the Association with their further training and realization of their scientifi c works, inventions and innovation proposals; f) scientifi c and methodological assistance with arrangements of teaching basics of modern gerontology in higher and secondary school, making contacts with scientifi c societies studying al-lied sciences; g) participation in the work of interna-tional societies of scientists and specialists in the fi eld of gerontology and geriatrics.

The leaders of Belarusian Association of Gerontology and Geriatrics

The Chairman of Association is professor Andrei N. Ilnitski. The interests of Anrei Ilnitski are: the study of pathophysiological mechanisms of age-ing and of course the age-associated pathologies, in particular, A. N. Ilnitski actively developed theory of development, the prevention and treatment of senile asthenia (frailty); the development and implementa-tion of comprehensive geriatric examination meth-ods; organization of gerontological and geriatric care, training, health and social services the provision of assistance to elderly people, in particular, A. N. Ilnitski for the fi rst time in Belarus was developed and im-plemented in the postgraduate education of doc-tors, nurses and social workers course on «geriatric Giants». A. N. Ilnitsky is the author of more than 20 monographs and textbooks on gerontology and geri-atrics, numerous articles and abstracts.

The Vice-Chairman of Association is professor Kyril I. Prashchayeu. He studies the phenomenon of polymorbidity in elderly and senile age and features of its prevention, diagnosis, treatment and rehabilita-tion; the study neuroimmunoendocrine aging mecha-nisms and course of age-associated pathologies; the organization of gerontological and geriatric care, en-suring the interaction of medical and social services.

13


K. I. Prashchayeu is the author of more than 20 monographs and textbooks on gerontology and geriatrics, numerous articles and abstracts.

Scientifi c activity of Association

The main scientifi c directions of Association are:• the study of the phenomenon of polymorbidity

in elderly and senile age and features of its preven-tion, diagnosis, treatment and rehabilitation;

• the study of neuroimmunoendocrine aging mechanisms and course of age-associated patholo-gies; organization of gerontological and geriatric care, ensuring the interaction of medical and social services.

During the period of functioning the Association were organized 5 conferencies, the Internet re-source «Club of professionals in gerontology» (www.geriatricsclub.com), journals «Gerontology jour nal of Kuprevich» and «Gerontology» (www. gerontology. su). In 2011 at the initiative of K. I. Pra sh chayeu, A. N. Ilnitski and N. Savenko was created Autonomous nonprofi t organization «Re-search medical center «Gerontology», which aims to bring together scientists of diff erent profi les, dealing with the problems of elderly people and integration into the world scientifi c community.

The Belarusian Association of Gerontology and Geriatrics is the IAGG member since 2013.

The Prospects

The future activity of Association will be the fol-lowing: to perform activities aimed to achieve statu-tory objectives; create various committees, groups to study specifi c issues; provide assistance with arrange-ments of scientifi c and research studies by its own ef-forts, attracting practitioners; receive and distribute data related to its activities; organize and hold con-sultations, readings, discussions related to problems

of gerontology and allied sciences by its own eff orts; organize and hold meetings, conferences, sympo-siums and workshops, to participation in which all members of the Association are entitled, to discuss scientifi c and administrative issues related to the ob-jectives of the Association; provide psychological support to older people for free only; create its own mass media, maintain its own website and perform publishing activities in accordance with the procedure established by the applicable laws; provide assistance to members of the Association with publishing their works and implementing results of their scientifi c studies and inventions into practice; participate in creating textbooks, study guides, fi lms related to ger-ontology issues; review and discuss scientifi c literature and textbooks related to issues of gerontology and allied sciences; provide assistance with foundation of laboratories, libraries, exhibitions and arrangements of other events to achieve its objectives; give answers to questions received under requests of agencies and institutions; protect rights and legal interests, as well as represent interests of its members in state authori-ties and other agencies; maintain contacts with other public organizations and unions; make scientifi c con-tacts and exchange scientifi c literature with scientifi c public organizations and institutions of Belarus and foreign scientifi c public organizations and associa-tions; participate in the foundation of international public organizations and unions in foreign countries, joins international public organizations and unions founded in foreign countries. The Association shall maintain direct international contacts and communi-cation, enter into relevant agreements and perform other activities permitted by the laws of the Republic of Belarus, including international agreements of the Republic of Belarus.

Referenceshttp://www.gerontolog.infohttp://www.gerontology.su


14

There were few Bulgarian scientists — Stamen Grigoroff , Assen Zlataroff and Methodii Popoff — who had contributed to the theory of ageing during the fi rst half of the 20th Century.

The bacteriologist Dr. Stamen Grigoroff (1878–1945) discovered in 1905 two of the agents causing the fermentation of the Bulgarian sour milk (lactoba-cillus bulgaricus and streptococcus termophilus) and then helped the theory of ageing of Elia Mechnikov. He published his discovery in the Revue Medicale de la Suisse Romande (Grigoroff , 1905). The head of Grigoroff in Geneva Professor Leon Massol wrote to Mechnikov: «Dear friend, …my assistant St. Grigoroff is an exceptional man, and I think he could be very useful to you, especially to you. After multiple attempts in our laboratory, he succeeded to discover and isolate the agent of the Bulgarian sour milk…You work, inspired by the striving to fi nd ways and means to prolong the men’s life. Among your remark-able phagocytes, please think of the Bulgarian yogurt and of this rod-like bacillus, discovered by Grigoroff , which also I saw under the microscope». Some ear-lier Mechnikov has studied the longevity in 36 coun-tries and he hypothesized that the high number of centenarians in Bulgaria could be linked with the use of Bulgarian sour milk (possibly counteracting the chronic intestinal intoxication) in the traditional diet of Bulgarian people. The results of Grigoroff were discussed and fully approved at the Pasteur Institute, and personally by Mechnikov.

The founder of Bulgarian biochemistry Professor Assen Zlataroff (1885–1936) and the eminent bi-ologist Professor Methodii Popoff (1881–1954) have thoroughly worked on the theory, and with extensive experiments, on cell stimulation and ageing (Zlatareff , 1911; 1966; Popoff , 1957; Popoff und Gleisberg, 1930) (See also Stoynev, 1975).

A systematic gerontological research in Bulgaria began in 1963 with the foundation of the Sofi a Centre of Gerontology and Geriatrics (CGG) at the

Minisrtry of Health and Social Cares. From its begin-ning the CGG was based for the next 20 years on the Old People’s Home No 11 in Sofi a, a new built social home designed for older people. The fi rst Director of CGG was the eminent Bulgarian physiologist and gerontologist Professor Dragomir Mateeff (1902–1971). He skillfully grounded extensive research in the main directions of gerontology and geriatrics. The full range of research activity began at February 1964 with the appointment of the fi rst researchers of the CGG: Liudmila Venova, Luben Valnarov, Sofi a Todorova, Enio Boyadjiev, Ignat Petrov. Beginning as a research centre, CGG carried out during the next years also educational, clinical and methodical activi-ties. In the CGG have been developed seven sections: Physiology of Ageing (headed by Luben Valnarov, and later by Maria Guncheva); Psychology and Psychopathology of Ageing (head Ignat Petrov); Biochemistry (head Pavlina Angelova, later Otto Zlatarev; Atanas Kiriakov); Morphology (Georgi Chavrakov and Marta Hristova); Physical Activity and Ageing (head Enio Boyadjiev); Social Gerontology (head Georgi Stoynev); and Geriatrics (head Vladimir Denev, later Georgi Angarov; Velichko Golemanov; Ignat Petrov). The main contributions of CGG in its fi rst 8–9 years were published in 8 volumes of Problems of Gerontology and Geriatrics, edited by Meditsina i Fizkultura 1965–1972, as well as in nu-merous books, chapters of books and scientifi c papers in Bulgaria and abroad. One of the main topics of Mateeff and his colleagues from 1964 to 1971 were the longitudinal studies about the eff ects of physical and mental activity on the health and well-being of older people. They were published in volumes IV and V of Problems of Gerontology and Geriatrics (Mateeff , Valnarov, Boyadjiev, Petrov, Angelova, Konstantinov, Vlahlijska, Guncheva, Manolova and Krasteva, 1969; Petrov, 1969). Valuable personal studies of Mateeff on the biological nature and theory of ageing (focusing on activity versus inactivity) were published in the last year of his life in prestigious in-


NOTES ON THE GERONTOLOGY RESEARCH IN BULGARIA

Ignat Petrov

Clinical Centre of Endocrinology and Gerontology, Medical University of Sofi a

15


ternational journals (Mateeff , 1971a, Mateeff , 1971b) as well in the volume VI of Problems of Gerontology and Geriatrics (Mateeff , 1971c). Another studies of Ignat Petrov (one part of them in collaboration with Konstantin Konstantinov) on the role of mental and physical activity for the mental health in ageing: Petrov 1966a, 1966b, 1969, Petrov and Konstantinov, 1971, Konstantinov and Petrov, 1971.

Other important studies of CGG in that period have been on:

• morbidity in ageing (Georgi Stoynev, Milka Bagrenska, Mihail Rashev et al.)(See: Stoynev, Vizev, Bagrenska, 1967; Rashev and coll., 1971; Stoynev, 1977, Bagrenska, 1980);

• death rates in diff erent ages (Mateeff , Stoynev, Vizev, Doichinova, 1969; 1970);

• life expectancy after retirement (Georgi Stoynev, Zvetana Doivhinova and Stoyan Vizev, 1971)

• longevity, Bulgarian centenarians (Georgi Stoynev and colleagues — Stoynev, 1969, 1970, Vutov and Stoynev, 1969; Konstantinov, Stoynev and Petrov, 1972).

Further gerontological population studies were carried on:

• a homogeneous representative sample of rural people from 46 Shopp villages (initiated by Georgi Stoynev and continued by Ignat Petrov as a longitu-dinal and cross-sectional assessment on mental health and ageing) (Petrov, 1976; Petrov, 2002; Petrov, Denev, Petkov, Arnaudova, 2007);

• the mental health problems also of an el-derly population sample of Sofi a City (Konstantin Konstantinov, 1978);

• the dyslipoproteinaemias in the population (Atanas Kiriakov and coll.).

Many other contributions of CGG are valuable, among them on:

• the energy aspects of metabolism in ageing (Pavlina Angelova – P. Angelova-Gateva, 1969, 1971);

• hearing and ageing (Velichko Golemanov, Kiril Popov) (Golemanov, 1978; Popov, 1985);

• ageing and vision (Vladimir Denev; Emilia Peicheva) (Denev, 1971a; 1971b; Denev, Aladjov and Guguchkova, 1973; Peicheva, 1980);

• anthropometric evaluation of ageing (Velislav Todorov; Enio Boyadjiev) (Todorov, 1976; Boyadjiev, 1973);

• ventilation and lung functions in ageing (Maria Guncheva – Guncheva: 1971, 1982, Petrov and Guncheva, 1977);

• ageing and arterial hypertension (Sabina Zacharieva – Zacharieva, 1980);

• ageing and diff erent aspects of atherosclerosis (Professor Mihail Rashev and his research group in-cluding Nevena Pelova and Athanas Kiriakov); also epidemiology of atherosclerosis (Stoyan Vizev) (Vizev, 1976, 1989);

• other geriatric aspects of internal medicine (Milka Bagrenska; Stoyan Vizev; Diana Brinikova; Ivancho Ivanov; Ilija Popiliev et al.) (See: Stoynev, Vizev and Bagrenska, 1967; Rashev et al., 1971; Bagrenska, 1980; Brinikova, 1984; Ivanov, 1984; Popiliev, 2003; et al.)

• generally on ageing, health and illness (Georgi Stoynev; Velichko Golemanov; Ignat Petrov) (Stoynev, 1977; Petrov, 1973, 1978);

• ageing and psyche (Ignat Petrov) psychology and psychopathology of ageing (Ignat Petrov, Konstantin Konstantinov) (Petrov, 1965, 1975, 1978, 1982, 1983, Konstantinov, Petrov and Christozov, 1982);

• ageing and depression (Ignat Petrov) (See: Petrov, 1979, 1981, 1982, 1983, 2009; Petrov and Kirov, 1983).

• culture therapy in old people’s home (Ignat Petrov and Lilia Vlahlijska); cultural interests and activities and social integration of the elderly people (Lilia Vlahlijska) (Vlahlijska and Petrov, 1971; Petrov and Vlahlijska, 1972; Vlahlijska 1982);

• ageing and blood coagulation (Georgi Angarov; Dimitar Tharaktchiev); ageing and lipoproteins (Pavlina Angelova, Otto Zlatartev and colleagues, including Evgenija Ivanova; Athanas Kiriakov and colleagues) (See: Goranov, Zlatarev, Ilinov, 1983; Ivanova, 1983; Kiriakov, 1987, etc.)

• methods and eff ects of regular physical exercises on ageing people (Enio Boyadjiev, Liudmila Venova, Ivan Tulilov, Ivan Petkov, Bagra Delcheva etc.); the eff ects of physical activity in older people in good health and after illness, including after myocardial in-farction (Ivan Petkov), and with lung diseases (Bagra Delcheva) (Venova, 1984, 1991); Petkov (1975, 1985, 1987); Delcheva (1971);

• longitudinal assessment of physically active old-er people (Ivan Petkov) (Petkov, 1998);

• social and economic studies of people over the age of retirement (Zvetana Doichinova, now Arnaudova) (Doichinova, 1069; Stoynev, Doichinova, Vizev, 1971; Arnaudova et al., 1984);

• other aspects of social gerontology (Sylvia Maksimova; Lubomir Tomov);

• transcultural Bulgarian-Hungarian gerontologi-cal studies Ignat Petrov, Bela kolozsi, Yanos Bartok, Nadia Dumeva, Laszlo Ivan)

16


(See: Kolozsi, Petrov, Bartok and Dumeva, 1981a, 1981b, 1982); Petrov, Kolozsi, Dumeva and Bartok, 1981, 1982, 1983).

• the health of the participants in the commu-nist movement 1941–1944, studied at the 1970’s (R. Kermova; Lubomir Tomov);

• the long lived people (Stoyan Vizev, Raisa Yatzemirska and colleagues).

The teaching activity of CGG began in 1969 with regular every year’s post-graduate courses in geron-tology and geriatrics for physicians, nurses, physio-therapists and other professionals. Also since 1969 the clinical geriatric activity marked out a further development through a co-operation of leading geri-atricians of CGG with some University clinics of the Sofi a Medical Faculty: so Konstantin Konstantinov and Ignat Petrov worked on the basis of the University Psychiatric Clinic; Vladimir Denev and Emilia Peicheva — in the Ophtalmology; Velichko Golemanov and Kiril Popov — in the Otorhino-laryngology; a number of geriatricians worked in the Clinic of Endocrinology. Many researchers have obtained their PH degree in the CGG, and many of them work now at leading positions in other medical Institutes.

In 1972 Dr. Georgi Stoynev was appointed as head of CGG. The same year, with the project of the communist party to form a gigantic Medical Academy, the CGG was merged mechanically in the Institute of Endocrinology. At 1972 CGG had 7 sec-tions and a staff of 86 persons. But the sections of gerontology and geriatrics have been subordinated and gradually assimilated in the new institute. At the offi cial circles there predominated an underestimat-ing of the gerontology with a misunderstanding of its identity and multidisciplinary essence. This negative tendency continued during the 1980s and 1990s. The loss of independence and the further assimilation of the sections of CGG had result in the loss of dozens of educated and motivated gerontologists and geri-atricians who were constrained to shift their specialty.

Nowadays a successor of the CGG is the Clinical Centre of Endocrinology and Gerontology (CCEG) at the Medical University of Sofi a. Few of the re-searchers from the former CGG continue to work now in the CCEG, whose function is only in the fi eld of education — but on the basis of one purely en-docrinological clinic. Other gerontologists have been transferred to the Faculty of Public Health of the Medical University, whose activity is also purely edu-cational. Within that Faculty there work successfully the researchers-gerontologists Zacharina Savova (so-

cial gerontology); Polina Balkanska (psychology) and Zhenia Georgieva (psychotherapy and ageing).

Meanwhile the participation of Bulgarian geron-tology in the activity of the powerful International Association of Gerontology and Geriatrics (IAGG) has increased considerably. In 1994 researchers from CGG (a part of them retired) and public fi gures founded the Bulgarian Association on Ageing, an NGO-member of IAGG since 1997.

Among the contributions in gerontology in the last years are:

• the book «The elderly patients» edited by Professor Iliya Popiliev (2003) with valuable chap-ters, among them about ageing and cardio-vascular (Iliya Popiliev), lung (Iliya Popiliev) renal diseases (Nikolai Belovejdov), diabetes (Dragomir Koev), thy-roid disorders (Boyan Lozanov), surgery problems (Ilija Popiliev), and clinical pharmacology with older people (Nikolai Belovejdov);

• the book of Krassimir Vizev (2009) on the bio-logical age and the impact of endocrine factors;

• the book edited in 2009 by Tsekomir Vodenicharov ‘Actual Problems of Ageing and Old Age’, with chapters of the gerontologists Sylvia Maksimova (Medical-social aspects), Polina Balkanska (Psychology and psychopathology), Zhenia Georgieva (The elderly person, family and society), Jasmine Pavlova (Social-economic aspects), Zaharina Savova (Psycho-social adaptation) et al.;

• the publications of Dimitar Tcharaktchiev on gerotechnologies;

• the study of Ignat Petrov on the feelings and attitudes of older people towards the changes in the period of transition (Petrov, 1996, I997a; 1997b). The elderly in a period of transition was one of the central topics at the 18th World Congress of Gerontology and Geriatrics in Rio de Janeiro 2005, where Ignat Petrov organized and convened a sym-posium. That work of Petrov was further published in the Annals of New York Academy of Sciences (Petrov, 1997c) and in the International Journal of Geriatric Psychiatry (London).

Finally, a fruitful collaboration in psychogeron-tology exists now between our Centre and the group of Professor Peter Coleman, University of Southampton, UK, with a number of publications 2011–2012 and a book on the attitudes and feelings of older people: Ageing, Ritual and Social Change (eds. Peter Coleman, Daniela Koleva and Joanna Bornat), Farnham, Surrey, Ashgate Publishing, 2013. (See also, Coleman et al., 2012; Petrov and Coleman, 2012, 2013).

17


Welcoming the 50th anniversary of the Bulgarian Centre of Gerontology and Geriatrics, we have the mission to continue the gerontology research in Bulgaria and to take pains to restore the full range of activities in our multidisciplinary and unique sci-ence. The imperatives of nowadays Bulgarian society oblige all us.

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Konstantinov K., Petrov I. Some changes in verbal associa-tions, attentions, intellectual work capacity and memory in elderly and old people physically trained in the course of three years. Giornale di Gerontologia, 1971, 19, 6, 385–398.

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Vizev M., Bagrenska M. Comparative sick-rate study of elder-ly and old people. In Problems of Gerontology and Geriatrics (Eds. D. Mateeff et al.), volume III. Sofi a, Meditsina i fi zkultura, 1967, 73–78. (In Bulgarian; summaries in Russian and English).

Rashev M., Stanchev L., Orbetsov M. et al. Moprbidity in the age over 60 among the population of Kazanlik and region. In Problems of Gerontology and Geriatrics (Eds. D. Mateeff et al.), vol. VI. Sofi a, Meditsina i fi zkultura, 1971, 50–54. (In Bulgarian).

Bagrenska M. Citologic-chemical studies on neutrophile leu-cocytes in peripheral blood in ageing and in acute pneumonia at different ages. Ph.D. Dissertation. Sofi a, Medical Academy, Institute of endocrinology, Gerontology and Geriatrics, 1980.

Brinikova D. Immunity and its changes in atherosclerosis and arterial hypertension. A clinical and experimental study. Ph.D. Dissertation. Kiev, Institute of Gerontology, 1984.

Ivanov Iv. Intracardial haemodynamics and myocardial con-tractibility in older patients with ischemic disease of the hearth. Doctoral Dissertation. Kiev, Institute of Gerontology, 1984.

Mateeff D., Stoynev G., Vizev St., Doichinova Zv. A study of the death causes among elderly and old people in Bulgaria during 1966. In Problems of Gerontology and Geriatrics (Eds. D. Mateeff et al.), vol. IV. Sofi a, Meditsina i fi zkultura, 1967, 145–154. (In Bulgarian; summaries in Russian and English).

Mateeff D., Stoynev G., Vizev St., Doichinova Zv. Death rates among the population in the age over sixty in Bulgaria. Sofi a, Meditsina i fi zkultura, 1970 (In Bulgarian; summaries in Russian and English).

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Stoynev G., Vutov M., Velichkov L. Studies on the X-ray changes in the form and structure of the lower jaw in centenarians. In Problems of Gerontology and Geriatrics (Eds. D. Mateeff et al.), vol. III. Sofi a, Meditsina i fi zkultura, 1969, 155–164. (In Bulgarian; summaries in Russian and English).

Vutov M., Stoynev G. The state of the masticatory system in centenarians. In Problems of Gerontology and Geriatrics (Eds. D. Mateeff et al.), vol. IV. Sofi a, Meditsina i fi zkultura, 1969, 165–172. (In Bulgarian; summaries in Russian and English).

Stoynev G. A study on the orthobiosis and health status of the centenarians in Bulgaria. Ph.D. Dissertation. Sofi a, Institute of Phisiotherapy, 1970 (In Bulgarian).

Petrov I. C. Self-evaluation of some personality aspects of the aged by the Dembo-Rubinstein test. Experimental-psychologic and clinical psycho-pathologic investigation. Ph.D. Dissertation. Sofi a, Meditsinska Academia (In Bulgarian; abstract in English).

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Golemanov V. Age changes in the hearing, smelling and taste organs. Ph.D. Dissertation. Sofi a, Medical Academy, Institute of endocrinology, Gerontology and Geriatrics, 1978.

Popov K. Ageing decrease of hearing under different envi-ronment conditions. Ph.D. Dissertation. Sofi a, Medical Academy, Institute of endocrinology and Gerontology, 1986 (in Bulgarian).

Denev Vl. A study on the characteristics of eye pathology in elderly and old people treated in some ophthalmologic clin-ics in Bulgaria. In Problems of Gerontology and Geriatrics (Eds. D. Mateeff et al.), vol. VI. Sofi a, Meditsina i fi zkultura, 1969, 102–106 (in Bulgarian).

Denev Vl. An attempt of comparative study of retinal vessels and the functional state of the yellow spot in people in late life. In Problems of Gerontology and Geriatrics (Eds. D. Mateeff et al.), vol. VI. Sofi a, Meditsina i fi zkultura, 1969, 164–168 (in Bulgarian).

Denev Vl., St. Aladjov, Guguchkova Pr. Comparative studies of the electrocoagulogramme, the light-macular test and the caliber of the vessels in old people. Ophtalmologia, 1973, 3, 77–79 (in Bulgarian).

Peicheva Em. The state of the corneal perception in clinically healthy and ill with some eye diseases persons in middle and old-er age and after eye surgery. Ph.D. Dissertation. Sofi a, Medical Academy, 1980 (in Bulgarian).

Todorov V. Changes in some anthropologic characteristics in ageing. Sofi a, Medical Academy, Institute of Endocrinology, Gerontology and Geriatrics, 1976.

Boyadjiev E. A study on the physical development and capac-ity of males and females aged from 50 to 90 years (data from 1150 rural people). Ph.D. Dissertation. Sofi a, Institute of Endocrinology, Gerontology and Geriatrics, 1973. In Bulgarian).

Guncheva M. Changes in some indices of external breathing in persons aged from 45 to 90 years. In Problems of Gerontology and Geriatrics (Eds. D. Mateeff et al.), vol. VI. Sofi a, Meditsina i fi zkultura, 1969, 205–213 (in Bulgarian).

Guncheva M. Bioelectric activity of the breathing muscles in practically healthy persons over 60 years of age. Ph.D. Dissertation. Sofi a, Medical Academy, Institute of endocrinology, Gerontology and Geriatrics, 1982 (in Bulgarian).

Petrov I. C., Guncheva M. Mental changes in older people with various degree of ventilatory insuffi ciency. In: Problemi na va-treshnite bolesti (Eds. E. Bosadjieva et al., 1977, 5, 2, 101–110). (In Bulgarian, summary in English.)

Zacharieva S. The system rennine-angiotensine-aldosterone in elderly and old people and people with arterial hypertension aged 60 and over. Ph.D. Dissertation. Sofi a, Medical Academy, Institute of Encocrinology, Gerontology and Geriatrics, 1980 (In Bulgarian).

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Vizev St. Ageing and atherosclerosis: morbidity, death rates, risk factors. Doctoral Dissertation. Sofi a, Medical Academy, 1989 (In Bulgarian).

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Petrov I. C. Biological basis of mental ageing. In K. Kon-stantinov, I. C. Petrov and Chr. Christozov: Psychology and psy-chopathology of late life. Sofi a, Meditsina i fi zkultura, 1982, 19–23 (In Bulgarian).

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Konstantinov K., Petrov I. C. Mental changes in ageing and old age. Changes in the word associations. In Nevrol., psihiat. i nevrohirurg. Sofi a, 1973, 12, 2, 81–88 (In Bulgarian; summaries in Russian and English).

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Petrov I. C., Konstantinov K. Changes in the course of the as-sociative experiment in elderly and old people during physical train-ing. In Problems of Gerontology and Geriatrics (Eds. D. Mateeff et al.), vol. III. Sofi a, Meditsina i fi zkultura, 1967, 127–133 (In Bulgarian; summaries in Russian and English).

Petrov I. C. Depressive states after 70 years of age. Bulletin of the Research Institute of Neurology, Psychiatry and Neurosurgery, 1979, 2, 53–58 (in Bulgarian).

Petrov I. C. Etats depressifs apres l’age de soixante-dix ans. Etude clinique et experimentale sur un groupe homogene de 701 habitants ruraux. Minerva Medica, 1981, 72, 47, 3191–3195.

Petrov I. C. Affective disorders in ageing and old age. In: K. Konstantinov, I. C. Petrov and Chr. Christozov: Psychology and psychopathology of late life. Sofi a, Meditsina i fi zkultura, 1982, 97–103 (in Bulgarian).

Petrov I. C., Kirov K. On the clinics of depressions arising in the age over 65 years. Medical archives, 1982, 20, 5–6, 75–82.

Petrov I. C. Ageing and depression. Nevrol., psihiat. i nevro-hirurg. Sofi a, 1983, 22, 3, 186–193 (in Bulgarian; summaries in Russian and English).

Petrov I. C. Mental health of the elderly. Focus on depression. A poster presented at the XIX World congress of Gerontology and Geriatrics, Paris, 4–7 July, 2009.

Vlahlijska L., Petrov I. C. A study on the interests and some kind of activities of elderly and old people. In Problems of Gerontology and Geriatrics (Eds. D. Mateeff et al.), vol. VI. Sofi a, Meditsina i fi zkultura, 1971, 131–137 (in Bulgarian).

Petrov I. C., Vlahlijska L. Culture therapy in the old people’s home. Gerontologist, 1972, 12, 4, 429–434.

Vlahlijska L. Social integration of the ageing person. Ph.D. Dissertation. Sofi a, Medical Academy, 1982 (in Bulgarian).

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Goranov Iv., Zlatarev O., Ilinov P. Lipids. Sofi a, Meditsina i fi zkultura, 1983.

Ivanova E. Blood triacylglycerol heterogeneity: clinical-labo-ratory informativeness in the third age. Ph.D. Dissertation. Sofi a, Medical Academy, Institute of endocrinology, Gerontology and Geriatrics, 1983.

Kiriakov At. Importance of the quantitative lipoprotein’s analy-sis for the present-day clinical-laboratory diagnostics of dyslipopro-teinemias. Doctoral Dissertation. Sofi a, Medical Academy, Institute of endocrinology, Gerontology, and Geriatrics, 1987.

Venova L. The infl uence of various types of physical loading on the eye tension in healthy persons and persons with glaucoma. Ph.D. Dissertation. Sofi a, NSA, 1984 (in Bulgarian).

Kinesitherapy in internal diseases and in geriatrics (Ed. L. Venova). Sofi a, NSA, 1991 (in Bulgarian).

Petkov Iv. Studies on the effect of long applied kinesitherapy in elderly people after myocardial infarction. Ph.D. Dissertation. Sofi a, NSA, 1975 (in Bulgarian).

Petkov Iv. Physical activity and longevity. Sofi a, Meditsina i fi z-kultura, 1985 (in Bulgarian).

Petkov Iv. Handbook of kinesitherapy for the elderly. Sofi a, Meditsina i fi zkultura, 1987 (in Bulgarian).

Delcheva B. Results from a kinesitherapy of elderly and old people with lung emphysema. In Problems of Gerontology and Geriatrics (Eds. D. Mateeff et al.), vol. VI. Sofi a, Meditsina i fi zkul-tura, 1971, 241–248 (in Bulgarian).

Petkov Iv. A longitudinal study on the effect of kinesitherapy in ageing. Doctoral Dissertation. Sofi a, NSA, 1998 (in Bulgarian).

Doichinova Zv. On the problem of social security for elderly and old people. In Problems of Gerontology and Geriatrics (Eds. D. Mateeffet al.), vol. IV. Sofi a, Meditsina i fi zkultura, 173–192 (In Bulgarian; summaries in Russian and English).

Stoinev G., Doichinova Zv., Vizev St. A study on the eco-nomic activity of people in the age of retirement. In Problems of Gerontology and Geriatrics (Eds. D. Mateeff et al.), vol. VI. Sofi a, Meditsina i fi zkultura, 36–41 (In Bulgarian).

Arnaudova Z. et al. A study on people in the age after re-tirement in Bulgaria. Sofi a, National Statistics Institute, 1984 (in Bulgarian).

Maksimova S. An appraisal of the processes of ageing by means of biologic indexes. Ph. Disserattion, Sofi a, Medical Academy, 1990 (in Bulgarian).

Yatsemirskaya R. S. The mental state of long-lived per-sons. Clinical-psychologic and social-hygienic aspects. Doctoral Dissertation. Sofi a, Medical Academy, Institute of Endocrinology and Gerontology, 1990. (In Russian).

Kolozsi B., Petrov I., Bartok J., Dumeva N. Characteristiques medicales et psychologiques des patients des soins geron-tologiques. Comparaison bulgaro-hongroise. Zeischrift für Alterns-forschung, 1981, 36, 6, 499–507.

Kolozsi B., Petrov I., Bartok J., Dumeva N. Gerontologiai gondozast igenilo budapesti es szofi ai idosek demografi ai egeszsegi es onertekelesi jellemzoinek osszehasonlitasa. Orvosi Szociologia, Orvosi Hetilap, 1981, 122, 6, 335–338 (In Hungarian).

Kolozsi B., Petrov I., Bartok J., Dumeva N. Self-evaluation of aged people who voluntarily required preventive periodical ge-

rontological examination. Archives of Gerontology and Geriatrics (Elsevier Biomedical Press), 1982, 1, 117–124.

Petrov I. C., Kolozsi B., Dumeva N., Bartok J. Social-psychological studies on dispanserized elderly volunteers — in-habitants of Sofi a and Budapest. I. Relations between personality structure and self-evaluation. Nevrol., psihiat. i nevrohirurg. Sofi a, 1981, 20, 6, 437–444.

Petrov I. C., Kolozsi B., Dumeva N., Bartok J. Social-psycho-logical studies on dispanserized elderly volunteers — inhabitants of Sofi a and Budapest. I. Analysis of self-evaluation. Nevrol., psi-hiat. i nevrohirurg. Sofi a, 1982, 21, 3, 188–197.

Petrov I. C., Kolozsi B., Dumeva N., Bartok J. Social-psycho-logical studies on dispanserized elderly volunteers — inhabitants of Sofi a and Budapest. III. Motives self-evaluation. Transcultural comparisons. Nevrol., psihiat. i nevrohirurg. Sofi a, 1983, 22, 1, 49–56.

The elderly as patients (Ed. I. Popiliev). Plovdiv, Medical Publishing Raikov, 2003.

Balkanska-Georgieva P. The elderly person as a patient. Sofi a, 2003.

Vizev K. The biological age as a medical and social problem and the infl uence of endocrine factors on it. Sofi a, Hermes, 2009.

Actual problems of ageing and old age (Ed. Ts. Vodenicharov). Sofi a, Simel, 2009.

Petrov I. C. Feelings and attitudes toward the changes during social and economic transition. A Study of Sofi a autonomous el-derly subjects. Romanian Journal of Gerontology, 1996, vol. 17, tome 1–2, 73–82.

Petrov I. C. Feelings and attitudes toward the changes during social and economic transition. A study on Sofi a community elderly with active lives. Part II. Evolution of the feelings and attitudes. Comparison with health, personality and social variables. Roma-nian Journal of Gerontology, 1997a, vol. 18, tome 3–4, 31–48.

Petrov I. C. The elderly in a period of transition in Sofi a. International Journal of Geriatric Psychiatry (London), 1997b, vol. 12, issue 7, 773–774.

Petrov I. C. The Elderly in a Period of Transition: Health, Personality, and Socio-Cultural Aspects of Adaptation. Introductory Paper to Invited Symposium. 18th World Congress of Gerontology, Rio de Janeiro, 26–30 June, 2005.

Petrov I. C. The elderly in a period of transition. Health, per-sonality, and social aspects of adaptation. Annals of the New York Academy of Sciences, 2007, 1114, 300–309.

Coleman P. G., Carare R. O., Petrov I. C. et al. Spiritual belief, social support, physical functioning and depression among older people in Bulgaria and Romania. Aging and mental health, 2011, 15, 3, 327–333.

Petrov I. C., Coleman P. G. The high rates of depressions among older Bulgarian rural people: is there a real depression or a pessimistic self-evaluation? Ageing Clinical and experimental re-search. Suppl. to No 1, February, 2011. Editrice Curtis, 268–270.

Petrov I. C. Social support and mental health in ageing and old age. In Social Determinants and Mental Health (Ed. S. Baehrer). Hauppauge, NY, Nova Science Publishers, 2011, 83–102.

Petrov I. C., Coleman P. G. Social change and well-being. The place of religion in older Bulgarian men’s life. In: Ageing, ritual and so cial change. Ashgate Publising, Farnham, Surrey, 2013, 179– 200.


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1843 — Prof. Josef Hamerník (1810–1887) announces his lectures on «ad-vanced age diseases with clinical demonstrations» in the Faculty of Medicine at the Charles Uni-versity.

He studied at the Faculty of Medicine in Prague and gradu-ated in 1836 as a doctor of medi-

cine. He extended his education in a year-long intern-ship in the faculty in Vienna, founded there by Czech physicians Josef Škoda and Karel Rokytanský. In 1837 he returned to Prague where he started working in the General Hospital. He founded and led a course of pathology until the authorities prohibited him to do so. In 1845 he became the senior physician of the department and clinic of mammary diseases, then the docent and associate professor of the science of auscultation and percussion. Hamerník was a distinc-tive personality. His rough, unrefi ned behaviour and life-style was subject of numerous jokes. However, his extensive medical knowledge and reputation of good diagnostics expert gained him wide popularity.

1904 — Lectures given by Prof. František Procházka (1864–1934) on old age diseases from the social perspective were started.

1907 — Prof. Vladimír Růžička (1870–1934) issues the original physicoche mi cal colloid theory of «morphological meta bolism and protoplasm hys-teresis» in the piece Struktur und Plasma.

Following the leaving exami-nation in the Brno Grammar School (1888) he studied at the Faculty of Medicine at Charles

University in Prague. In 1901 he graduated it with doctorate. In 1907 he was in an internship in Munich at O. Hertwig’s and habilitated for general biology and experimental morphology in his alma mater (it was the very fi rst habilitation in the biology branch in our country). In this branch, he became the associ-ate professor (in 1909) and the full professor (in 1920)

(the brevet professor as early as in 1917). At that time attention was raised by his theory of ageing based on the so-called protoplasm hysteresis. Knowledge gained in study of microorganisms led him to, at that time quite rare, recommendation of bacteria as a suit-able model object in the genetic research.

1921 — Rudolf Eiselt (1831–1908) begins to deal with the issue of geriatrics.

He was a professor of sur-gery and pathology, and later a docent of special pathology of the 1st Clinic of Medicine and the senior physician of the 1st Department. He was an obstetrician as well. He was the fi rst Czech teacher at the

Faculty of Medi cine in Prague; after his habilitation he gave his lectures exclusively in Czech language. He proposed and founded, with support by J. E. Purkyně, the fi rst Czech medical journal «Journal of Czech Physicians» (1862), he became the secretary of the as-sociation and the fi rst science editor of the journal. He became a member of the «Royal Czech Society of Sciences» and other leading scientifi c institutions. In 1871 he founded the fi rst Czech clinic of internal medicine in the today’s General University Hospital in Prague.

1924 — Prof. V. Růžička elaborates his colloid theo ry for ageing processes (ageing as thickening, solidify-ing, and change of sol in gel).

1929 — R. Eiselt changes the Institute for Old Age Diseases to the Department of Old Age Diseases, the fi rst geriatric university department in the world. F. Tvaroh, another one of the founders of the Czech geriatrics also works in the clinic.

In the period after World War II, in the 50s and early 60s the society situation necessitated foundation of the so-called type 2 internal departments. Despite follow-up treatment of long-term ill patients trans-ferred from acute care hospitals those centres also fulfi lled the social function in relation to gradual, so-ciologically defi nable disintegration of families and occurrence of limited opportunities of family back-


MILESTONES OF CZECH GERONTOLOGY AND GERIATRICS

21


ground. Reaction of services, both medical and so-cial, was considerably delayed in terms of both quan-tity and quality. Extensive development of industry, urbanization, founding of new residential areas and building of housing estates and other circumstances helped various solutions.

1958 — Prof. B. Prusík (1886–1964), a follower of Prof. Eiselt in the development of gerontology, ini-tiated foundation of the Section of Gerontology at the Czech Society of Internal Medicine and at the age of 72 years he became the fi rst chairman for the fi rst four-year pe-riod. At the same time, be became a co-founder of the International Society for Gerontology IAGG.

Bohumil Prusík (1886–1964) graduated 1910 at the Medical Faculty of Charles University. He worked at the II. internal department, at oph-thalmology department and obs tetric department. He was a founder of czech angiology, 1912 he iniciated fi rst usage of ECG in Czech republic. His studies explainig the infl uence

of adrenalin on the human myocardium during com-plete atrioventricular blockade or the infl uence of nicotinic acid on vessel diseases induced worldwide response. He published basic monography of modern czech angiology 1959 — Vessel diseases in clinical practice.

1962 — establishment of the independent Czech Society for Gerontology at ČLS JEP. The fi rst chair-men of the society: B. Prusík (1958–1962), F. Bláha (1962–1963), J. Groh (1963–1967), R. Bureš (1967–1973).

1969 — establishment of the Outpatient Geron-tology Centre in Thomayer Hospital, led by J. Trojan.

1973 — Vladimír Pacovský becomes the chairman of ČGGS.

Prof. V. Pacovsky (1928–2012) — after his gradu-ation 1952 he started his activities at the III. Internal department of General Faculty Hospital and his entire professional life he devoted to that department, since 1969 as professor. He was a member of Czech Science Academy. He led the III. Department of Internal Medicine of Medical Faculty of

Charles University from 1970 to 1990. He was a dean of Medical Faculty of Charles University since 1985 and at the same time the vicerector of Charles

Univerity. He was one of main founders of gerontol-ogy and geriatrics and university education in nurs-ing. Professor V. Pacovsky wrote a modern textbook of internal medicine.

1974 — establishment of the Cabinet of Geron-tology and Geriatrics of Postgraduate Edu cation Institute. Heads of the Cabinet: V. Pacovský (1974–1990), J. Neuwirth (1990–1995).

1981 — K. Dohnal becomes the chairman of ČGGS (1981–1994)

In the 80s, the proportion of the old population increases signifi cantly along with increase in need of healthcare and welfare — this trend signifi cantly ac-celerated further development.

1983 — Geriatrics becomes an independent spe-cialty with a three-year education programme con-nected to the internal base with a specialty attestation. In this period also the fi rst gerontology textbooks were written — V. Pacovský was the author of the fi rst text-book.

Owing to the historically developed structure of inpatient departments, in 1983 the hospitals for long-term ill patients became the inpatient base of the spe-cialty. This connection, although corresponding to the reality, caused that since its origination the specialty has been wrongly identifi ed with the long-term care, nursery care and social issues. Unfortunately, up until the 90s it was not possible to enforce establishment of model geriatric clinics and departments which would develop particularly the acute geriatric care, such as that found in the world, including e.g. Slovakia.

1985 — Establishment of the Gerontology and Metabolic Department at Uni-versity Hospital Hradec Krá lové, directed by prof. Zdeněk Zadák.

1986 — establishment of the Centre of Geriatrics Pardubice, directed by Ivo Bureš.

1991 — Gerontology Information Centre at WHO in České Budějovice, initiated by J. Reban.

1993 — after splitting of the Czechoslovakia to Czech and Slovak Republics the association name was changed to the Czech Society of Gerontology and Geriatrics (ČGGS) of Czech Medical Society of Jan Evangelista Purkyně.

1994 — Jaroslav Přehnal becomes the chairman of ČGGS (1994–2003).

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1995 — The Cabinet of Gerontology and Geriatrics ILF was changed to the Sub-Department of Geriatrics at IPVZ with education bases in Prague and Zlín. The Heads: Jiří Neuwirth (1990–1998), Eva Topinková (1998 — to date) in Prague and Jaroslav Rybka, Jaroslav Přehnal and Milan Forejtar in Zlín.

1995 — establishment of the Department of Geriatrics at the University Hospital Brno — head Pavel Weber; in 1999 it becomes the university department.

Last decade of the 20th cen-tury saw development of geri-

atric departments which abroad represent the usual form of services provided to the senior population, and the results confi rm appropriateness of this way. Hospital departments of geriatrics provide (sub)acute bed care to especially risky old patients with multi-morbidity, reduced adaptability, endangered with the risk of specifi c geriatric complications. They concen-trate on early diagnostic and intensive care, with the intensifi ed parts of physiotherapy and nursing.

Patient’s stay in the geriatric department does not depend on the duration of stay or his/her social issue but — by analogy to the paediatrics — speci-alities of diagnostics and treatment of diseases in the senior age. Compared to «non-geriatric» depart-ments, stay in the department of geriatrics increases patient’s chances of survival, shortens the total dura-

tion of hospitalization and increases patient’s prospect of discharge. The result is improve-ment of the quality of care and simultaneous reduction of overall costs of health care. Since 2000, when the share of the elderly population reached 13.5 % and continued, the number of beds was again, mainly due

to economic reasons, to the current 400 beds in the whole Czech Republic.

2003 — an offi cial journal of the Society — Czech Geriatric Revue — starts to be issued. The edi-torial board consists of E. Topinková, I. Hol merová, B. Jurašková and H. Kube šová.

2003 — I. Holmerová becomes the president of the Czech Society of Geron-tology and Geriatrics (2003–2011).

2008 — a substantial change in the welfare system — the new law on social services be comes eff ective, which moves most of the economical burden generated by social care for the elderly to the municipalities and

the old people themselves. This trend results in reduc-tion of the number of qualifi ed general-practice nurs-es in the welfare facilities, due to economical reasons.

2011 — the journal Czech Geriatric Revue is no more issued because of discontinued cooperation with the publisher.

2011 — H. Matějovská Kubešová becomes the chair of the Society (2011 — to date)

2012 — renewal of publishing of the offi cial journal — in coop-eration with the Czech Medical Society J. E. Purkyně, under the title Geriatrics and Gerontology, as

a peer-reviewed quarterly journal.In view of other

me dicine specialties the geriatrics is a young spe cialty which is, how-ever consistently and constantly integrated in the general network of healthcare services due to ever-growing social need and order. Therefore the aim of the specialty is to im-

23


prove health care for patients of older and oldest age groups across all medicinal specialties, achieve im-provement of health conditions and functional ability of the elderly population and improve quality of life at the old age with all medicinal, social, ethical and economical consequences.

Current network of geriatric centres in the Czech Republic

Geriatric Department of the General University Hospital and 1st Faculty of Medicine at Charles University Prague

Head: Eva Topinkova, prof., MD, PhDThe Geriatric Department provides both out-

patient and inpatient specialized geriatric care for patients of older age from the region and super-consultancy care. The Geriatric Clinic specializes in prevention, diagnostics and treatment of the most frequent diseases of older age, evaluation of func-tional ability and self-suffi ciency. In addition to the diagnostic and treatment and physiotherapeutic care the emphasis is put on quality nursing care and holis-tic insight to the complex health and social issues of hospitalized elderly people. At present, the clinic has 74 beds available, out of which 54 beds is dedicated for geriatric care and 20 beds are used for nursing follow-up care. Specialized outpatient clinics: a general geriatric and internal outpatient clinic, a policlinic for wound healing and a policlinic for memo ry disorders.

In the department, the subject of geriatrics is taught in the fourth year of the master study of gen-eral medicine, in a form of one-week block intern-ship, and education of obligatory optional subject Geriatrics — Clinical Casuistics for the fi fth year of the general medicine study. Emphasis is put on inpa-tient clinical practice, diff erential diagnostics of the most frequent diseases in older age, development of communication skills and student’s ability of working and leading an interdisciplinary team. Practice in the department is completed with seminars, clinical dem-onstrations and students’ presentations.

In the clinic, the subject of geriatrics is taught for students of the third year of the bachelor study of

nursing, ergotherapy and physiotherapy. Students are led to a complex approach to elderly patient, inter-disciplinary and team work. Department provides organization of pre-attestation education — de-partment is accredited, therefore clinical internship and specialization courses are held here (Module I, Module II and Module III, course: Functional geriat-ric examination, course: Pharmacotherapy of elderly people). The department off ers postgraduate doctor-ate study of biomedicine-gerontology.

Department of Internal Medicine, Geriatrics and General Practice of Faculty Hospital and Medical Faculty of Masaryk University Brno

Head: Hana Matejovska Kubešová, prof., MD, PhDThe Geriatric Department was founded 1995

and on 1st October 1999 connected with the bach-elor specialty of nursing, and the Institute of Family Medicine into Department of the Medical Faculty of Masaryk University in response to the current de-mographic trends in development of our population. The aim is to develop the clinical gerontology as an independent science discipline, and to include teach-ing of the geriatric profession issues in all clinical spe-cialties, particularly the subject of general medicine. The Department with its bed capacity provides care for 1/3 of Brno inhabitants in the fi eld of internal medicine. At the beginning of September 2002 the Specialized Geriatric Outpatient clinic at KIGOPL started its activity, serving to the ill elderly as a clas-sical «internal» outpatient clinic. It also comprises a clinic for falls and a clinic for memory disorders. The subject of the interest covers above all specifi c geriatric syndromes. The issue of immobility, insta-bility, falls, incontinence, intellectual and some oth-er old-age related problems, which jointly form the above-mentioned geriatric syndromes, is monitored continuously. There is also targeted monitoring of the issue of old-age diabetes and its complications; the issue of insulinotherapy in diabetic patients over 75 years of age; the anaemic syndrome; immobiliza-tion syndrome and the issue of delirium conditions and Alzheimer dementia. The Department also pays attention to the issues of polypharmacotherapy at old age, in particular its adverse events and interactions

24


in relation to polymorbidity and age. In recent years, the department develops activities in the fi eld of pre-vention of geriatric syndromes in cooperation with elementary, secondary schools and universities.

The educational activities include postgraduate education of general medicine students and bachelor students in such specialties as general nurse, obstet-ric assistant, radiological assistant, medical rescuer in both full and combined form of study. The depart-ment is accredited for postgraduate education in the speciality of internal medicine, geriatrics and general practice medicine. Each year two traditional educa-tional events are held for medical and non-medical staff — The Brno Geriatric Day and The Brno Days of Practical Medicine in autumn months.

The Centre of Gerontology Prague

Head: Iva Holmerova, assoc. prof., MD, PhDThe District Authority in Prague 8 decided in

1991 to establish the Centre of Gerontology as its contribution organisation and health and social care provider. Prague 8 District has 106 thousands inhabit-ants (16 % 65 years old and older) and it is one of the major districts of Prague. One part of this district is situated on the Northern Terrace of Prague, where the Centre is situated. The Centre has been develop-ing its activities according to needs of Prague 8 in-habitants in order to assure continuity of a spectrum of health and social care services for older persons. Subsequently, the Centre has developed diff erent ser-vices. At present the Centre the new (2005) rehabili-tation unit with 35 beds for older patients who need further therapy and rehabilitation.

The unit of dementia care has 12 beds for older persons suff ering from Alzheimer´s disease and other forms of dementia in terminal phases, including those people with dementia who need rehabilitation and continuing therapy or management of behavioural disturbances and problems. The day care unit for per-sons with dementia (15 places) has been established in 1996, as the fi rst day care unit of this type in the Czech Republic. The team of the Centre has devel-oped in the collaboration with the Czech Alzheimer

Society (situated in the Centre) diff erent methods and tools for care of persons with dementia.

In-patient departments of the Centre are comple-mented by out-patient, home care and home help ser-vices. Home care nurses usually start to provide conti-nuity care by visiting patients during their stay in the rehabilitation unit. These nurses take over the care for patients and they continue in the rehabilitation and in the home environment. This service is supplemented by the medical aid lending service, by meals on wheels services, the alarm system etc. and also by home as-sistance services. The main aim of the Centre is to support older people, including those with complex nursing needs, in their home environment and enable them to stay there as long as possible.

Gerontometabolic Department of University Hospital Hradec Králové

Head: Luboš Sobotka, prof., MD, PhD

Dept. of GerontologyHead: Božena Jurašková, MD, PhD

An internal department providing both outpa-tient and inpatient treatment care with special focus on acute diagnostics and treatment of acute condi-tions at old age, treatment of patients with metabolic and nutritional disorders, intensive metabolic care, care for critically ill patients with internal diagnoses and internal complications of surgical and traumato-logical diseases. Diagnostics and treatment of internal diseases with special focus on internal disorders of the old age and the issue of pre-term ageing, diagnostics and treatment of renal diseases including treatment of acute and chronic renal failure via haemodialysis, peritoneal dialysis and continuous methods, follow-up and treatment of patients post transplantation of kid-ney, securing of patients who require parenteral and enteral nutrition, particularly in complicated situa-tions, special diagnostics and therapy of diseases of metabolism and nutrition.

The clinic consists of 2 intensive care units, inter-nal and geriatric, and 4 standard wards, metabolic,

25


nephrology, geriatrics and diabetology. The clinic also includes a haemodialysis centre and it is the technical base for interdisciplinary centre of diabetology, see also the Centre of Diabetology.

The clinic has general outpatient clinics and spe-cialized consulting outpatient clinics resulting from the profession profi le of the clinic. It is the base of a sub-department of diabetology, nephrology and gerontology for postgraduate education and the base for fi nal training and specialization of physicians and nurses in metabolism, nutrition and intensive care. It takes part in pre-graduate education according to the medical school schedule, and provides separately postgraduate education in all the above-mentioned specialties.

The Clinic is the base for clinical research focused on metabolism, clinical nutrition, gerontology, inten-sive care and diabetology and nephrology.

Centre of Clinical Gerontology, Zlín

Head: Milan Forejtar, MD, PhDThis facility has both inpatient and outpatient

part. It provides complex care for geriatric patients from acute care, subacute or aftercare with physio-therapy and nursing care. A part of it is also the DIOP department — long-term intensive nursing care. Duration of hospitalization in the Centre of Clinical Gerontology depends on patient’s health condition and a need of professional medical and nursing care. Once health condition is stabilized and the most pos-sible mobilization of patient is achieved discharge to the outpatient care is possible. The department holds regular educational courses. The educational courses are intended for the public, caregivers for dependent or disabled patients at home. They also include pre-sentations of basic nursing physiotherapeutic proce-dures, and guidance in appropriate medical aids.

The Centre comprises an inpatient ward with the total capacity of 184 beds which are placed in sev-eral buildings located in the central part of KNTB.Department of acute geriatrics (30 beds) dealing with diagnostics and treatment in particular of acute in-ternal diseases, acutely occurred chronic diseases and

decompensation of health and functional status in fl imsy elderly patients suff ering from multiple severe diseases and a risk of complications which worsen prognosis and self-suffi ciency of a geriatric patient. Department of subactue care with physiotherapy — long-term care hospital (LDN) (120 beds) follows overcome or stabilization of the acute phase of dis-ease with the aim to re-establish the previous self-suf-fi ciency or reduce dependency on a nursing person. When this status is achieved, patient is discharged to home care, even though with some medical or func-tional handicap.

Department of nursing (26 beds) for patients whose clinical conditions require professional nursing care supervised by a physician. Long-term intensive nursing care for patients with consciousness disorder and intensive care for respiratory tract (8 beds).

Geriatrics Department of University Hospital Olomouc

Head: Zdeněk Záboj, MD, PhDProvides care for older age patients mostly over

60 years of age, specializes in prevention, diagnostics, treatment of diseases, evaluation of functional ability and self-suffi ciency, physiotherapy. It is currently the only facility in the Olomouc District and neighbour-ing region which provides outpatient geriatric and in-patient care at the level of a clinical institution. The principles of a specifi c geriatric regimen are realized there — individually determined adequate diagnos-tics and therapy with the aim of the best possible im-provement of the quality of life, curing physiotherapy in the required range focused on improvement of self-suffi ciency, individually resolved health and social policy in the elderly including follow-up outpatient and inpatient care. Currently, the average duration of hospitalization in the Geriatrics Department is 14 days.

The Geriatrics Department primarily admits patients based on a consultation examination in all clinics and FNOL departments, and through a ge-riatric policlinic upon recommendation a general practitioner or specialist, provides curative and phys-iotherapeutic care, in particular in the states following a trauma, acute cerebrovascular and cardiovascular

26


events, with chronic cardiovascular and neurological problems, gastrointestinal, kidney and endocrine dis-eases, following orthopaedic, surgical, cardiosurgical and neurosurgical operations.

The geriatric outpatient clinic provides diagnostic and curative activities in the fi elds of geriatrics and internal medicine, consultation examinations, special-ized counselling clinics — nutritional, geriatric, nurs-ing and treatment of chronic wounds, memory dis-orders, incontinence and targeted pharmacotherapy.

The department provides education in general and specialized geriatrics, internal propedeutics and nursing in medical and non-medical branches of study in pre-graduate and postgraduate preparation of students in full or combined form of study in LF UP, FZV UP. In the department a practices of nurses studying at the Secondary Medical School, Advanced Vocational School, Dorkas, Caritas has been estab-lished. It also participates in the research of geriat-ric and nursing care. The Geriatrics Department at FNOL is an accredited workplace of type II for edu-cation in geriatrics and long-term care and partici-pates in education of physicians prior to their attesta-tion in the internal medicine.

Geriatric and Physiotherapeutic Centre in Kladno

Head: Helena Pomahačová, MDProvides medical services particularly, but not

limited to, for patients in the Central Bohemia in a region with approx. 200 000 inhabitants. It was built as a new facility in 1988 and extended gradually to its current form with 152 medical and 22 social beds, a home care agency and several outpatient clinics. The aim is to provide interrelation of services from dis-charge from an acute care ward in neighbouring hos-pitals — inpatient treatment and physiotherapy — to long-term care at the place of residence via home care or outpatient clinics. It focuses on rendering of post-acute treatment to patients who can profi t from the specifi c geriatric regimen (old and chronically ill people). Patients are given complex care including physiotherapy, mostly for the period of several weeks

to months. During hospitalization, they are also of-fered help in solving of their social situation, although due to lack of rooms in old-people’s homes and in-suffi ciently developed terrain services it is not always easy. Once discharged, the patients living in close distance can also use services provided by our own home care agency which agrees with the patient and his/her attending physician on the scope of required services before his/her discharge. Some patients may become for some transient time — till they resolve their social situation — the clients in the social beds.

Medical services at the Geriatric and Physio-therapeutic Centre are rendered by a team of medi-cal staff consisting of physicians of several specialties, speech therapist, psychologist, social worker, physio-therapists, nurses, nutrition therapist, assistants and paramedic; 190 full-time and part-time employees.

Geriatric Centre Pardubice

Head: Ivo Bureš, MDThe facility was established in 1987. In 1993

along with increase in needs of medical care for se-nior people is was changed to the Geriatric Centre which provides complex medical care. The inpatient part /70 beds/ is divided into acute geriatric beds and follow-up care beds / long-term care. Outpatient clin-ic services are also developed, including a home care department, and we also had our own general practi-tioner. Currently, the development of the spectrum of outpatient clinic services continues. A geriatric outpa-tient clinic deals with the group of polymorbid old pa-tients, dementia patients, off ers consulting services for care givers. One of the outpatient clinics deals with treatment of chronic wounds. In addition to physi-cians and nurses, also medical assistants, attendants, paramedics, physiotherapists, speech therapists, social workers take part in the care for senior people. In the facility we also deal with educational activities, we teach gerontology and geriatrics at university which educate non-medical healthcare specialists, we coop-erate with a secondary medical school, teach at a so-

27


cial high school. A number of physicians and nurses give lectures in national and international congresses and publish their articles. The institution achieved accreditation of the highest degree for postgraduate education of physicians.

Long-Term Care Hospital Klokočov

Head: Milan Stolička, MD, PhDLocality. Long-term (LDN) Klokočov is a de-

tached facility of the University Hospital Ostrava. It is located near the town Vítkov, in Moravian-Silesian Region at the altitude of almost 600 meters, im-bedded in the picturesque countryside of the Nízký Jeseník range.

Capacity: 140 beds of follow-up care, 20 social beds.

Spectrum of care. The nursing home for long-term ill people in Klokočov has been in operation since the seventies and is a typical regional facility, providing the follow-up medical, physiotherapeutic, nursing and palliative care for patients coming from the University Hospital Ostrava and other inpatient and outpatient medical facilities in the Moravian-Silesian Region. The facility has high-quality tech-nical- and personnel-equipped centres of curative physiotherapy, including an optional application of a wide spectrum of curative procedures (curative physical education, ergotherapy, application of physi-cal procedures — electrotherapy, magnetothereapy, ultrasound, hydrotherapy, paraffi n, gas injections, laser scanner, inhalation). Physiotherapy is focused on treatment of motor apparatus disease, condi-tions post cerebral events, post traumas. The facil-ity cooperates with a range of clinical centres of the University Hospital Ostrava. Within the nursing care a programme of prevention and treatment of pres-sure sores and treatment of chronic wounds is devel-oped. In 2010 the nursing home which is a part of the University Hospital Ostrava, was granted an interna-tional accreditation JCI and in 2013 reaccreditation of it.

Department of Geriatrics and A� ercare of Hospital Opava

Head: Ingrid Ryznarova, MDInpatient part. The Department of Geriatrics

and Aftercare provides the follow-up care. Patients are admitted via transfer from acute departments in the hospital after stabilization of their acute state or upon referral from a general practitioner or a spe-cialist from home. The specialty has a wide focus and deals with both the issue of internal complica-tions or functional decompensation which occurs in old people during an acute disease or after a surgi-cal intervention. The aim of the hospitalisation is the stabilization of worsened health and functional state of elderly polymorbid patients. These patients are in danger of complications, unfavourable prognosis, loss of self-suffi ciency and increasing dependency. We perform preoperative preparation of polymorbid ge-riatric patients for planned surgical procedures. Our care is based in the assumption, that recovery abilities and metabolism are protracted and limited at old age, and changes in proportions of muscle, fat tissue and water occur. Well prepared patient is able to better undergo the post-surgical care, both in terms of mo-bility and nutrition. As for the age range, our patients belong to the older category but also hospitalized here are younger patients, e.g. following trauma.

Outpatient part provides care for patients with osteoporosis in the osteology out-patient department, patients with malnutrition or in a risk of malnutrition of within the frame of pre-surgical preparation in the nutritional out-patient department.

A health-social worker at the department of ge-riatrics and follow-up treatment provides compre-hensive social-legal and social-health counselling, including the particular social help. When a patient is admitted, the worker fi nds out data personal, oc-cupational, family, medical and dwelling situation of patients and their families, makes analysis based on objective evaluation of the received data, and deter-mines the social strategy.

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Long-term Care Hospital in Valtice

Head: Olga Měšťánková, MDThe Valtice Hospital is found in the very centre of

the known historical town, in beautiful baroque prem-ises with their own garden. It provides services of a long-term care in the form of standard wards and one luxury ward. Within the scope of social services it pro-vides the so-called «social beds». Dependent geriat ric patients with endangered or lost self-suffi ciency in basic everyday activities are provided with complex team care, in which continuity, good coordination and active approach is necessary. The aim of our care is our endeavour to maintain patients’ quality of life. We put big emphasis on qualifi cation of medical staff (continuous education, registration of nurses, special-ty study, university study, professional seminars, certi-

fi ed courses), so that we are able to provide services at really above-standard level. For eff ective activation of the client we have a top-quality physiotherapeutic team available. Quality of the care is markedly sup-ported by new technologies in antidecubitary systems, disposable aids for incontinent patients, quality heal-ing cosmetics, new approaches in the procedure of wet healing of chronic wounds. Monitoring of nutri-tional screening of our patients is considered a stan-dard procedure. Our medical facility is equipped with oxygenators, infusion pumps and a shower bed.

Current board of Czech Society of Gerontology and Geriatrics:

President: Hana Matějovská Kubešová;Vicepresidents: Pavel Weber, Iva Holmerova,

Božena Jurašková;Scientifi c

secretary: Eva Topin kova; Treasurer: Alena Jiroudkova; Members: Milan Forejtar,

Helena Pomahacova, Ivo Bureš, Zdeněk Zaboj, Jiri Zajíc, Ladislav Kabelka, Iva Dole zelova;

Control comitee: Lubomír Grepl, Milan Stolička, Ingrid Ryznarova


29

Finland has 3 national societies related to geron-tology and geriatrics, and they are in the age or-der: The Finnish Gerontological Society (Societas Gerontologica Fennica, SGF), The Finnish Society for Growth and Ageing Research (Kasvun ja van-henemisen tutkijat, KaVa), and Finnish Geriatricians (Suomen Geriatrit, SG). A summary of each society follow, in addition, the history of geriatrics and social gerontology in Finnish universities and geropsychiat-ry in Finland is presented.

Finnish Gerontological Society (Societas Gerontologica Fennica, SGF)

General history

Multidiciplinary Societas Gerontologica Fennica (SGF) — the Finnish Gerontological Society — was founded in 1948 to promote scientifi c ageing re-search in Finland. Founding members included many authorities from various fi elds. First president was archatry (arkkiatri, the most prominent physician in Finland, one at a time) Oswald Renkonen. First sec-retary was professor Eeva Jalavisto, who later proved to have a very central role in the SGF and Finnish ageing research.

The SGF yearbook Geron started in 1949. At fi rst it was in Finnish, later in English, and contin-ued to be published until 1985. SGF also promoted the birth of practical geriatric activity in Finland, and in 1952 started an ambulatory clinic for older people in Helsinki. SGF also co-operated to launch the fi rst support offi ce for older people.

«The Mother of Finnish Geriatrics» professor Eeva Jalavisto was a remarkable gerontologist of her time. She was both a biogerontologist as well as a practicing geriatrician, she also wrote many articles about older people and their treatments. In order to highlight her outstanding work, SGF has organized several Eeva Jalavisto-symposia and given the Eeva Jalavisto Award to several investigators in the fi eld

of gerontology (latest professor Timo Erkinjuntti in 2014).

When the SGF turned 50 years in 1998, one of the highlights was the Congress of the IAGG European Region Clinical Section in June 1998 in Helsinki with the general theme «Evidence based medicine in the Elderly». Another important event in 1998 was the special Eeva Jalavisto-symposium, which displayed contemporary gerontological research in Finland.

The SGF has been Finland’s channel to inter-national gerontological co-operation, especially in the Nordic arena with the Nordisk Gerontologisk Föreningenissä (NGF). With other Finnish geronto-logical and geriatrics societies, SGF has organized the Nordic gerontological congresses in 1977, 1986, 1996 and 2006, next one will in 2016 in Tampere ((see http://23nkg.fi /). Representatives of SGF have also been active in organizing the Nordic Gerontological Research School, which started in 2002. SGF has its representatives in the International Association of Gerontology and Geriatrics (IAGG) and its Europe Region. SGF also had a representative in the European Union Geriatric Medicine Society (EUGMS) Full Board up to 2013, whereafter Finland is represented in the EUGMS by the Finnish Geriatricians (SG). The current president of the SGF, professor Timo Strandberg serves as the President of the EUGMS in 2014–2015.

SGF is a member of the Finnish Scientifi c Societies.

Aims

SGF aims to foster multidiciplinary scientifi c re-search in gerontology and geriatrics and promote wide scientifi c cooperation. To do this, SGF:

• organizes scientifi c symposia and training ses-sions

• promotes research with fi nancial support to in-dividuals

• promotes discussion of scientifi c matters in its meetings promotes publications in gerontology and


GERONTOLOGY AND GERIATRICS IN FINLAND. Societies and Development in Finnish Universities

Timo Strandberg

30


geriatrics, and since 2011 cooperates with other soci-eties to publish the Finnish journal Gerontologia

• maintains the website Gernet (www.gernet.fi ) with Finnish Geriatricians.

Current activities

SGF aims to be a link between gerontological research and practice. It cooperates with other non-profi t organizations in Finland (Vanhustyön keskusli-itto, Suomen Geriatrit, Kasvun ja vanhenemisen tut-kijat, Ikäinstituutti, Suomen Kuntaliitto).

Scientifi c symposia, training sessions, activity on the internet and annual one-day symposium in spring are core functions of the SGF. SGF produces a news-letter to members several times a year. The society also aims to develop geriatrics sessions for various national medical meetings. SG cooperates with other societies in organizing every 3 years a national «Gerontology Days», a 2-day meeting in late spring.

Members

SGF has currently ca. 250 members from all areas of gerontology. Everyone interested in gerontological research can apply for membership, approved by the SGF executive board.

Current president (since 2001) is professor Timo Strandberg ([email protected] ) and secreta-ry Sirpa Immonen, PhD ([email protected] ).

The Finnish Society for Growth and Ageing Research (Kasvun ja vanhenemisen

tutkijat, KaVa)

The Finnish Society for Growth and Ageing Research was founded in 1980 with the idea of wid-ening the scope of ageing studies to cover various life-stages in investigating human growth and ageing. Alongside the strong emphasis of a life-course per-spective the society wanted to stress the importance of interdisciplinarity in gerontology. Professor Eino Heikkinen was the fi rst president of the society and Dr. Pertti Pohjolainen its fi rst secretary. Most of the young researchers who founded the society more than three decades ago have later become leading scholars in various fi elds of gerontology. The society is aimed at all researchers and operatives in the gerontological fi eld. There were about 350 members in the society at the end of the year 2013.

Particular aims of the society are to• promote premises of good ageing and distribu-

tion of knowledge about ageing

• promote scientifi c research on human growth and ageing throughout the life-course and the appli-cation of research fi ndings in practices and policies relating to ageing

• organize scientifi c conference and seminars, de-velop training and participate in societal discussion on ageing

• assemble researchers interested in ageing as well as teachers, students and various professionals of the fi eld

• participate in international research collabora-tion on human growth, ageing and life-course

One of the key aims of the Society is to promote publishing multidisciplinary scientifi c research on ageing in Finnish language. The Finnish Society for Growth and Ageing Research has been publishing Gerontologia (Gerontology) journal since 1987 (4 issues/year). The journal is the only Finnish scientifi c geron-tological journal and has appeared to be an important forum for collaboration between researchers, teach-ers, students, offi cials, NGOs and representatives of social and health care. Gerontologia is a peer-reviewed scientifi c journal which publishes original articles, reviews and commentaries on ageing in Finnish and Swedish languages. The articles approach human life-course, ageing and old age from several diff erent perspectives, and the authors represent multiple dis-ciplinary backgrounds ranging from social sciences and psychology to health, sport and medical sciences. Alongside scientifi c research the journal provides its readers with information about new developments within elder care, introduces latest gerontological lit-erature and also off ers a channel for critical discussion and debate. Since 2011 Gerontologia has been a mem-bership journal of the Finnish Gerontological Society, Finnish Geriatricians and The Finnish Society for Growth and Ageing Research.

The society is a member of the Finnish Scientifi c Societies and closely collaborates with other associa-tions, research and training institutions and universi-ties. One of the key partners is Gerontology Research Center, a collaborative eff ort in ageing research jointly run by the University of Jyväskylä and the University of Tampere (see www.gerec.fi /en). The so-ciety also collaborates with the Nordic Gerontological Federation (Nordisk Gerontologisk Förening, see www.ngf-geronord.se) by, among others, participat-ing in organisation of the Nordic Conferences of Gerontology, next time in Tampere, Finland, in 2016 (http://23nkg.fi /). The society has had a central role in organisation of national conferences of gerontolo-

31


gy that have been arranged as joint projects by Finnish gerontological societies every 3 years since 1992.

Current president of the society is Dr. Ilkka Pietilä (University of Tampere) (ilkka.pietila[at]uta.fi ) and secretary Jari Pirhonen (University of Tampere) (jari.pirhonen[at]staff .uta.fi ).

Finnish Geriatricians (Suomen Geriatrit, SG)

Before the number of geriatricians started to grow, geriatricians in Finland were loosely organized under the umbrella of the Finnish Medical Association. The executive board circulates in 5 cities with medical fac-ulties (Helsinki, Turku, Oulu, Kuopio and Tampere) and the period is 3 years. The board has organized a national geriatric survey in 2001, 2008 and 2013 and the results have been published in the Finnish Medical Journal. Since 2003 the Board has annually organized national «Geriatrics days», a 2-day meet-ing at end of January.

The increasing activity and number of members required a formal society and Finnish Geriatricians was formally established and registered in 2009. All medical doctors specialized or specializing in geriat-rics can apply for membership, current number is ca. 300.

SG cooperates with other societies in the jour-nal Gerontologia and on the website Gernet (www.gernet.fi ), and organizes every 3 years a national «Gerontology Days», a 2-day meeting in late spring. Since 2013, SG represents Finland in the Full Board of the European Union Geriatric Medicine Society (EUGMS). In the Nordic arena SG cooperates with other societies in the Nordisk Gerontologisk Föreningenissä (NGF), and organises with other so-cieties the 2016 Nordic Conference of Gerontology in Tampere.

Current president is Marja-Liisa Laakkonen, MD, PhD, and secretary Sanna Liitsola, MD.

Geriatrics in universities

Academic teaching of geriatrics started gradu-ally in Finland during the 1960s–1970s with lectures of geriatrics for undergraduate medical students. Pioneers in the fi eld were Drs. Ilmari Ruikka and prof. Leif Sourander in Turku, Dr. Juhani Salokannel in Oulu, Dr. Lauri Autio in Helsinki and Dr. Rauno Heikinheimo in Tampere. In 1979 geriatrics was es-tablished as a subspecialty of internal medicine, psy-chiatry and neurology. Geriatrics as a principal spe-cialty was founded in 1985. In contrast to many other countries, teaching and training of medical specialties have belonged to the duties of universities.

The fi rst ordinary professor of geriatrics was nominated at the University of Turku in 1984 (Leif Sourander). Gradually all fi ve medical faculties re-cruited full-time ordinary professors for both teaching and research (see table).

Professorship of gerontology was established at University of Tampere already in 1975. This post (Eino Heikkinen 1975–1979, Antti Hervonen 1983–2010, Marja Jylhä 2004–) has also been responsible for geriatrics education in Tampere.

Apart from professorships other resources for ge-riatric education and research have been limited in all universities. Consequently, the research has been mainly supported by funds and non-governmental organizations. The Turku Aging Study started in early 1960s (Sourander L. B., Ruikka I., Kasanen A., Tuomi E.: Cardiovascular diseases in persons aged 65 years and over in Turku. Ann Med Intern Fenn. 1967; 56 (1): 9–14.) is perhaps the fi rst geriatric research re-port in this country. Since then all academic centers have conducted population-based cross-sectional and longitudinal studies, some of them lasting already for over forty years.

The major research topics include clinical trials of diff erent treatments and rehabilitation models in Helsinki and Oulu, whilst other centers have focused

Ordinary Professors of Geriatrics in Finland

Helsinki Kuopio (University of Eastern Finland) Oulu Tampere Turku

Reijo Tilvis1986–2011

Raimo Sulkava1993–2013

Petteri Viramo (acting professor)

2003–2005

Jaakko Valvanne2010–

Leif Sourander 1984–1996

Timo Strandberg2012–

Eija Lönnroos (acting professor)

2013–

Timo Strandberg2005–2012

Aapo Lehtonen1997–1999

Riitta Antikainen (acting professor)

2012–

Matti Viitanen2003–

32


more on cognitive disorders. Gerontological research including population-based studies have been con-ducted in Jyväskylä (no medical faculty, professors Eino Heikkinen and Taina Rantanen) at gerontol-ogy research center (GEREC) that is jointly run by the University of Jyväskylä and the University of Tampere. Fortunately, some professors of general medicine (professor Sirkka-Liisa Kivelä and professor Kaisu Pitkälä) have strongly oriented to geriatrics that has brought fruitful accretion to the geriatric research in Finland. In Jyväskylä, also research on musculoskel-etal aging and physical exercises has been performed (profesors in exercise gerontology Harri Suominen and Sarianna Sipilä).

In 2014 there are ca. 300 specialists of geriatrics in Finland (pop. 5.5. million). They work at all levels of health care, from primary care to university clinics. Main areas are memory clinics, acute care, geriatrics ambulatory clinics, and rehabilitation.

Social Gerontology in universities

The research community of social and cultural gerontology is mainly organized within the Finnish Society for Growth and Ageing Research. There have been three chairs of social gerontology in Finnish universities, but, paradoxically enough, academic resources are shrinking just now when the needs to study social implications of diff erent kind of popula-tion ageing and related socio-political challenges are increasing.

In University of Jyväskylä, there are long tradi-tions of sociological ageing research, founded by Faina Jyrkilä, professor in sociology (1964–1984). Social gerontology has been taught since 1994, in connection with sociology, with Marjatta Marin as the fi rst professor. Her successor professor Jyrki Jyrkämä (2001–2013) has had a strong infl uence in the Finnish research community especially through developing theory of agency. When he retired, the chair was not fi lled any more. In University of Lapland, the fi eld the of professorship was renamed gerontological so-cial work when Marjaana Seppänen, the current edi-tor in chief of Gerontologia, followed Simo Koskinen (2000–2005) and Marja Vaarama (2005–2008) as professor. However, the bulk of teaching and research in the chair is still connected to social gerontology. In University of Helsinki, Antti Karisto has been work-ing as a professor of social gerontology (2002–) in social policy, with a broad range of research themes, such as the baby boomers and retirement migration. However, his chair is not permanent, and there are no

guarantees of its continuity. University of Tampere and University of Eastern Europe lack chairs in so-cial gerontology, although a lot of social and cultural gerontology-oriented research is done also in these universities.

Social gerontology is a multidisciplinary fi eld, where relevant research is made in many disciplines. Also research institutes outside universities act as important bases for social gerontology, and, on the whole, the Finnish community of social gerontology is relatively strong. Research is directed to macro-level issues of population ageing but also to varied micro-level themes of individual ageing. In addition to the most evident research subjects — such as health and wellbeing, care and pension policy — iridescent themes are investigated, such as biographies and life courses, third age activities and life styles, ageing in place, gerontechnology, ethical issues, generations and reciprocity between them. Research is based on quantitative longitudinal data but also on diff erent kind of qualitative data, and the mixed method ap-proach is increasingly utilized.

Geropsychiatry in Finland

Until the late 1970s older adults with severe men-tal disorders and dementia were treated in psychiatric hospitals and nursing homes. Outpatient services and mental health community care were rarely available. Specialized geropsychiatric services evolved in late 1970s when the proportion of elderly people was for the fi rst time substantially increasing in Finland. At the same time, assessment and treatment for demen-tia syndromes was removed from psychiatry to neu-rological and also to evolving geriatric services. After emerging of acute geropsychiatric wards, the geropsy-chiatric outpatient services were started in the 1980s and 1990s. Geropsychiatrists are nowadays active in consultation and co-operation with primary care and collaborate with other specialties such as neurology and geriatrics. They are responsible for services pro-vided in specialized geropsychiatric in- and outpatient service units.

The development of geropsychiatry was support-ed by the introduction of geriatric subspecialty within psychiatry in 1978. The number of trained geropsy-chiatrists remained, however, limited. The geropsy-chiatric subspecialty was abolished in 1998 as a part of the EU-triggered integration of training programs. Since 1998 geropsychiatry has been taught as a part of the specialist training in psychiatry. Universities of Oulu, Tampere and Helsinki provide an additional

33


two-year module for geropsychiatry including train-ing in geropsychiatric consultations and clinical hos-pital and outpatient care. The trainees participate in theoretical seminars and take a formal examination at the end of the training period. In 2013, Helsinki University appointed the fi rst professor in geropsy-chiatry (prof. Hannu Koponen) to promote psychoge-riatric training and research.

Geropsychiatric research in Finland has been multifaceted. Research on neuropsychiatric themes has focused on neuropsychiatric syndromes such as neurocognitive impairment related to chronic schizo-phrenia or alcohol use disorder. In addition, recently a series of papers have been published on the predis-posing eff ect of dementia to delirium. On the other hand, geropsychologists have directed their research on old age depression and development of person-ality at diff erent age periods including also old age. There is also a continuing research interest in psycho-therapeutic work methods. Currently running Finnish research projects also focus on anxiety disorders in the elderly, schizophrenia in old age and very late-onset psychoses.

The future challenges are related to the rapid increase of the very old population, the national re-structuring of health services and ongoing organi-zational changes in psychiatric service system. The national plan for mental health and substance abuse work defi nes the core principles and priorities for the future of mental health and substance abuse work until 2015. The plan starts from the premises that

mental health and substance abuse problems have great signifi cance for the public health. For the fi rst time the plan outlines common national objectives for mental health and substance abuse work. Old age mental health services are mentioned in the program that emphasizes integration of the services. Although the number of old age psychiatrists in Finland is still low, the service model is multidisciplinary and collab-oration with nurses, psychologists, social workers and other professionals is well established. In addition, the importance of collaboration with service users and carers is recognized. Among the challenges are work-force availability and diminishing fi nancial resources.

Biogerontology in Finland

Over several decades this important area has been covered in several universities and research institutes in Finland, often in multidisciplinary collaboration. Topics include basic research in genetics, mitochon-drial function, musculoskeletal physiology, neurode-generative and vascular diseases. Developments have been recently covered in a review (Strandberg and Sipilä 2011).

LiteratureStrandberg T. E., Koistinen P., Antikainen R. et al. Increased

work-satisfaction amongst geriatricians in Finland — an encourage-ment for further development of the specialty? Survey among geri-atricians in Finland in 2008. Europ. Geriatr, Med, 2010; 1: 73–76.

Strandberg T. E., Sipilä S. Biogerontology in Finland. Bioge-rontology. 2011; 12: 71–75.

www.eugms.org


34

Aging process is very heterogeneous, because a number of diff erent factors (biological, genetical, so-cial, familial) play a remarkable role, as well as frailty, disability and cognitive impairment. Some important questions are:

1) Which is the role of out-of-hospital geriatrician?2) Who is out-of-hospital geriatrician and why is he

important in old people care?3) How can he manage in fulfi lling his role?4) What are the possible pitfalls in elderly people

management in out-of-hospital setting?In Italy in 1951 over-65 year-old people were 8 %

out of the general population, whereas in 2011 they have become 19.6 % and remarkably over-70-year old people are 14.5 % out of the general population. They are expected to become 23.9 % in 2023 and 34.4 % in 2050. At that time life expectation will be 86.6 and 88.8 years old for men and women respec-tively (1).

On the other hand our care system, guaranteed by our welfare system (both social and health) will have to confront with the care needs related to aged population. This may be attributed to the equation

Aging : comorbidities = chronicity : disabilityFurthermore, aging population is linked to the in-

crease in health care spending; Health Care System needs to plan primary care for elderly people in out-of-hospital setting. In other words, this means that ter-ritorial health care in our country will come to have a key role, thus becoming more and more important in the coming years. The hospitals will keep their role in taking care of patients aff ected with diseases in the acute stages; this is the model of «on demand» health care. On the contrary, out-of-hospital setting plays an important role for chronic diseases manage-ment. Almost half of all people with chronic illness have multiple conditions. The future will be the trans-formation of health care, from a system that is essen-

tially reactive — responding mainly when a person is sick — to one that is proactive and focused on keeping a person as healthy as possible (the so called «initiative health care»). This will lead to overcome a number of defi ciencies, such as rushed practitioners not follow-ing established practice guidelines, absolute lack of care coordination, lack of active follow-up to ensure the best outcomes and patients inadequately trained to manage their illness (2).

This new route implies diff erent organization and planning, both professional and especially cultural, a new defi nition of health care models and the revision of the role of territorial (or out-of-hospital) geriatri-cian. Territorial geriatrics is perhaps the most well-oriented and leading specialty in the fi eld of medicine. Furthermore, geriatrics per se carries forward the idea of possible well-being; anyway, this does not mean the absence of disease, rather being the possible outcome of regain the lost skills in the activities of daily living. Of course, the target is quite diff erent compared to young people, where the aim is recovery.

In facing chronic diseases and frailty, the most im-portant professional tools result to be the multidimen-sional assessment of care needs and, in particular, the personalization of care pathways.

Some remarkable prerequisites are undoubtedly a familiar cultural way through multidimensional assessment tools and the ability to integrate his own work with other health and non-health professionals. The ability must be high both in the detection of care needs and in the following caring of elderly people. In particular, territorial geriatrics has historically opened a new runaway, focusing specifi c tools and privileging multidisciplinary and multi-professional work.

Therefore, from these cultural premises the nec-essary and «physiological» baggage typical of out-of-hospital geriatrician can be summarized as follows:

• use of multi-dimensional assessment;


OUT-OF-HOSPITAL GERIATRICS IN ITALY: DEFINING IT AND SEARCHING FOR TOOLS AND STRATEGIES

Pietro Gareri*, Salvatore Putignano**

* AGE (Associazione Geriatri Extraospedalieri) Italian Advisory Board Council, ASP Catanzaro, Catanzaro, Italy; ** AGE Italian President, Naples, Italy

35


• ability to integrate other professionals, not only belonging to the healthcare universe itself.

Clinical skill is enriched with, fi rst of all, a cultural added value, which can have direct welfare implica-tions and should be the guide for all the other health-care territorial professionals.

As above mentioned, it’s partially simple to iden-tify the role of hospital geriatrics, the aim of which is to treat acute diseases. On the contrary, identifying the role of out-of-hospital geriatrician is much harder for the extreme variability and complexity of the dif-ferent care settings:

• ambulatory care;• home care;• half-residential and residential care;• intermediate care.In other words, putting apart other specifi c geriat-

ric skills, (such as working in Dementia care), the main characteristics of out-of-hospital geriatrics are quite diff erent from those one belonging to other medical specialties. For example, the role of geriatrician must not be restricted to mere consultant activities. In our country it’s important for out-of-hospital geriatrician to test the various care settings together with all the other territorial actors (i.e. caregivers, nurses, general practitioners, social workers, hospital health workers, etc.). He must become a professional health worker who represents a crucial meeting point in the network services. This means for him to have a leading role in elderly care, that is the director of the continuity of care and the one who is really able to manage the health complexity typical of elderly people aff ected with comorbidities and often poly-treated. This also means that out-of-hospital geriatrician is the true elderly patient’s care manager, moving his clinical re-sponsability from a consultant role (typical for other specialties) to a role in coordinating care.

This role is only apparently in contrast to the sys-tem keeper, typical for the general practitioner; in fact, both in home and residential care, caring elderly pa-tients with high health complexity is extremely chal-lenging. The concept for a geriatrician is not treating but caring an elderly patient; the main challenge is to try preventing the loss of autonomy and promoting the continuity of care through multidimensional as-sessment and multi-professional teams. We can say it loud, it’s a typically geriatric skill!

Furthermore, comorbidities and poly-treatment together with the increasing social and personal needs, require clinical and assessment knowledge which sometimes go beyond the skills and the possible engagement of general practitioner.

Social demographic transformation, chronic dis-eases and the onset of new care needs urges the defi -nition of new care models possibly capable to face chronicity epidemic; for example, as already said, brand new models ought to be oriented towards ini-tiative medicine.

The geriatrician’s care context and the frequent elderly frailty is included between health and social (sometimes prevalent) needs. This context cannot be fragmented at all, in other words care needs must be never faced separately, but as a whole. Frail elderly people with their complex care needs assume the building of care models which are quite diff erent from those one we are used to deal with and to move inside.

Chronic care management requires appropri-ate skills, because geriatrician needs to compete with more complex care settings than traditional ones and he needs to be conscious of his new role in a health subsystem which is only a part of a more complex system. In other words, geriatrician needs:

• to make use of all the community resources;• to follow the multidimensional assessment; to

this aim, he personalizes the care interventions;• to make use of multiprofessional teams;• to use all the information for modulating or re-

modulating the interventions;• to stratify cared people according to their level

of complexity;• to make use of the proactive role of the cared

people (and/or their family).Furthermore, it becomes questionable whether

there are two diff erent kinds of geriatrics, hospital and out-of-hospital geriatrics. Undoubtedly geriatrics needs to maintain its unicity, even if there are diff er-ent roles. On the contrary, unicity represents one of the most important cultural and operative requisites that geriatrics must keep for allowing the continuity of care. For example, especially for frail elderly peo-ple, a logical process could be moving them from the out-of-hospital care setting to the hospitals and vice versa in a dynamic and fast process where care needs, both social and health, can rapidly and continuously change. A breakthrough is surely represented by the protected hospital discharges in the integration pro-cess between hospital and out-of-hospital care set-tings. To this aim territorial geriatrician must have an active and purposeful leading role, also through ser-vices computerization and close cooperation with the general practitioners. This process could have positive impact on those wrong hospitalizations involving peo-ple with prevailing social rather than health problems. Therefore, specifi c geriatric care is strongly requested

36


and needs appropriate planning of network services and boosting availability of out-of-hospital geriatri-cians. In fact, an appropriate implementation of ter-ritorial geriatrics could also allow resources saving, for example through the implementation of home care.

The whole process requires multidimensional as-sessment scales, i.e. VAOR (MDS/RAI — Minimum Data Set/National Nursing Home Resident Asses s-ment Instrument) scale, both for home and resi dential care (3), VALGRAF (VALutazione GRAFica) (4) and SVAMA (Scheda di Valutazione Multi dimensionale dell’Anziano) scales (5). We cannot say to have an ideal scale, anyway the most appropriate scale should meet some requirements:

– completeness in the area analyses;– ability to summarize the information;– balance in the diff erent areas study;– scientifi c foundation;– ease of use;– ability to detect the care needs.Defi nitely, those tools must work in managing the

possible critical care needs, i.e. infections, malnutri-tion, iatrogenic damage, falls, heart failure, dementia and immobility.

The future perspectives will be represented by Home care and Telecare which will allow safe home management both through wireless technology and electromedical instruments for people unable to leave their home (portable ultrasound and echocardio-graph, Doppler ultrasound, etc.) (6).

Last but not least, elderly patients need to tell their own story, the experience transformed and clinging in life memories. More than every other person, elderly patient needs a special care need, that is to be listened. As Professor Marco Trabucchi says «…Listening is al-ready caring…the story told allows to place pain in-side a multifaceted life, preventing it from taking up

all the hidden spaces of existence, which remain open and vital just through the stories….» (7).

We conclude with a true poster of our discipline through the words of Professor William R. Hazzard (Unit of Gerontology and Geriatric Medicine — University of Washington, School of Medicine) (8): «..My most typical patient is the old-fashioned picture of frailty, a man, or more often a woman, who lives on the razor’s edge between indipend-ence and triggering a tragic cascade of diseases, disabilities, and complications that all too often prove irreversible… As a geriat-rician, I am by defi nition an expert in subtlety and complexi-ty…. I am acutely aware of the interaction between physical, psychological, and social factors that aff ects the lives of each of my elderly patients. Because the care of my patients is so de-manding and so complicated, I often work with family members and other professionals who contribute to the care of my patients and try to orchestrate the best care as their primary physician».

References1. ISTAT — Tendenze demografi che e trasformazioni sociali nu-

ove sfi de per il sistema di welfare – Roma, 2014.2. Putignano S., Cester A., Gareri P. Geriatria nel territorio —

un metodo per i vecchi, per i medici e per il futuro….(book). Critical Medicine Publishing s.r.l., Roma, 2012.

3. Lattanzio F., Mussi C., Scafato E. et al. Ulisse Study Group. Collaborators 138 (..Gareri P.….). Health care for older people in Italy: The U. L. I. S. S. E. Project (Un link informatico sui servizi sanitari esistenti per l’anziano — a computerized network on health care services for older people). J. Nutr. Health Aging, 2010; 14(3), 238–242.

4. Pascazio L., Morosini P., Bembich S. et al. Description and validation of a geriatric multidimensional graphical instrument for promoting longitudinal evaluation. Arch Gerontol Geriatr. 2009 May–Jun; 48(3): 317–324.

5. Pilotto A., Gallina P., Fontana A. et al. Development and val-idation of a Multidimensional Prognostic Index for mortality based on a standardized Multidimensional Assessment Schedule (MPI-SVaMA) in community-dwelling older subjects. J. Amer. Med. Dir. Assoc. 2013 Apr; 14(4): 287–292.

6. Ministero della Salute — Telemedicina — Linee guida nazi-onali, Roma, 2014.

7. Trabucchi M. L’ammalato e il suo medico. Successi e limiti di una relazione (book). Ed. Il Mulino. Bologna, 2009.

8. Hazzard W. R. I am a geriatrician. JAGS, 2004; 62: 161.


37

Republic of Kazakhstan is the state located in the centre of Euroasia. It was founded in 1465 as a Kazakh Khanate. Its capital is Astana. It is a President Republic with its President Nursultan Nazarbayev. Its territory is the 9th largest in the world (2,7 mln km2), population (for 1.02.2015) — 17,4 mln people (62th

in the world), density — 6 prs per km2 (181th place in the world), GDP (2014) — 41st in the world, per capita — 47th in the world, HDI — 0,75 is high (69th in the world).

The Republic of Kazakhstan refers to one of the Emerging markets and one of the key Nation States in Eurasia. It helps to meet the challenges of the population ageing providing for the development of human resource and poverty decrease. Demographic challenges of the third millennium are indicative for socio-economic developments of the Republic of Kazakhstan pursuing its entering the block of leading countries of the world.

Changes occurring in the modern demographic situation in the Republic of Kazakhstan are related

fi rst of all to the pronounced processes of population ageing. At present the share of population aged 65 and older exceeded 7 %, thus including it into the list of «ageing» countries. The proportion of population at the age of 60 and over reached 11,2 % by the by the beginning of 2015 with a tendency of increasing up to 25 % by the middle of the century. At the same time the share of population aged 80 and older will triple. Projected average life expectancy in the com-ing decade will grow from 70,3 to 72,0 years. Thus by 2020 expected increase of these indices for men and women will reach 65,76 and 75, 02 years correspond-ingly (Figure), which is still below those in the counries of the Western Union by 8–12 year.

At that, probability of survival till the age of 60 years is predicted for 65,8 % of men and 84,8 % of women, while till the age of 75 years — for 30,3 and 57,8 %, correspondingly.

The Republic of Kazakhstan is armed with a power ful research potential. During 22 years of its inde pendence the Republic of Kazakhstan turned to


GERONTOLOGY IN THE REPUBLIK OF KAZAKHSTAN

V. V. Benberin, A. K. Eshmanova, V. V. Chaykovskaya

63,861,9 62,2

64,8

5860,3 60,3

63,5 64,2 64,56 65,76

74,872,4 72,7 74,1

69,471

71,8 73,2 73,8 74,06 75,02

55

60

65

70

75

80

1975 1979 1984–1985 1989 1995 1999 2005 2009 2011 2015 2020

Males

Age

Calendar year

Females

Dynamics of life expectancy at birth in the Republic of Kazakhastan (years)

38


be one the most signifi cant states in Eurasia, whose opinion is greatly valued. During this period the coun-try reached signifi cant success in the development of national culture, research and policy.

Thus, the Republic of Kazakhstan enjoys early stage of demographic ageing and an increase in the share of the older population. The issues of ageing require a complex approach that is why they occupy important place being integrated into the govern-mental policies. The State Programme of Health Development in the Republic of Kazakhstan for 2011–2015 includes tasks specifi c for elaboration of gerontological area, i.e. development and improve-ment of evidence-based protocols for diagnosis, treat-ment and rehabilitation of old and senile patients; development and introduction of educational pro-gramme in geriatrics and palliative aid for doctors, paramedical personnel and social workers; develop-ment and implementation of the system of estima-tion (indices) of eff ectiveness of gerontological and geriatric care, framing of a new system of geriatric assistance run by the state.

It should be noted that alongside mainstreaming health issues into governmental programmes, NGOs, research institutions and international foundations participate in improving health care on the national level to increase active period of life and strengthen the role of senior citizens in social and economic de-velopment of the Republic of Kazakhstan.

The leading role among them is played by the Society of gerontologists of the Republic of Kazakhstan (hereinafter referred to as Society), which was founded in 2007 by the group of medi-cal researchers with Professor Valery Benberin at the head. In 2013 the Society received membership in the International Association of gerontology and geriat-rics (IAGG). This plenipotentiary membership will give further impulse to the development of gerontol-ogy and geriatrics in the Republic of Kazakhstan.

The Society is chaired by Professor Valery Benberin, Doctor of Medical Sciences, Head of the Medical Centre of President’s Aff airs Administration of the Republic of Kazakhstan.

The Society is a public research organization. Its main tasks consist in studying mechanisms of ageing inhibition and prevention of ageing associated diseas-es (ischemic heart disease, arterial hypertension, cere-bral vascular diseases, diabetes mellitus, etc.), social protection of pensioners in the period of transition, development of programmes aimed at improvement of life quality and organization of medical assistance, elaboration of biomedicine and gerontology, infra-

structure of geriatric service, provision of informa-tion within the framework of implementation of the Madrid International Plan of Action on Ageing in Kazakhstan.

The citizens of Kazakhstan involved in research, medical workers, gerontologists and geriatricians, social workers, lecturers at High schools may apply for the membership in the Society. Society members work for promotion of gerontology and geriatrics into social life of the country and they do everything for the purpose.

Demographic ageing by itself leads to the in-crease in the number of people who need permanent medical and social assistance. Therefore one of the Society’s strategic targets consists in creation of steady research as well as applied and educational resources necessary to meet the challenge.

In this context, in 2014 there was formed a Research section within the Society of Gerontologists of the Republic of Kazakhstan. This section is represented by the Innovative Research School in Gerontology of the Kazakh National University named after S. D. Asfendiyarov. A. K. Eshmanova, Ph.D. is a research supervisor of the section and Professor V. V. Chaykovskaya is a research con-sultant of the section. Strategic directions of the Research section of the Society of Gerontologists of the Republic of Kazakhstan comprise formation of solid scientifi c basis and consolidation of ties with other organizations in the fi eld of gerontology which will ensure comprehensive interaction of profession-als from various spheres. This will contribute to the development of new gerontotechnologies, elabora-tion of prognosticative investigations aimed at iden-tifi cation of most prospective studies in gerontology, formulation of methodology for the development of geriatric structures and geriatric service, interaction of governmental and non-governmental structures; building up and increase of research and manpower potential in the fi eld of gerontology; distribution of knowledge about the Madrid International Plan of Action on Ageing and contemporary viewpoint on the analysis of situation and «road map», compiling information basis for a wide system of medical and social aid to seniors and their families, promotion of volunteering among students and retirees, establish-ment of the Third age university for the elderly with the help of medical students.

One of the major prerequisites for the develop-ment of gerontology as a scientifi c discipline and applied specialty is education and training of highly qualifi ed human resource, since increased share of

39


older population in the country requires increased volume and level of medical and social service. Therefore, Kazakh National Medical University named after S. D. Asfendiyarov opened the module «Gerontology and Geriatrics» in 2013 to teach stu-dents of the 5th year of the faculty «General medi-cine» and postgraduates to improve qualifi cation of physicians and nurses within the research and technical programme of the Health Ministry of the are Republic of Kazakhstan «Development of the model of anti-ageing and active longevity of se-niors in Kazakhstan». Start-up and development of the gerontology and geriatrics module is based on the transfer of advanced technologies in gerontol-ogy. As a result of this module activity and that of research team of the Kazakh National Medical University named after S. D. Asfendiyarov there has been created a special web-site http://www.100let.kz, there has been issued a text book «Gerontology and Geriatrics» for geriatricians, social workers, stu-dents of high schools, there has been issued a spe-cial guide book for pensioners of the Republic of Kazakhstan and their families edited by the prin-cipal of the University, Honoured scientist of the Republic of Kazakhstan, Professor A. A. Akanov and Professor K. A. Tulebayev. In this guidebook, a pen-sioner can fi nd all necessary information in regard to his/her social status: legislative and medical informa-tion, reference data about the pension security agen-cies, advices of healthy life, available training and ed-ucational programmes, etc. Special web-site http://www.100let.kz provides detailed information useful

for elderly people and their families, as well as practi-cal resource for medical and social workers occupied in the system of geriatric service of the Republic of Kazakhstan.

In 2015, Eurasian Research Institute of Geron-tological Problems was established on the basis of the Medical Centre of President’s Aff airs Administration of the Republic of Kazakhstan for coordination and development of research in the fi eld of gerontology.

ReferencesState programme of health care development in the Republic

of Kazakhstan «Salamatty Kazakhstan» for the period of 2011–2015 (adopted by the Law of the President of the Republic of Kazakhstan of November 29, 2010, № 1113).

Benberin V. V. The problems of development of the geronto-logical service in Kazakhstan./ Journal of the Research Institute of Cardiology and Internal Diseases of the Health Ministry of the Republic of Kazakhstan. 2013. P. 93.

Akanov A. A., Tulebayev K. A., Eshmanova A. K., Chaykov-skaya V. V. Analysis of the modern situation and prospects in ge-riatric care of population of Kazakhstan/ Advances in Gerontology. 2014. Vol.27. № 3. P. 589–595.

Akanov A. A., Yamashita S., Meyermanov S. et.al. Elderly people and their problems: experience in Japan and Kazakhstan. Nagasaki; Almaty, 2008.

Sidorenko A. V., Mikhailova O. N. Implementation of the Mad rid International Plan of Action on Ageing in CIS countries: the fi rst 10 years /Advances in gerontology. 2013. Vol. 26. № 4. P. 585– 593.

Ageing in the XXI century: triumph and challenge / Press re-lease Final.rus.1,10.2011

Senior generation in Kazakhstan: looking into the future, Almaty, 2005, UNFPA, 144p.

Sidorenko A. Wold Policies on Aging and the United Nations // In: Global Health and Global Aging/ Ed. by: M. Robinson et al. Jossey-Bass, San Francisco, 2007. P. 3–14.

World population aging 1950–2050. New-York: United Nations. 2002.


40

A lot of water has fl owed under the bridge since, in their anticipation of a Turkish invasion, the Order of St. John perceived older persons as ‘useless civil-ians’ and evacuated them to Sicily. Malta holds a key place in the history of international ageing policy. The Maltese Government was the fi rst nation to bring a motion before the United Nations that called for an action plan in regard to the world’s ageing popula-tion. This occurred in 1968 when Malta successful-ly appealed to the United Nations for the theme of ‘population ageing’ to be included on the agenda of the 24th session of the General Assembly. As a result, Malta played a key role in the United Nations World Assembly on Ageing in 1982 whose designated chair-person was a Maltese citizen. In 1987, Malta was one of the very fi rst countries whose ministerial cabinet included a Parliamentary Secretariat for the Care of the Elderly. In 2013, the Parliamentary Secretariat was renamed ‘Parliamentary Secretariat for Rights of Persons with Disability and Active Ageing’ to em-phasise the Government’s commitment away from the biomedical model and towards a holistic per-spective of care in later life. This paper will high-light the main travails of gerontology and geriatric educatin in Malta and will elaborate on the history of the Gerontological Unit at the University of Malta, the University of the Third Age, the International Institute on Ageing (United Nations–Malta), and the Maltese Association for Gerontology and Geriatrics.

Contemporary ageing policy in Malta

Latest statistics report that as much as 24 per cent of the total population — or 102,026 persons — were aged 60-plus in 2013 (National Statistics Ofi ce, 2014). Recent months witnessed a number of silver linings in contemporary Maltese ageing policy (Formosa, 2013; 2015; Formosa and Scerri, 2015). Indeed, on 25 November 2013 the Maltese Government launched

the a National Strategic Policy for Active Ageing: Malta 2014–2020 (Parliamentary Secretariat for Persons with Disability and Active Ageing, 2013). The Strategic Policy is premised upon three themes: active participa-tion in the labour market, social participation, and in-dependent living. Primarily, the national strategic pol-icy aspires to increase the number of older workers in the labour market, whilst enabling persons above stat-utory retirement age to remain in or re-enter employ-ment. These objectives are necessary so that Maltese society mitigates against falling levels of working age populations, and the latter’s impact on dependency ratios and skills shortages. Secondly, it aims for con-tinuous participation of older persons in social, eco-nomic, and civic aff airs. Whilst acknowledging that individual aspirations alone are not enough to sustain participative lifestyles, its recommendations aim to aid older persons to overcome structural barriers and diffi culties that may result in unwelcome experiences of material and social exclusion. Finally, the Strategic Policy accepts that transforming society’s perception of ageing from one of dependency to active ageing requires a paradigm shift that enables independence and dignity with advancing age. It therefore advocates the strengthening measures of health promotion, care and protection, all of which aid older persons to en-sure high physical and mental functioning that fosters independent living.

The adoption of the National Strategic Policy for Active Ageing is being complimented with other poli-cy measures. In 2014, the Government issued the National Dementia Strategy (Parliamentary Secretariat for Persons with Disability and Active Ageing, 2014a) and the National Minimum Standards for Care Homes for Older People (ibid., 2014b) for public consultation, whilst also sponsoring the running of a new centre for Malta’s University of the Third Age. Moreover, each government-owned care home and day cen-


THE DEVELOPMENT OF GERONTOLOGY AND GERIATRICS IN MALTA

Marvin Formosa, Ph.D.

Gerontology Unit, Faculty for Social Wellbeing, University of Malta; International Institute on Ageing (United Nations – Malta)

41


tre for older persons now include Representative Associations for its residents and members respec-tively, that function to empower older persons in the running of such entities. Other ongoing policies in-clude the (i) transformation of Day Centres for the Elderly into Centres for Active Ageing that fulfi l the role of ‘lifelong learning hubs’, (ii) organisation of nationwide pre-retirement learning programmes, (iii) amendment of the Criminal Code to safeguard vul-nerable older persons from elder abuse, (iv) collabo-rating with Local Councils towards the employment of social work personnel to outreach vulnerable older persons, (v) providing in-service training programmes to social and health care personnel working with old-er people, and (vi), exploring how recent advances in assistive technologies enable older persons to ‘age in place’.

The World Health Organisation classifi ed Malta as the 5th best performing health system from a total of 191 countries (Azzopardi, 2011). This is primarily due to the fact that health care in Malta boasts excep-tional levels of equity as it is available to all citizens, irrespective of income. Malta has also come a long way in the past quarter of a century as far as geriatric services are concerned. As it was recently reported,

Geriatric medicine has been established in Malta since the year 1989 when the fi rst consultant geriatri-cian post was advertised and fi lled in the state-run health services...the post of lecturer in Geriatrics at the University of Malta was created and the sub-ject taught to medical students. A Department of Geriatrics was only offi cially inaugurated in the year 2007... An offi cial postgraduate training programme in most specialities including Geriatrics was set up in Malta in… 2008. (Ekdahl et al., 2012 : 388)

The past 25 years also witnessed the opening of an assessment and rehabilitation hospital specifi -cally for older persons with an emphasis on enabling them to return back into the community, and the introduction of modules on geriatric medicine for medical students. Presently, geriatric medicine is rec-ognised as a separate specialty, with the government of Malta employing 11 consultant geriatricians who work mainly in the public rehabilitation hospital and residential/nursing homes. This means that there is a consultant geriatrician for every 9,275 persons aged 60-plus (2012 fi gures) — compared to Germany: 7,496, Spain: 7,701, United Kingdom: 8,871, and Switzerland: 9,250 (Ekdahl et al., 2012). The Offi ce of the Prime Ministerreported that in 2012 there…were approximately 1,287 admissions into geriatric wards at [the national rehabilitation hospital], com-

pared to 1,141 in 2011 and 979 in the year 2010. 88 % of admissions for the year 2012 were transfers from [the national hospital] (compared to 82.5 % in 2011). In conjunction with the rehabilitation consul-tant, 2,972 consulations were assessed at [the national hospital] compared to 2,400 in the year 2011 and 1,780 in the year 2010. 142 patients were managed in the orthogeriatric unit. As regards day hospitals and outpatient clinics, there were 668 new cases assessed (compared to 2,825 in 2011 and 2,464 in 2010 re-spectively) and 3,191 follow ups (compared to 2,825 in 2011) and 2,464 in 2010)... (Offi ce of the Prime Minister, 2013 : 181)

In addition, the department of Geriatrics occu-pied a key role in specialised clinics related to memo-ry, continence, movement disorders, falls, ophthalmic and pulmonary disorders.

The Institute of Gerontology / European Centre for Gerontology

The Institute of Gerontology was set up in 1989 as an autonomous academic institution that sought to develop interdisciplinary scientifi c teaching, edu-cation and research in gerontology and geriatrics. In line with Malta’s membership in the European Union, in 2002 the Institute came to be known as The European Centre for Gerontology. The main objective of the Institute, as well as the Centre, was to off er training programmes to respond to the ur-gent demand for trained personnel in the fi eld of ageing. From October 1991 to June 2010, the main academic programme off ered by the Centre was the Postgraduate Diploma in Gerontology and Geriatrics. Its full programme is found in Box 1.

Until September 2010, both the Institute of Gerontology and the European Centre for Gerontology off ered a Master in Gerontology and Geriatrics as a separate degree. Admission require-ments stipulated an average mark of 70 % or higher in the Postgraduate Diploma in Gerontology and Geriatrics. The Master degree was entirely research based. Following a successful proposal, students were required to author a 50,000 word dissertation that re-searched a topic of either a gerontological or geriatric concern in a country of their choice. The majority of students opted to base their empirical research in their respective home country. The number of candidates studying gerontology and geriatrics at the University of Malta during the years 1990–2009 is presented in Fig. 1 — namely, 110 Maltese and 121 international students.

42


In October 2010, the University of Malta stream lined its degree programmes according to the inter national Bologna agreement. As a result, the Postgraduate Diploma and Master Degree in Geron tology and Geriatrics were streamlines into one program me of study under the name of Master in Geron tology and Geriatrics. The newly formed mod-el of the Master in Gerontology and Geriatrics, which is still retained at the time of writing, comprised a two year programme.

The programme of study includes study-units of a total of 120 ECTS, of which 60 ECTS are assigned to taught study-units conducted in the fi rst year, and the remaining 60 ECTS credits assigned to a research dissertation of 50,000 words to be carried out in the second year. Admission requirements are as follows: (i) a Bachelor degree obtained with at least Second Class Honours or Category II, or a professional qual-ifi cation considered by the Board to be comparable to a degree; or (ii) a Bachelor degree as above or a

professional qualifi cation considered by the Board to be comparable to a degree; or (iii) a Bachelor degree obtained with Third Class Honours or Category III if applicants are also in possession of other qualifi ca-tions, including relevant experience; or (iv) a profes-sional qualifi cation in one of the caring professions, together with at least fi ve years’ experience which to-gether are deemed to be comparable to the level of a fi rst degree.

During the fi rst year, students enrol in compulsory study-units — each 5 ECTS and including 28 lectur-ing hours — plus a practice placement of 240 hours (5 ECTS). As can be seen from Box 2, the 11 study-units are evenly balanced in both areas of gerontolo-gy and geriatrics.

However, it is noteworthy that the regulations al-low students who do not wish to continue with their research component to be awarded a Postgraduate Diploma in Gerontology and Geriatrics. Students who do not achieve at least a 65 % average mark in

Box 1: The Postgraduate Diploma in Gerontology and geriatrics (1991–2010)

Compulsory study-Units. Thirteen study units (eight core and fi ve electives), each requiring 50 hours of study (4 ECTS) normally including 18 lecture hours, tutorials, and programme assignments. The eight core modules, evenly balanced in both areas of gerontology and geriatrics, covered the following areas: population ageing; sociology of ageing; health promotion; biology and physiology of ageing; psychology of ageing; research and evaluation; clinical aspects of old age; and medical and social rehabilitation.

Elective study-units. Students had to choose fi ve of the following elective study units: social policies and strategies; medical problems; programmes and services: international comparison; psycho-geriatrics; geriatric supportive ser-vices; social welfare with older persons; epidemiology; statistics and computing; income security for older persons; and nutrition.

Practice placements. Participants were required to have an internship of 240 hours divided into four practicums of 60 hours each. Practical placements of both observational and hands on type, were aimed at enabling the participants to apply theoretical knowledge to practical solutions

Dissertation. Dissertation on an approved area of study chosen in consultation with a supervisor. The dissertation (15,000 words) required a sustained effort in defi ning the chosen area of investigation, in researching the issue at hand, in integrating the empirical data collected into a wider context of the subject, and in drawing conclusions and recommendations.

Final examinations. Three fi nal comprehensive examinations.

Source: van Rijsselt et al., 2007: 89–90

0

5

10

15

20

25

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

International students Maltese students

Fig. 1. Students studying gerontology and geriatrics (1990–2009), University of Malta

43


their fi rst year results are not allowed to continue with the research component, and be awarded the Postgraduate Diploma. As can be witnessed from Fig. 2, a total of 29 candidates (25 Maltese and 4 in-ternational students) studied gerontology and geriat-rics during the period 2010–2015.

The year 2010 also witnessed the launch of a Doctorate programme in Gerontology and Geriatrics which was designed to prepare students for leadership roles ranging from academics, researchers, planners to policy makers in the fi eld of ageing studies. This programme enables candidates to investigate an area of interest in great depth and become a leading ex-pert in their own right. To-date, two candidates have applied successfully to read for a Doctorate Degree in Gerontology and Geriatrics with research propos-als focusing on dementia care in later life and ethical concerns in later life respectively.

The Gerontology Unit

In June 2014, the European Centre for Geron-tology migrated to the Gerontology Unit within the Faculty for Social Wellbeing. Presently, the Unit of-fers the two graduate programmes discussed above — namely, the Master and Doctorate programmes in Gerontology and Geriatrics — but will also be launch-ing of two other qualifi cations: a Higher Diploma in Gerontology and Geriatrics in October 2015 and a Master in Ageing and Dementia Studies in February 2016.

The Higher Diploma in Gerontology and Geriatrics was designed to cater for students who have

completed their higher education and are looking to expand their knowledge of gerontology and geriatrics through a recognised university programme. It targets persons already working with older persons and in the fi eld of ageing, those who wish to work with old-er persons, and others who wish to commence their studies in the fi eld of gerontology and geriatrics. This programme of study provides a broadly based, multi-disciplinary perspective on ageing, later life, and older persons, whilst also disseminating knowledge and skills related to clinical and practical interventions with older persons. It also sensitises the students to the application of gerontological and geriatric research fi ndings to practice. The Diploma’s study units are presented in Box 3.

Box 2: The Master in Gerontology and Geriatrics (ongoing since 2010)

Study-Units. Eleven study units of 5 ECTS each and normally including 28 lecture hours. Study-units include: Sociology of ageing; Quality of life; Biological issues in old age; Health promotion; Research and evaluation; Social policies, programmes and services in the fi eld of ageing; Clinical conditions and health care services in geriatrics medi-cine; Psychological and psychogeriatric issues; Social interactions in later life; Pharmacological issues in later life; Gerontology: Multi-disciplinary and inter-disciplinary approaches.

Practice placements. Participants are required to have an internship of 240 hours divided into four practicums of 60 hours each (5 ECTS). Practical placements of both observational and hands on type enable participants to apply theoretical knowledge to practical solutions.

Dissertation. Dissertation (50,000 words) on an approved area of study chosen in consultation with a supervisor.

International students Maltese students

0

1

2

3

4

5

6

7

8

9

10

2010 2011 2012 2013 2014

Fig. 2. Students studying gerontology and geriatrics (2010–2014), University of Malta

Box 3: The Higher Diploma in Gerontology and Geriatrics (October 2015 onwards)

Study-Units. Twenty-four study units of 5 ECTS each and normally including 28 lecture hours. Study-units include: Key principles in social gerontology; Physiological and medical issues in old age; Community services for older peo-ple; Biological aspects; Research methods; Economic and social aspects of ageing; Health care professionals in old age; Theoretical issues in ageing policy; Mental health issues in later life; Researching ageing and later life; Food and nutrition in later life; Familial networks and informal care; Pensions and their sustainability in Malta; Social reha-bilitation in later life; Introduction to abuse and neglect; Income security, social protection and poverty prevention; Diversity and discrimination in later life; Long-term services for population ageing; Educational gerontology; Multi-disciplinary health services for older people; Legal issues in later life; and Recognising and preventing elder abuse in long-term settings.

44


Upon completion of the Higher Diploma, gradu-ates are expected to be able to provide higher levels of social and health care services to older persons which, in turn, will function to improve the quality of service to older adults. Most especially, candidates will be able to meet the needs of prospective employ-ers by being knowledgeable in embracing the roles of fi nancial planning for older persons, engaging in case work, and assisting in the organisation and adminis-tration of social and related services in community and residential care.

In 2015, just over 6,000 individuals have demen-tia in the Maltese islands, a fi gure equivalent to ap-proximately 1.5 per cent of the general population. As the population ages, the number of individuals with dementia will increase signifi cantly such that by the year 2030, it is projected that 9,883 individuals in Malta will have dementia. As a direct result, there is an urgent and warranted demand for ensuring good quality care through the provision of training and ed-ucational programmes for staff in direct contact with individuals with dementia, with particular importance to challenging behaviour and palliative care. In this respect, the Master in Ageing and Dementia Studies makes a valuable contribution to the development of dementia care knowledge, research and practice. The objective of the degree is to reinforce and mature the understanding, skills, competencies and attitudes of students working between the interface of ageing and dementia. The Master of Ageing and Dementia Studies was planned and developed to provide stu-dents with an in-depth, research-based knowledge of dementia, including theory, innovative and best prac-tices, policy issues, as well as a grounding in academic and research skills. Therefore, promising to act as a catalyst for candidates’ professional development with regards the meeting of needs of both present and in-coming cohorts of older persons with dementia. This Master’s study units are found in Box 4.

The Master Degree of Ageing and Dementia Studies makes a valuable contribution to the develop-ment of dementia care knowledge, research and prac-

tice is designed in a way to promote collaboration be-tween disciplines of nursing, medicine, occupational therapy, social work and other professionals working with persons living with dementia and their families/signifi cant others. It is anticipated that graduates of this Master Degree will be enabled to promote and develop excellence in dementia care in their practice setting — thus, ensuring that older persons with de-mentia live a dignifi ed and meaningful life that re-spects their citizenship rights.

In order to verify the quality of its programmes and to ensure that academic standards are main-tained, the Gerontology Unit engages on an annual basis the services of international external examiners. The Unit ensures that their academic expertise re-fl ects the interdisciplinary nature of the programmes off ered by alternating examiners with gerontological and geriatrics expertise on a frequent basis. It is also noteworthy that the Gerontology Unit collaborates closely with a number of universities, academic in-stitutes, and centres in the fi eld of aging, throughout the world. It also cooperates with a number of United Nations organisations and agencies and in particular with the International Institute on Ageing, United Nations–Malta. For many years, a range of scholar-ships were off ered to deserving candidates through the United Nations funds.

The University of the Third Age

Founded in January 1972 in Toulouse, Universities of the Third Age (U3A) can be loosely defi ned as socio-cultural centres where older persons acquire new knowledge of signifi cant issues, or validate the knowledge which they already possess, in an agree-able milieu and in accordance with easy and accept-able methods. The University of the Third Age in Malta — or as it is called in Maltese Universita’ tat-Tielet Eta’ — is the only local voluntary institution that caters solely to the learning interests of older adults. This is possible because the University of Malta sub-sidises the rent of its premises, as well as for the fees

Box 4: The Master in Ageing and Dementia Studies (from February 2016)

Study-Units. Eleven study units of 5 ECTS each and normally including 28 lecture hours. Study-units include: Social policies, programmes and services in the fi eld of ageing; Clinical conditions and health care services in geriatrics medicine; Ageing: Psychological and psychogeriatric issues; Social interactions in later life; Pharmacological issues in later life; Gerontology: Multi-disciplinary and inter-disciplinary approaches.

Practice placements. Participants are required to have an internship of 240 hours divided into four practicums of 60 hours each. Practical placements of both observational and hands on type, are aimed at enabling the participants to apply theoretical knowledge to practical solutions.

Dissertation. Dissertation (25,000 words) on an approved area of study chosen in consultation with a supervisor.

45


of lectures and a full-time coordinator. Membership can be easily acquired by those who have passed their 60th birthday and are willing to pay a nominal fee of €12. The U3A operates from four centres — namely, Floriana, Sliema, Kottonera, and Gozo.

The Maltese U3A is governed by two main com-mittees (Formosa, 2012a : passim). Whilst academic matters are in the hands of a committee chosen by the University of Malta, its social undertakings are man-aged by a democratically elected ‘Association’ from U3E members. The U3A off ers courses which are not intended to lead their participants to obtain any material or credential gains. It approaches education as consisting of the pursuit of non-utilitarian knowl-edge through which one’s mind and personality can be enhanced. The U3A coordinates a wide variety of courses based on the assumed needs and interests of older persons. These range from ‘heavy’ courses on philosophical concerns to day-to-day courses focus-ing on gardening. Members have no direct control over the institution’s programme content. Although learners are free to suggest new courses, this deci-sion rests solely in the hands of university academics. The U3A’s prospectus states that the curricular pro-gramme covers aspects of special interest related to the social rights and responsibilities of older persons that may range from fi nancial matters, support social services, health care, physical exercise and dieting, to the prevention of illness and disability. Tutors are non-U3A members, either full-time or part-time university lecturers, and are paid according to university rates. Members tend to be in the 60–74 age band, with both membership and participation falling steadily with increasing age. Female members outnumber males (3:1), with the ratio increasing when one focuses solely on course attendance (5:1). Members also tend to re-side in the Southern and Harbour Regions.

The majority of U3A learner members are mar-ried and still living with their spouses, so the organi-sation seems to be functioning more to combat the

reduction of social roles resulting from retirement rather than to allay social solitude (Formosa, 2012a). Members also possess higher-than-average levels of educational attainment and qualifi cations. As much as 72 per cent of persons in the Maltese 60-plus co-hort hold no educational qualifi cations compared to only 10 per cent of U3A members. U3A members are six and twenty times more likely to be in posses-sion of secondary school certifi cates and tertiary cre-dentials respectively than the average Maltese older person. The typical female member holds a history of working in ‘female’ professions such as teaching and nursing, whilst many male counterparts boast a ‘man-agerial’ career within the civil service. The majority joined the U3A to ‘make up for lost opportunities’, and view the learning environment as a place where ‘one meets people of similar interests’. Moreover, members hold strong appreciation for learning for its own sake and highlight with excitement the new directions it opens up, the feelings of self-fulfi lment that result with satisfying their curiosity and creative potentials, and the sociable enjoyment from engaging in social and cultural activities.

Attending the U3A gave me real confi dence. I had three children in succession so participation in edu cational courses was always out of the question. I always saw myself as incomplete, curious about life, but never able to satisfy this desire (older learner, age 62, cited in Formosa, 2012a : 118).

Refl ecting other international research, many older learners claim to fi nd their participation in educational and learning classes as indispensable in overcoming the various social and psychological chal-lenges brought on by the onset of later life and retire-ment. As one interviewee put it,

Both my daughters left home as much as fi fteen years ago. The both live in London. I missed my grandchildren. I used to stay indoors, afraid that I meet my neighbours’ grandchildren on my way out … Learning German was my way out of that rut.

Table 1

U3A members by centre and gender (academic year 2013/2014)

U3A Centre 60–69 70–79 80–89 90+ TotalTotal

Males Females

Floriana 265 179 73 10 527 153 374

Sliema 55 23 17 1 96 42 54

Kottonera 22 4 4 1 31 11 20

Gozo 24 32 7 2 65 6 51

Source: House of Representatives, (2014)

46


Time fl ies when listening to language tapes or doing homework. I am now able to have a decent conversa-tion in German. I have been twice to Germany re-cently, and was able to converse with native people. It gave me an enormous self-confi dence. I feel very good, I feel a sense of achievement which I lacked before (older learner, age 65, cited in Formosa, 2012b: 282).

The above testimonies are all strong demonstra-tions of the ways in which U3As aid older persons to cope with adverse circumstances whether social, eco-nomic, or health-related.

The International Institute on Ageing (United Nations – Malta)

Following upon its long-standing interest in in-ternational co-operation within the fi eld of Ageing, and in harmony with the spirit and objectives of the Vienna International Plan of Action, the Government of Malta proposed to the Secretary-General, in September 1985, the establishment in Malta of a United Nations International Institute on Ageing (INIA) to help developing countries prepare for the inevitable consequences of a dramatic in-crease in the older population. The United Nations reacted favourably to this initiative and conducted a feasibility study, which was subsequently examined by an inter-governmental expert group. As a result, the UN Economic and Social Council, in its Resolution 1987/41, recommended to the Secretary-General the establishment of INIA. On the 9th October 1987, the United Nations signed an offi cial agreement with the Government of Malta to establish the International Institute as an autonomous body under the auspices of the United Nations. The Institute was inaugu-rated on 15th April 1988 by the then United Nations Secretary-General, H. E. Mr. Javier Perez de Cuellar. INIA serves as a catalyst for governments to create bold and ambitious long-term policy frameworks for ageing societies. Whilst older persons constitute an important resource for societies, later life should be experienced as an age of opportunity.

In accordance with the mandate given by the United Nations Economic and Social Council, and the Agreement signed between the United Nations and the Government of Malta, INIA’s main objective is to fulfi l the training needs of developing countries and to facilitate the implementation of the Madrid International Plan of Action on Ageing. In order to reach this objective the principal activities of the Institute focus on data collection, publishing research

reports, technical cooperation with international stakeholders, and most importantly, training. Indeed, provides training in gerontology and geriatrics to of-fi cials, who hold positions as policy-makers, planners, programme executives, educators, and professionals dealing with challenges in the fi eld. Training pro-grammes are off ered in appropriate formats includ-ing, but not limited, to colloquia, seminars, and work-shops tailored to the needs of the participants and the nature of the specifi c subject.

INIA conducts four international short-term programmes on an annula basis in Malta — name-ly, Social Gerontology; Health Promotion, Quality of Life and Wellbeing; and Policy Formulation, and Implementation of the Madrid International Plan of Action on Ageing. All training programmes opt for an interdisciplinary perspective on ageing, emphasise the importance of mainstreaming ageing issues in a country’s development planning, whilst also address-ing options for policy formulation and services imple-mentation. Since its foundation, INIA has trained over 2,095 participants from 141 countries in its regu-lar international short and long-term training pro-grammes held in Malta. Since 1995, INIA has also carried out 96 ‘in-situ’ training programmes in 27 dif-ferent countries — thus training another 3,009 various professionals in the fi eld of ageing. So far, INIA has held regional or national training programmes in the following countries: Azerbaijan, Barbados, Belarus, Federative Republic of Brazil, People’s Republic of China, Czech Republic, Egypt, Republic of Ghana, Republic of India, Kazakhstan, State of Kuwait, Republic of Macedonia, Malaysia, United Mexican States, Republic of Moldova, Republic of Panama, Republic of the Philippines, State of Qatar, Romania, Russian Federation, Republic of Singapore, Republic of South Africa, Kingdom of Thailand, Tunisian Republic, Republic of Turkey, Ukraine and United Arab Emirates. This is a formidable achievement, and refl ects the good work achieved by my predeces-sors and the staff at INIA. Indeed, INIA’s capacity for the development of ageing policy in developing coun-tries is now recognised internationally.

The Maltese Association for Gerontology and Geriatrics

The Maltese Association of Gerontology and Geriatrics (MAGG) was set up in 1998. Its objectives are to promote professional and educational advance-ment of gerontologists and geriatricians. The associa-tion places great emphasis on research-based mutual

47


education by and of its own members throughout the world. It also stresses the importance of considering all the aspects of older persons — namely, physical, social, and psychological. The association is also a fo-rum for considering every aspect of ageing both lo-cally and internationally. The association’s functions, aims and purposes are listed in Box 5.

For many years, MAGG conducted bi-monthly seminars and lectures for its members on various top-ics of ageing, and an annual one-day gerontology and geriatrics national seminar to which all those involved in the fi eld of ageing are invited to participate. During these seminars, past students of the Gerontology pre-sented the results of the research work in various aspects of ageing, and which was carried out dur-ing their reading for the Postgraduate Diploma or Master Degree in Gerontology and Geriatrics. The association also had its own quarterly newsletter. It is noteworthy that in 1999 the association was accepted as a full member of the International Association of Gerontology and Geriatrics, the world body in the fi eld of ageing that represents national member or-ganisations from over the fi ve continents. In January 2000 the association became the 33rd member of the European Association of Gerontology. In 2009, MAGG also organised — in collaboration with the European Social Science Section of the International Association of Gerontology and Geriatrics, and the German Centre of Gerontology, Berlin — an interna-tional conference titles ‘Ageing in the Mediterranean

World’. The conference was attended by a group of thirty experts hailing from France, Germany, Israel, Italy, Lebanon, Malta, Netherlands, Portugal, Spain, Tunisia and the United Kingdom. Issues explored included the social worlds of ageing, long-term care, migration, and gerontological reasoning and geronto-logical practice in Mediterranean Countries.

Conclusion

In the foreseeable years, an increasing number of Maltese citizens will live into advanced age. This ex-plosive growth of older adults will result in a mix of opportunities and challenges. On one hand, an ageing population presents itself as an opportunity to com-munities because many older adults are committed, long-time residents, who contribute their time and energy to local issues. Older persons are both a social resources and key contributors to the socio-econom-ic fabric. On the other hand, supporting the needs of older persons represents a tough challenge. The Gerontology Unit is well equipped to meet this chal-lenge, with its international reputation determined by the fact that in the years 1990 to 2015 degrees more international than Maltese candidates were in receipt of degrees in gerontology and geriatrics. It is there-fore important that the government teams with the gerontology educators who are responsible for pre-paring tomorrow’s professionals to serve an increas-ingly ageing population. There is no doubt that an

Box 5: The Master in Gerontology and Geriatrics (ongoing since 2010)

Functions• maintaining contact with graduates from the Gerontology Unit;• disseminating and sharing information regarding gerontology and geriatrics;• to promote further advancement of research and practice in Geriatrics and Gerontology• enabling the improvement of the quality of life of older persons;• representing the professional interests of gerontologists and geriatricians;• co-operating with other professionals involved in the promotion of elder care;

Aims• promoting the educational advancement of gerontology and geriatrics;• placing great emphasis on research based mutual education by members;• stressing the importance of holistic elder care;• acting as a forum for gerontological and geriatric concerns;

Purposes• promote gerontology and geriatrics;• periodically review, enhance and clarify the role of gerontologists/geriatricians;• enable the diverse educational programmes of gerontology and geriatrics;• reach and unite all those who qualify for membership;• representing members in local and international forums;• fostering the professional education and training of gerontologists and geriatricians

48


examination of workforce literature predicts that we will need substantial numbers of trained ageing spe-cialists in the years ahead. However, it is disconcert-ing that Malta is already experiencing some key short-ages in workforce preparedness. Given the available demographic projections one must ask if institutions of higher education — especially the University of Malta and the Malta College for Arts, Science and Technology — are doing their utmost to provide the required number of applied gerontological personnel that is needed to serve the interests and need of the growing older adult population. To conclude there warrants an accreditation of degrees and diplomas in gerontology rather than concentrations or minors within various disciplines, which tend to fail in inte-grating gerontology in the disciplines in which they are embedded. Only the latter strategy will result in more reliable and valid studies on older persons, age-ing and later life, something that is crucially lacking at present.

ReferencesAzzopardi R. M. (2011). Social policies in Malta. London:

Commonwealth Secretariat and United Nations Research Institute for Social Development.

Ekdahl A., Fiorini A., Maggi S. et al. Geriatric care in Europe — the EUGMS Survey Part II: Malta, Sweden and Austria. Euro pean Geriatric Medicine. 2012. 3 (6): 388–391.

Formosa M. Education for older adults in Malta: Current trends and future visions. International Review of Education. 2012e. 58 (2): 271–292.

Formosa M. Education and older adults at the University of the Third Age. Educational Gerontology. 2012f. 38 (1): 1–13.

Formosa M. Population trends and ageing policy in Malta. Social Sciences. 2013a. 2 (2): 90–96.

Formosa M., Scerri C. (eds.) (forthcoming). Population age-ing in Malta: Multi-disciplinary perspectives. Malta: Malta University Press.

House of Representatives Malta (2014). Parliamentary Question 9898. Accessed 22/7/14 from: http://www.pq.gov.mt/pqweb.nsf/5ab326fbcb184092c1256877002c4f19/c1257881003b3b78c1257cfa0033d78f?OpenDocument

National Statistics Offi ce. Census of population and housing 2011, Vol. 1: Population. Malta: National Statistics Offi ce, 2014.

Offi ce of the Prime Minister. Annual reports of government de-partments 2012. Malta: Offi ce of the Prime Minister, 2013.

Parliamentary Secretariat for Rights of Persons with Disability and Active Ageing. National Strategic Policy for Active Ageing: Malta 2014–2020. Malta: Parliamentary Secretariat for Rights of Persons with Disability and Active Ageing, 2013.

Parliamentary Secretariat for Rights of Persons with Disability and Active Ageing. National Dementia Strategy: Public Consultation Document. Malta: Parliamentary Secretariat for Rights of Persons with Disability and Active Ageing, 2014a.

Parliamentary Secretariat for Rights of Persons with Disability and Active Ageing. (2014b). Social work unit. Accessed 6/6/14 from: https://activeageing.gov.mt/en/Pages/Social-Work/Social-Work.aspx

van Rijsselt R. J. T., Parkatti T., Troisi J. European Initiatives in Postgraduate Education in Gerontology. Gerontology & Geriatrics Education. 2007. 27 (3): 79–97.


49

The Norwegian Society for Age Research cel-ebrated its 60th anniversary in 2014 and naturally, a diamond anniversary off ered an excellent opportuni-ty for the board to refl ect on future challenges and op-portunities in age research, as well as an opportunity to take a trip down memory lane and celebrate prior achievements in the fi eld of gerontology in Norway. In short, we used the year of our 60th anniversary to refl ect on The Norwegian Society for Age Research’s past, present, and future.

The beginning — providing a new interdisciplinary scene for age research

The Norwegian Society for Age Research was established in 1954 under the name The Norwegian Gerontological Society. At the time of the society’s establishment, much of Norway’s age research was done in subfi elds or in separate areas of study, such as biology, medicine, sociology, and psychology — and a handful of Norway’s leading scientists and clinicians, supported by The Norwegian Health Association, recognized the need to join forces in a gerontological society.

The motivation behind a meeting place for those interested in aging and old age was not merely that there is strength in numbers, but a recognition that age researchers and practitioners alike would benefi t from an interdisciplinary network with a gerontologi-cal outlook on aging across the life span. This particu-lar fact was highlighted in the society’s inauguration speech of April 29, 1954, in which Dr. Gedde-Dahl of The Norwegian Health Association indicated that knowledge produced in distinctive professional fi elds, so-called specialized knowledge, could very well be perceived as a handicap in age research, a handicap that possibly hindered researchers’, educators’, and practitioners’ access to the complex picture of aging in a rapidly changing world.

If one is not handicapped with (…) special knowledge one is likely to defi ne gerontology as the study or teachings of life in, and walk towards, old age. As such it is the study

of those who are older and those who are aging. (Gedde-Dahl, 1954. The Norwegian Gerontological So ciety inauguration speech)

The idea of joining forces as a strategy to broaden the perspectives on «the study of those who are older and those who are aging» is detectable throughout Dr. Gedde-Dahl’s visionary inauguration speech. The promotion and establishment of an interdisciplinary gerontological society characterizes the establishment of The Norwegian Gerontological Society — as both the Swedish and Danish gerontological societies were rooted in medical associations. The founders of The Norwegian Gerontological Society aimed to ensure that all four pillars of gerontology (chronological ag-ing, biological aging, psychological aging, and social aging) be represented in both governance and mem-bership. However, contemporary documents clearly show that it was novel in the 1950s to combine and integrate knowledge from several separate fi elds of study to highlight the processes behind the elderly’s health and well-being.

The society soon became an interdisciplinary meeting place for clinicians, researchers, and edu-cators who eagerly worked to increase age-research activities in Norway, and by doing so, they aimed to provide a more solid scientifi c foundation for devel-oping care strategies appropriate for the aging pop-ulation and for infl uencing issues relating to senior politics (Thorsen 2004). In 1957, a research center, The Norwegian Health Association’s Gerontological Institute, was established in collaboration with the so-ciety to highlight the elderly’s health and living condi-tions, their dietary habits, as well as their participation in working life. In addition, the society worked hard to promote and communicate gerontological issues to laypersons interested in aging and old age. When the society was founded in 1954, few in the general pop-ulation were familiar with the term «gerontology,» and therefore the society changed its name in 1962 (Beverfelt 2004; Thorsen 2004). The new name, The Norwegian Society for Age Research (Norsk selskap for aldersforskning), was considered to have a broader


THE NORWEGIAN SOCIETY FOR AGE RESEARCH — THE WALK TOWARDS OLD AGE

50


appeal amongst members and laypersons, and has been used since.

Throughout the years, the society has been very active. Besides numerous seminars and conferences arranged to inform the public and to discuss current gerontological research, the society began publishing its own journal (Norske Gerontologiske Skrifter, later re-named Gerontologiske skrifter) in 1955.

Aging in Norway then and now — approaching new challenges

In Norway, perhaps the most striking features re-lating to aging the last 60 years are the increase in life expectancy and the growth in the elderly popu-lation — in both size and share of the total popu-lation. In the 1950s, life expectancy in Norway was close to 70 years for men and 73 years for women. Today it is nearly 80 years for men and 84 years for women (Fig. 1) — making Norway among the top ten countries in the world with the highest life expectancy. Furthermore, within ten years, when the large birth cohorts after the Second World War approach old age, the number and share of 80-year-olds will excel rapidly (Fig. 2). Actually, up to 2024, there will be a slight fall in 80+-year-olds because of small birth co-horts during the depression in the 1930s. Following the Le-Carter method of population projections, the number of 80–89-year-olds will double from about 200,000 today to 400,000 in 2045 (Fig. 2). The num-ber of 90+-year-olds will grow even more rapidly af-ter 2030, and the number of centenarians will grow from 829 in 2014 to 12,500 in 2100 (Brunborg, 2012). This aging of the population will occur regardless of the diff erent reasonable assumptions regarding fu-

ture fertility, mortality, immigration, and emigration. Because of this shift in the population’s age distribu-tion, the number of people of working age per old person will decrease from roughly 5 today to around 2 in 2100 (Brunborg, 2012).

Thus, we will experience the same challenges with a growing baby-boomer population as seen in the rest of the West. The large cohort born after the Second World War is responsible for a rapidly aging popula-tion that challenges the welfare and health systems. The need for care and medical attention in an aging population is great. Nevertheless, questions exist re-garding the future health and functioning of the next generation of elderly. Is there a compression of mor-bidity? Will they be fi tter than previous generations of elderly and thereby be more independent? There is still a lack of understanding regarding such questions.

Much research attention has been given to the medical, social, and psychological challenges that ac-company old age; however, in a new body of age re-search, focus seems to have shifted from the potential loss and challenges that accompany old age to a focus on the older population’s resources and positive con-tributions in society and in the workforce. This body of research highlights factors that promote successful aging and is of course becoming an important foun-dation for the society’s work.

The Norwegian Society for Age Research today

As stated by Dr. Gedde-Dahl in 1954, gerontol-ogy benefi ts considerably from being an interdisci-plinary fi eld, and maintaining the society as an inter-disciplinary meeting place has been a priority for the board throughout the years. However, for the past six

100

Females

Males

ProjectionsH — high life expectancyM — medium life expectancyL — low life expectancy

90

80

70

60

50

401825 1850 1875 1900 1925 1950 1975 2000 2025 2050 2075 2100

HHM

M LL

19500

200 000

400 000

600 000

800 000

1 000 000

1 200 000

Calendar year

1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 2060 2070 2080 2090 2100

70–79 years

80–89 years

90–99 years

Registered

Fig. 1. Life expectancy at birth. The fi gure is based on observations and projections for three scenarios (high, medium,

and low life expectancy), 1825–2100. (Brunborg, 2012. Published with the approval of Norsk Epidemiologi)

Fig. 2. Number of elderly persons in 10-year age groups, 1950–2100. Source: Populations projections 2011–2100.

Medium, high and low variant (Brunborg, 2012. Published with the approval of Norsk Epidemiologi)

51


decades, the society’s presidents have been, with only one exception, either physicians or psychologists:

Viktor Gaustad — physicianPer Hanssen — physician

Johan Torgersen — physicianSol Seim — psychologistErling Haug — physician

Johannes Hirsch — physicianPer Sundby — physician

Aase-Marit Nygård — psychologistKirsten Thorsen — psychologist

Anette Hylen Ranhoff — physicianArnhild Valen-Sendstad — physician

Hilde Sylliaas — physiotherapist

Still, while medicine and psychology have domi-nated among the society’s leadership, board members have always had a large variety of professional and methodological qualifi cations — and as such, rela-tionships between the interlocking pillars of gerontol-ogy have been signifi cant in our 60-year history. The current board, led by geriatrician, Dr. Börje Bjelke, refl ects this tradition by bringing together board members from medicine, nursing, physiotherapy, so-cial anthropology, economics, and epidemiology.

Today, our meeting activities are characterized by a wish to maintain the commitment to provide re-sources and opportunities for our members by high-lighting diff erent perspectives on aging and old age and by communicating this knowledge to the public. In 2009, the society’s journal was replaced by the inter-net — we now have a homepage and a Facebook page to reach and inform the new generations of age re-searchers, educators, and clinicians. We organize two seminars yearly — and in 2014, a well-visited seminar at Oslo and Akershus University College highlighted the topic of Reablement. In addition, we celebrated our

60th anniversary in style, with a celebratory seminar held in Oslo on November 13. During the seminar, we presented a series of lectures refl ecting 60 years of age research and knowledge sharing in gerontol-ogy. We were delighted for the opportunity to bring together so many people interested in gerontology.

What about the next 60 years?

It is diffi cult to predict the future of The Norwegian Society for Age Research — by most standards, we are a small society with close to 200 members and the fact remains that many professionals prioritize membership in knowledge- or profession-specifi c so-cieties. Nevertheless, The Norwegian Society for Age Research will continue promoting the gerontological outlook on aging and old age that was fi rst conceptu-alized in Dr. Gedde-Dahl’s 1954 inauguration speech; the diversity of gerontology is a strength. Dr. Gedde-Dahl’s line of reasoning is repeated in an article by Kirsten Thorsen written for the society’s 50-year jubi-lee in 2004 and it needs to be repeated here in 2015. The future challenge of gerontology in Norway is pinpointed as maintaining gerontology as an interdis-ciplinary fi eld — simply because understanding aging and old age in the 21st century requires attention from a wide range of disciplines.

ReferencesBeverfelt E. Norsk selskap for aldersforskning gjennom 50 år.

I Kirsten Thorsen (red): Nye tider, nye livsløp, nye eldre? Oslo: BK Grafi sk as., 2004.

Brunborg H. Increasing life expectancy and the growing el-derly population. Norsk Epidemiologi 2012. 22(2): 75–83.

Gedde-Dahl T. Planlegging av helse og velferdsarbeid for el-dre i Norge. Oslo: Nasjonalforeningen for folkehelsen, 1954.

Thorsen K. NSA — 50 år. Et gerontologisk selskap for den gamle og den nye tid. I Kirsten Thorsen (red): Nye tider, nye livsløp, nye eldre? Oslo: BK Grafi sk as., 2004.


52

The major stages of gerontology development in Russia are highlighted. The issues of training in gerontology and geriatrics, institutional infrastruc-ture within Gerontological Society of the Russian Academy of Sciences have been considered therein. Special attention is given to the prospects of gerontol-ogy in Russia.

Introduction

The analysis of gerontological science in Russia has been given in recent works which also outlined prospects for its development in the coming years (Anisimov 2001; Mikhailova et al. 2005; Anisimov & Mikhailova, 2011). There are several key events in the history of Russian gerontology. First of all, this is a book by Ilia Mechnikov «Etudes sur la na-ture humaine: Essai philosophie optimiste» (1903), where he introduced the term «gerontology» and put the cornerstone of the scientifi c discipline in bio-logy and physiology of ageing. In the 20-ies of the ХХ century the works of N. A. Belov, A. A. Bogdanov, S. A. Voronov, I. I. Schmalhausen not only evoked in-terest towards the investigation in the processes of age-ing per se, but also raised the question on the possible increase in the life span of animals and humans. The 30–40-ies are characterized by the origin of the fi rst national gerontological schools in this country — in Kiev and Kharkov (A. A. Bogomolets, A. V. Nagorny, I. N. Bulankin) and in Leningrad (Z. G. Frenkel, E. S. Bauer, V. G. Baranov). In 1938 in Kiev there took place the fi rst scientifi c conference on ageing. In 1957 in Leningrad on the initiative of Z. G. Frenkel and I. I. Likhnitskaya there was organized the very fi rst in this country City Scientifi c Society of Gerontologists and Geriatricians. The same year in Moscow there was organized the section of gerontol-ogy within Moscow Society of Nature Investigators

(MSNI). In 1958 there was established Research Institute of Gerontology of the USSR Academy of Medical Sciences in Kiev. In 1963 in Kiev there took place the fi rst All-Union Conference (Congress) on Gerontology and Geriatrics. The Academic Council in Gerontology and Geriatrics of the USSR Academy of Medical Sciences alongside with sec-tion «Biological and Social Bases of Gerontology» of the Joint Research Council in Human Physiology of the USSR Academy of Sciences and Academy of Medical Sciences coordinated research work in all Union republics. A long-term All-Union compre-hensive research program in gerontology and geriat-rics was elaborated in the period from 1981 to 1990. This period is characterized by active development of gerontology in the Ukraine and other regions of the country — in Leningrad, Moscow, Tbilissi, Kishinev, Minsk. Of great importance appeared to be workshops «Basic problems of ageing» orga-nized by N. M. Emanuel (1970–1984). The Group (Laboratory) of Mechanisms of Ageing was orga-nized by V. M. Dilman in 1973 at the Institute of Experimental Medicine in Leningrad.

Four All-Union Congresses were held in 1972, 1976, 1982 and 1988. In 1990 in Kiev the fi rst is-sue of the All-Union (further Ukrainian) Journal “Problems of Ageing and Longevity” saw the light. Desintegration of the USSR resulted in the collapse of all former All-Union structures and actual closure of systematic studies in gerontology and geriatrics on the territory of the Russian Federation. Practically anew, we started looking for professionals and estab-lishing research and practical institutions of this pro-fi le. The convocation of the Russian founding confer-ence «Medical and social aspects in gerontology and geriatrics» organized by the St. Petersburg Scientifi c Gerontological Society in 1994 in St. Petersburg became a crucial moment in the modern history of


GERONTOLOGY IN RUSSIA: MIlestones and perspectives of development

Vladimir N. Anisimov*, Olga N. Mikhailova**

*Department of Carcinogenesis and Oncogerontology, N. N. Petrov Research Institute of Oncology, St. Petersburg, Russia;* St. Petersburg Institute of Bioregulation and Gerontology, St. Petersburg, Russia

53


Russian gerontology. Gerontological Society of the Russian Academy of Sciences (RAS) united leading sci-entists in gerontology and geriatrics around the coun-try irrespective of their agency belonging. In August 1997 at the 16th IAG World Congress in Adelaide (Australia) the Gerontological Society was accepted into the IAG. The same year the fi rst issue of the jour-nal «Advances in Gerontology» (St. Petersburg) and the 1st issue of the journal «Psychology of Maturity and Ageing» (Moscow) were published. The Russian Congresses of Gerontologists and Geriatrists was held in 1999 (Samara), 2003 (Moscow) and 2012 (Novosibirsk). In 2000 Saint Petersburg hosted the 2nd European Congress on Biogerontology with 300 participants from 33 countries. In June 2002 in Moscow there was held the 6th European Congress of Clinical Gerontology. The 6th European Congress of IAGG held on 5–7 July 2007 in St. Petersburg was an event of utmost importance for European and Russian gerontology. It gathered over 1500 partici-pants from 70 countries of the world. On the initia-

tive of the Gerontological Society a scientifi c specialty «Gerontology and Geriatrics — medical and biologi-cal sciences» has been introduced into the offi cial list of specialties of the Russian Federation Ministry of Industry and Science in 2001. More 300 thesis were defended on the new specialty since this event. It is worth noting that numerous researchers from Belarus, Kazakhstan, Kirgizia, Uzbekistan, Equador, Syria and Sweden held their theses at the Dissertation Councils in Russia. The award and mutual recogni-tion of scientifi c degrees in diff erent countries will fos-ter education and training of researchers and fi nally, progress of gerontological studies.

Chronology of most important events in the development of Russian gerontology is given in the Table 1.

A long-term All-Union comprehensive research programme in gerontology and geriatrics was elabo-rated in the period from 1981 to 1990. This period is characterized by active development of geronto-logy in the Ukraine (D. F. Chebotarev, V. V. Frolkis,

Table 1

Chronology of Russian gerontology development (1957–2014)

Year Event

1957 Foundation of the Leningrad Scientifi c Society of Gerontologists and Geriatricians; The gerontological section in the Moscow Society of Nature Testers (MSNT)

1958 Research Institute of Gerontology of the USSR Academy of Sciences (Kiev)

1963 1st All-Union Conference (Congress) of Gerontologists and Geriatricians;The All-Union Research Medical Society of Gerontologists and Geriatricians

1970–1984 Workshops «Fundamental problems of aging» (Moscow)

1973 The Group (laboratory) of Mechanisms of Aging at the Institute of Experimental Medicine, Leningrad

1986 The Chair of Geriatrics at the Leningrad Medical Institute for Postgraduate Education

1991 The 1st issue of the journal “Problems of aging and longevity” (Kiev)

1989 Nizhny Novgorod Regional Geriatric Center

1992 The St. Petersburg Institute of Bioregulation and Gerontology; The Moscow (later Inter-regional) association “Gerontology and Geriatrics”

1994 All-Union founding conference «Medical and social aspects in gerontology and geriatrics» (St. Petersburg);The Gerontological Society of the Russian Academy of Sciences (RAS);The City Geriatric Medical and Social Centre (St. Petersburg);The Chair of Gerontology and Geriatrics at the Russian Medical Academy for Postgraduate Education (Moscow)

1995 Adoption of the medical specialty “physician-geriatrist”;The 1st issue of the journal “Clinical Gerontology” (Moscow);Institution of the annual award of the Gerontological Society of the RAS for young scientists for the best work in gerontology

1996 Samara Research Institute “International Centre for the Problems of the Aged”;The 1st issue of the “Herald of Gerontological Society of the RAS (St. Petersburg); The 1st issue of the journal “Older Generation” (Samara)

54


V. N. Nikitin), and other regions of the country — in Leningrad (I. I. Likhnitskaya, N. S. Kosinskaya, M. D. Alexandrova, V. M. Dilman), Moscow (I. A. Ar-shav sky, N. M. Emanuel, B. F. Vanyushin, I. V. Davy-dovsky, L. V. Komarov), Tbilissi (N. N. Kip shidze), Kishi nev (V. Kh. Anestediadi), Minsk (T. L. Dubina). Of great importance appeared to be workshops «Basic problems of ageing» organized by N. M. Emanuel

(1970–1984). The Group (Laboratory) of Mechanisms of Ageing was organized by V. M. Dilman in 1973 at the Institute of Experimental Medicine in Leningrad. Four All-Union Congresses were held in 1972, 1976, 1982 and 1988. In 1986 there was organized the fi rst in Russia Chair of Geriatrics at the Leningrad Institute for Postgraduate Medical Education, in 1990 in Kiev the fi rst issue of the All-Union (further Ukrainian)

Year Event

1997 The Gerontological Society of the RAS joined International Association of Gerontology;Research Institute of Gerontology of the Russian Federation Ministry of Health (Moscow);The 1st issue of the journal “Advances in Gerontology” (St. Petersburg);The 1st issue of the journal “Psychology of Maturity and Aging” (Moscow);First elections in “Gerontology and Geriatrics” at the RAMS

1998 The Scientifi c Council on gerontology and geriatrics of the RAMS and Russian Federation Ministry of Health;International centers on the problems of the aged in Ul’yanovsk and Yaroslavl

1999 1st Russian Congress of Gerontologists and Geriatrists (Samara);The textbook “Gerontology and Geriatrics” (Samara); Section “Gerontology and Geriatrics” at the Academic Council of the Russian Federation Ministry of Health

2000 2nd European Congress on Biogerontology (St. Petersburg)

2001 Organization of the Institute of Social Gerontology at the Moscow State Social University;1st Congress of gerontologists and geriatrists of Siberia and Far East (Novosibirsk);European School of Oncology “Cancer in the elderly: achievements and prospects” (Moscow);Institution of a new scientifi c specialty “Gerontology and Geriatrics”;Organization of the fi rst two dissertation councils for upholding doctorate and candidate thesis in gerontology and geriatrics (Moscow, St. Petersburg)

2002 6th European Congress on Clinical Gerontology (Moscow)

2003 2nd Russian Congress of Gerontologists and Geriatricians (Moscow)

2004 Dissertation Council on Gerontology and Geriatrics at the Research Centre of Clinical and Experimental Medicine of the RAMS Siberian Branch in Novosibirsk;The Highest Attestation Committee of the RF Ministry of Education for the fi rst time awarded an academic title of “Professor” in “Gerontology and Geriatrics”

2005 2nd International School on Gerontology and Geriatrics (St. Petersburg)

2007 The 6th European Congress of the International Association of Gerontology and Geriatrics (St. Petersburg);The 3rd International School on Gerontology and Geriatrics (St. Petersburg)

2008 Program “Prevention of age-related pathology and accelerated aging, decrease of premature mortal-ity from biological causes and an extension of healthy period of the life for the population of Russia”; UN Workshop on Formulation and Implementation of Policy on Aging for the countries of the former USSR (St. Petersburg)

2009 The 4rd International School on Gerontology and Geriatrics (St. Petersburg)St. Petersburg Institute of Bioregulation and Gerontology is designated an IAGG Collaborating Centre

2010 United Nations Economic and Social Council (ECOSOC) granted a Special consultative status to the St. Petersburg Institute of Bioregulation and Gerontology

2011 Prof. V. Kh. Khavinson was elected as the President of IAGG-ER;The journal “Uspekhi Gerontologii” published in English as “Advances in Gerontology”

2012 3rd Russian Congress of Gerontologists and Geriatricians (Novosibirsk)

2014 The 5th International School on Gerontology and Geriatrics (St. Petersburg)

2015 The Executive course “Global Health, Diplomacy and NCDs” (Moscow)The Eurasian Society of Gerontology, Geriatrics and Anti-Aging Medicine

Table 1. Continuation

55


Journal “Problems of Ageing and Longevity” saw the light. Major stages of Russian gerontology develop-ment up to middle 80-ies of the last century are de-scribed in the monograph of Yu.K. Duplenko (1985).

The fi rst regional gerontological center was set up in Nizhny Novgorod in 1989, then followed city geriatric centre in St. Petersburg in 1994. In 1992 there was founded the Institute of Bioregulation and Gerontology in St. Petersburg.

Gerontological Society of the Russian Academy of Sciences united leading scientists in gerontology and geriatrics around the country irrespective of their agency belonging. In 1994 there was set up a Chair of Gerontology and Geriatrics at the Russian Medical Academy for Postgraduate Education in Moscow. In 1995 by the resolution of the Russian Health Ministry there was adopted a new medical speciality «physi-cian-geriatrist». The same year the fi rst issue of the Journal «Clinical Gerontology» (Moscow) and the manual for physicians «Practical geriatrics» (Samara) saw the light. In 1996 Gerontological Society joined European Regional Branch of International Association of Gerontology (IAG). The same year at the premises of the Samara Regional Hospital for War Veterans there was opened a research institute «International Centre for the Problems of the Aged». In 2007 the Institute was reorganized into geriatric centre. Regular issuing of the information bulle-tin «Herald of the Gerontological Society of RAS» (www.gersociety.ru) started since 1996. In 1997 in Moscow there was set up Russian Research Institute of Gerontology of the RF Ministry of Health, and in the Russian Academy of Medical Sciences there took place fi rst elections on the speciality “Gerontology and Geriatrics” (V. S. Gasilin). In August 1997 at the 16th IAG World Congress in Adelaide (Australia) Gerontological Society was accepted into the IAG and its representatives entered IAG Council. The textbook «Gerontology and Geriatrics», the fi rst issue of the journal «Advances in Gerontology» (St. Petersburg) and the 1st issue of the journal «Psychology of Maturity and Ageing» (Moscow), appeared in 1997. In 1998 Scientifi c council on gerontology and geri-atrics of the Russian Academy of Medical Sciences and Russian Ministry of Health, International cen-ters for older people on the basis of regional hospitals for war veterans in Ul’yanovsk and Yaroslavl were set up and started their work. The fi rst Russian Congress of Gerontologists and Geriatrists was held in 1999 in Samara. Resolution of the Russian Ministry of Health № 297 of 28 July 1999 «On the improvement of medical assistance to old and senile citizens in the

Russian Federation» played a signifi cant role in the development of national geriatric service. This docu-ment provided for organization of geriatric centres throughout the country, departments of medical and social assistance to the elderly within out-patient clin-ics and other important measures, including those on professional training. In 2000 Saint Petersburg hosted the 2nd European Congress on Biogerontology with 300 participants from 33 countries. Scientifi c Journal “Bulletin of Experimental Biology and Medicine” has a permanent section «Biogerontology». Since 2001 annual almanac «Gerontology and Geriatrics» has been issued by the Russian Research Institute of Gerontology.

In June 2002 in Moscow there was held the 6th European Congress of Clinical Gerontology, and in October 2003, also in Moscow, — the 2nd Russian Congress of Gerontology and Geriatrics. The 6th European Congress of IAGG held on 5–7 July 2007 in St. Petersburg was an event of utmost im-portance for European and Russian gerontology. It gathe red over 1500 participants from 70 countries of the world.

It is worth noting that for the fi rst time ever the Russian institution has been designated a Colla-bo rating Centre of the IAGG. This institution is St. Petersburg Institute of Bioregulation and Ge ron-tology of the North-Western Branch of the RAMS. This is a sign of international recognition of the re-search achievements of Russian gerontology.

Chronology of important events in the develop-ment of Russian gerontology is given in the Table 1.

Professional training in gerontology and geriatrics in Russia

A uniform system of education in geriatrics has been set up in Russia with respect to International ex-perience. Therefore, there have been set up Chairs of gerontology and elaborated regulations (Mikhailova et al., 2007). Teaching of gerontology in Russia has been included into curricula since 1993, and special-ity “physician-geriatrist” was adopted by the resolu-tion of the RF Ministry of Health and RF Ministry of Education № 33 of 1995. However, back in 1977 there was issued a Resolution of the USSR Ministry of Health “On the organization of Chairs of geriatrics in medical institutes and institutes for postgraduate stud-ies to train physicians-gerontologists». The system of personnel training in gerontology in the USSR takes its beginning from the onset of postgraduate course. As it was noted above, the fi rst in the country Chair

56


of Gerontology and Geriatrics was organized in 1970 on the basis of the Research Institute of Gerontology of the USSR Academy of Medical Sciences in Kiev for the needs of the Kiev Institute for Postgraduate Education of Physicians, and in 1986 there was set up the fi rst in Russia Chair of Geriatrics in Leningrad State Institute for Postgraduate Education, where the Course on Geriatrics has been launched since 1980 at the Chair of Therapy. The signifi cance of created system for personnel training at all levels (physicians, medical assistants, nurses) in the fi eld of geriatrics was stated in the Resolution of the RF Ministry of Health № 297 of 28.07.99 «On the improvement of medi-cal assistance to old and senile citizens in the Russian Federation».

In 1994, the Chair of Gerontology started its work at the faculty for postgraduate education of the Moscow Medical Dentistry Institute. Later on, in 1995 it was re-subordinated to the Russian Medical Academy for Postgraduate Education. There were elaborated qualifi cation requirements to physician-geriatrist in 1995 with its second edition in 1998; statute of physician-geriatrist in 1996, with its sec-ond edition in 1998; qualifi cation tests for specialty physician-geriatrist in 1996 with its second edition in 1998; uniform programme for postgraduate training of physicians in gerontology and geriatrics (1997). On the basis of these documents there was developed the document «Standard training of physician-geriatrist» at the I. M. Sechenov Medical Academy in Moscow.

According to the requirements developed on the basis of generalized world experience, geriatric edu-cation in Russia should be multilevel and multifocal (13). Undergraduate teaching in fundamental, social and medical gerontology and gerontotechnologies should be conducted during the whole course of stud-ies at therapeutic and dentistry faculties of medical higher schools with the help of uniform end-to-end programme of teaching at all Chairs. Postgraduate training of doctors should include general advance-ment in geriatrics, social gerontology and preven-tion of premature ageing (for physicians of general practice, district out-patient doctors and therapists working with old people) during 144 academic hours; primary specialization in «geriatrics» (for the staff of geriatric centers, hospitals and departments of medi-cal and social care) for at least 144 hours; attestation cycles for certifi ed specialists — 72–144 hours; topical advancement according to separate sections of geron-tology for health care organizers and «narrow» spe-cialists. Paramedical personnel need training in medi-

cal, social and psychological rehabilitation, as well as gerontotechnologies.

Along with the Chair of Gerontology at the Russian Medical Academy for Postgraduate Edu ca-tion other institutions carry out postgraduate training in gerontology and geriatrics. Thus; I. M. Se chenov Moscow Medical Academy has the Chair of Geriatrics and Hematology. The Chair of Gerontology and Geriatrics of the I. I. Mechnikov North-Western Medical University conducts training in clinical ger-ontology and medical-social expertise, as well as re-habilitation of old and senile patients. Advancement cycles are held for geriatrists and therapists with sub-sequent examination for the certifi cate of specialist — geriatrist, as well as for paramedical personnel with further exam and award with the certifi cate of geriat-ric nurse. Chair researchers carry out substantial sci-entifi c and practical work on age-related pathology of cardio-vascular, gastro-intestinal and genitourinary systems. In St. Petersburg, the license for educational activity in the area of professional (postgraduate and additional) training in gerontology and geriatrics was granted also to the St. Petersburg Institute of Bioregulation and Gerontology The Chairs or cours-es in gerontology and geriatrics are open in medical higher schools in Ekaterinburg, Yoshkar-Ola, Nizhny Novgorod, Novosibirsk, Rostov-on-Don, Yaroslavl and other Russian cities.

As for undergraduate training, there should be fi rst of all noted a tremendous work carried out by the Chair of Geriatrics of Samara State Medical University. Moreover, the courses in gerontology and/ or geriat-rics are conducted more than in 10 medical higher schools. For example, St. Petersburg I. P. Pavlov State Medical University initiated elective cycle on geron-tology and geriatrics for students of the 6th course. The cycle includes lectures on demography and geog-raphy of ageing, concepts and mechanisms of ageing, geroprotectors, interrelation of cancer and ageing, major aspects of geriatrics, its diagnostic peculiarities, characteristic features of nutrition in old and senile age. Practical studies are focused on organization and medical and social assistance to the aged, participa-tion in their therapy. The students and masters of the St. Petersburg State University (the Chair of genetics and selection of biology and soil faculty and medical faculty) enjoy lectures in gerontology.

Of great importance is the task of training para-medical personnel. Since 1997 there has been intro-duced into practice the State educational standard for paramedical personnel (speciality «nurse man-agement»), where issues of gerontology and geriat-

57


rics are given within the following disciplines: «The stages of human life and medical services to various groups of population» (the 1st year of education) and «Geriatrics» (the 3rd year of education.) 70 hours are allocated in the curricula to the issues of gerontology and geriatrics. Similar training of nurses has started in several regions. Thus, training programmes in ge-riatrics have been elaborated with the help of leading specialists of St. Petersburg City Geriatric Center. the training process has been carried out in St. Petersburg medical college № 2. Experience and methodologi-cal assistance of professionals from the USA, England and Finland is widely utilized in the training process.

Alongside training of medical workers in geron-tology and geriatrics there has been undertaken per-sonnel training in social sphere starting from 1992 (Marugina, 2001). It has been conducted in compli-ance with the state educational standards of higher professional education on specialties “Social work” and “Social pedagogy”. «Social work» standard has a special discipline «Social gerontology» therein. Demographic aspects are included into the course “Social politics”, the issues of pensioners’ rights pro-tection — into the course “Legal coverage of social work”, gender issues — into the course «Genderology and Feminology». According to the state educational standard, professional social work embraces popula-tion social protection, work with diff erent social, age, gender and ethnic groups, individuals in need of so-cial assistance and protection. Basic curricula include humanitarian, socio-economic and natural sciences. This multidisciplinary training has an integrative character. Postgraduate courses for social workers in the fi eld of gerontology are open in many national universities.

A personnel training for social and medical geron-tology is well organized in Republic Bashkortostan at the Institute for Postgraduate Studies of the Medical University, Bashkir State University, Medical colleges. During several years professional training in social gerontology is carried out at the M. V. Lomonosov Pomorsky State University in Arkhangelsk. Future progress in the education in geriatrics we will wait from The Institute of Postgraduate Medical Education es-tablished at 2014 at the North University.

International schools in gerontology launched in Russia gave a new impulse to personnel train-ing. Bearing in mind acute interest at the national level towards geriatric oncology and contribution of Russian gerontologists to the development of this is-sue, European school of oncology «Cancer in the el-derly: achievements and prospects» was organized in

November 2001 at the N. N. Blokhin Russian Cancer Research Center named after N. N. Blokhin of the Russian Academy of Medical Sciences (Moscow). In 2002–2014 there were held 5 International schools on gerontology and geriatrics organized by the Satellite Centre of the International Institute on Ageing — UN, (Malta) in Saint Petersburg formed by INIA, St. Petersburg Institute of Bioregulation and Gerontolgy and City Geriatric Medical and Social Centre.

Joint Finland—St. Petersburg projects «Personnel training for geriatric services» and «Development of geriatric services in St. Petersburg» may serve a vivid example of International collaboration in pro-fessional training. Within the framework of these projects doctors, nurses and social workers take post-graduate course in gerontology in Finland (Turku and Tampere).

Textbooks in gerontology issued in Russia serve a good practical basis for personnel training (Mikhai-lova et al., 2011). A valuable tutorial for students and doctors is «Glossary on social gerontology». International editions and manuals are being trans-lated into Russian. There are manuals summarizing experience of colleagues outside Russia, in particular, the experience accumulated in the United States and Great Britain.

Distant Internet-based course seem to be a pro-spective undertaking. Thus, Center «Compassion» within the project «Personnel training for the care of the aged» supported by Foundation «EuroAsia» made a web site (www.openweb.ru/gerocomp), which includes 6 sections containing information re-garding medical and social care. One of these sec-tion «Training» contains materials describing social work useful for distant training of social workers of Siberian region. Regional Public Foundation for Aged People Assistance «Dobroye Delo» has a web site www.dobroedelo.ru, containing materials useful for the personnel of non-profi t organizations working in the area of social and medical assistance to the elderly and old people, as well as for students of sociology faculties and those who are interested in the issues of social gerontology. On the basis of this site there has been made a Virtual Resource Centre of gerontologi-cal non-profi t organizations providing distant training (www.dobroedelo.ru/vrc).

Of utmost importance for the development of national gerontology is training of researchers. Recognition of the research speciality «Gerontology and Geriatrics» would be an essential step towards the development of the international system of training.

58


On the initiative of the Gerontological society a scientifi c specialty «Gerontology and Geriatrics — medical and biological sciences» has been intro-duced into the offi cial list of specialties of the Russian Federation Ministry of Industry and Science in 2001, 2 dissertation councils were set up at the St. Petersburg Institute of Bioregulation and Gerontology and Rus-sian Research Institute of Gerontology. More than two hundred and fi fty thesis were defended on the new specialty).

The award and mutual recognition of scientifi c degrees in diff erent countries will foster education and training of researchers and fi nally, progress of gerontological studies.

The work of young researchers in the laboratories outside Russia in the framework of joint projects con-stitutes an important aspect in education and training. Awarding young scientists with grants and prizes of national gerontological societies plays its role as well. For instance, Gerontological Society of the RAS insti-tuted in 1995 and awards annually since then the best work among young scientists and recommends young professionals for training at the International schools and courses in gerontology.

Organizational activity of the Gerontological Society of the Russian Academy of Sciences (RGS)

on development of research in Russia

The primary objectives of the Gerontological Society consist in promoting the development of ger-ontology and related fi elds of physiology and biology; integrating research results with practice; establishing and maintaining contacts with scientifi c gerontologi-cal institutions of the CIS and other countries and with international non-governmental scientifi c or-ganizations; organizing and convening meetings to exchange and discuss research and practical issues; assisting Society members in improving their profes-sional skills and research activities; providing research and methodological assistance in teaching gerontol-ogy and geriatrics at higher schools and those for paramedical personnel; membership in international scientifi c associations and participating in the inter-national meetings; fostering and distributing knowl-edge and recent scientifi c achievements in the fi eld of Society’s activity.

RGS was founded in 1994 and included 7 region-al branches at that moment. The participants of the Founding conference numbered 100 people. Today it embraces 46 branches with over 2510 members from over 50 regions.

Honorary members of the RGS are Pro fes-sors V. V. Bezrukov (Kiev, Ukraine), L. A. Boke ria (Moscow), G. M. Butenko (Kiev, Ukraine), W. B. Ersh-ler (Norfolk, USA), C. Franceschi (Bologna, Ita ly), F. I. Komarov (Moscow), E. A. Korneva (St. Peters-burg); B. A. Lapin (Sochi—Adler), M. Pas seri (Parma, Italy), V. P. Skulachev (Moscow), Y. Touitou (Paris, France).

Great attention in the Society is given to young researchers. In 1995 there was instituted the Award for young Russian scientists which is annually granted for the best research work in the fi eld of gerontology and geriatrics. Since then about 30 young researchers became its laureates. In 1999 within the framework of the National congress «Man and Medicine» (Moscow) there was open «the School of gerontologists». Upon the recommendation of the Gerontological Society a few young researchers and practitioners participated in the International courses and schools in gerontolo-gy and geriatrics (Romania, 1997; Italy, 1999, Malta, 2001–2007, Turkey, 2003, 2009).

Over 250 scientifi c conferences and sympo-sia, including 35 International ones have been or-ganized since the date of Gerontological Society foundation in 1994. Among them it’s worth men-tioning such signifi cant events as the 2nd European Congress on Biogerontology, 2000, St. Petersburg; the 6th European Congress of Clinical Gerontology, 2002, Moscow; the 6th European Congress of the International Association of Gerontology and Geriatrics, 2007, St. Petersburg; Petersburg; European school on oncolo gy «Cancer in the Aged: Ad vances and Prospects», 2001, Moscow, etc.

Prospects of Russian gerontology development

Despite growing interest to research in gerontolo-gy in Russia during last 20 ears, creation of infrastruc-ture (establishment of profi le research institutions, is-sue of new specialized journals, introduction of a new scientifi c specialty «Gerontology and Geriatrics», etc.) and a number of obvious scientifi c achievements of Russian gerontologists, it should be noted that there is defi nite lack of governmental support, fi nancial, in particular, especially in regard to basic research. It dooms national gerontology to backlog in devel-opment and inhibits solution of urgent problems the country faces. Demographic situation in Russia (de-creased birth rate, increased proportion of old people in the structure of population, especially in big cit-ies, such as Moscow, St. Petersburg, Ekaterinburg and other, unprecedented decrease of expected life span, decreased number of people of the working age and

59


their premature ageing) and unfavorable demograph-ic prognosis for the coming decades, put forward not only the issue of health in Russia, but its economic and political safety.

Table 2 contains a detailed list of priorities in up-to-date fundamental gerontology with reference to leading Russian institutions engaged in the studies at a high professional level providing publication of the results obtained in the reputable peer-reviewed na-tional and international journals.

The contribution of Russian science into major priorities of the world biogerontology is manifested by few groups of researchers conducting up-to-date studies. The research made by them in respect to above directions produce considerable and sometimes decisive impact on the solution of particular scien-tifi c tasks, which is confi rmed by the level of publi-cations, and their lecturing as invited speakers at the top International forums on gerontology, where they organize symposia and topical sessions and often are awarded with international grants.

Historically, research schools in Russian geron-tology got shape within the framework of other dis-

ciplines. However, Gerontological Society of the Russian Academy of Sciences set up in 1994 gave an impulse to the development of gerontology in Russia (Anisimov, 2014), and today we can talk about the ex-istence, rather formation of research schools, where gerontology studies occupy a substantial proportion. The most notable role in the national basic gerontology play schools which got shape on the basis of leading re-search institutions of this country, entering the system of the Russian Academy of Sciences, the Institutes of the Ministry of Health and Social Development of the Russian Federation, N. N. Petrov Research Institute of Oncology, St. Petersburg) and leading higher schools of the country (M. V. Lomonosov Moscow State University, St. Petersburg State University, Ulyanovsk State University, I. M. Sechenov Moscow Medical Academy, Russian State Medical University, St. Petersburg State Medical University named af-ter I. P. Pavlov, St. Petersburg Medical Academy named after I. I. Mechnikov, Samara State Medical University, Ural Medical Academy (Ekaterinburg), Tjumen Medical Academy and other).

Table 2

Priorities in modern gerontology: Participation of Russia

№ Research Directions Leading Institutions in Russia

1. Population genetics of aging

N. I. Vavilov Institute of General Genetics, RAS (Moscow); Institute of Therapy, RAMS (Novosibirsk)

2. Genetics of aging and longevity in humans, Studying of centenarians

St. Petersburg Institute of Bioregulation and Gerontology; Institute of Therapy, RAMS (Novosibirsk); D. O. Ott Research Institute of Obstetrics and Gynecology, RAMS (St. Petersburg); Institute of Biochemistry RAS (Ufa) ; Institute of Cytology RAS (St. Petersburg)

3. Genetics of aging and longevity in animals

St. Petersburg State University; Institute of Genetics and Cytology, RAS (Novosbirsk); Institutes of Biology, RAS (Syktyvkar)

4. Progeria Institute of Cytology, RAS (St. Petersburg)

5. Use of transgenic and mutant animals in aging research

N. N. Petrov Research Institute of Oncology (St. Petersburg); M. V. Lomonosov Moscow State University; Institute of Genetics and Cytology, RAS (Novosibirsk)

6. DNA damage, DNA repair and aging

Institute of Theoretic and Experimental Biophysics, RAS (Puschino); Institute of Cytology, RAS (St. Petersburg)

7. Cell aging, telomere, telomerase

Institute of Molecular Biology, RAS (Moscow) Institute of Cytology, RAS (St. Petersburg)

8. Apoptosis and aging A. N. Belozersky Institute of Physical and Chemical Biology (Moscow); M. V. Lomonosov Moscow State University; N. N. Petrov Research Institute of Oncology (St. Petersburg); Institute of Biology, RAS (Syktyvkar)

9. Free radical theory of aging

M. V. Lomonosov Moscow State University; N. M. Emanuel Institute of Biochemical Physics, RAS (Moscow); D. O. Ott Research Institute of Obstetrics and Gynecology, RAMS (St. Petersburg)

10. Aging of the brain and nervous system

Institute of the Brain, RAMS (Moscow); Institute of the Human Brain, RAS (St. Petersburg); Ural Medical Academy (Ekaterinburg)

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It should be emphasized that formation of steady research schools in gerontology is a marker of prog-ress in this discipline and its growing topicality, which in its turn, refl ects global changes in demographic situation and society demands in general. We believe that the development of gerontology would be more eff ective under governmental support. Enrollment of gerontology into the classifi er of research direc-tions sponsored by the Russian Foundation for Basic Research could play its positive role. Of utmost im-portance seems the “Programme for prevention of age-related pathology and accelerated ageing, reduc-tion of premature mortality due to biological reasons and extension of healthy period of life for the popula-tion of Russia” developed on the basis of the latest achievements of Russian researchers on the initiative of the St. Petersburg Institute of Bioregulation and Gerontology. On the initiative of the non-government organization Russian Foundation for the support of scientifi c research “Science for Life Extension”, a complex interdisciplinary programme for fundamen-tal research “Science against ageing” was prepared. Both programmes were presented at the 19th IAGG World Congress of Gerontology and Geriatrics, Paris, 2009.

References1. Abashidze A. Kh., Malichenko V. S. International and na-

tional legal mechanisms of ensuring social justice for the elderly. Adv. Gerontol. 2014; 27: 291–296.

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№ Research Directions Leading Institutions in Russia

11. Aging of the neuro-endo-crine system

I. P. Pavlov Institute of Physiology, RAS (St. Petersburg); I. M. Sechenov Institute of Evolutionary Physiology and Biochemistry, RAS (St. Petersburg);

12. Pineal gland and aging N. N. Petrov Research Institute of Oncology (St. Petersburg); St. Petersburg Institute of Bioregulation and Gerontology, RAMS; Research Institute of Medical Primatology, RAMS (Sochi-Adler); Tyumen Medical Academy

13. Peptide regulation of aging St. Petersburg Institute of Bioregulation and Gerontology, A. N. Belozersky Institute of Physical and Chemical Biology, Moscow State University

14. Geroprotectors N. N. Petrov Research Institute of Oncology (St. Petersburg); A. N. Belozersky Institute of Physical and Chemical Biology, Moscow

15. Aging and cancer N. N. Petrov Research Institute of Oncology (St. Petersburg); N. N. Blokhin Russian Cancer Research Center (Moscow)

16. Theories of aging M. V. Lomonosov Moscow State University; N. M. Emanuel Institute of Biochemical Physics, RAS (Moscow); The Institute of Chemical Physics, RAS (Moscow); Research Institute of Experimental Medicin, (St. Petersburg)

17. Mathematic models of aging

The Institute of Control Sciences, RAS (Moscow) The Institute of Numerical Mathematics, RAS (Moscow); St. Petersburg State University; Ul’yanovsk State University

18. Demography of aging St. Petersburg Economy and Mathematics Institute, RAS; St. Petersburg Institute of Bioregulation and Gerontology

19. Biomarkers of aging Perm Medical Academy; St. Petersburg Institute of Bioregulation and Gerontology

Table 2. Continuation

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21. Gerontology and Geriatrics. Major Publications of Russian Authors. Bibliography of 1994–2006. Compiled by Kud ryavtseva T. K., Ed. By: V. N. Anisimov, V. Kh. Khavinson St. Petersburg: KOSTA, 2007.

22. Gladyshev G. P. The principle of substance stability is ap-plicable to all levels of organization of living matter. Int. J. Mol. Sci. 2006: 98–110.

23. Golubev A. G. Biology of Life Span and Aging, N-L Publ., St. Petersburg. 2015.

24. Golubeva E. Iu. The role of social-medical care in en-hancing quality of life of elderly people in Russian part of Barents-Euroarctic region. Adv. Gerontol. 2014; 27: 310–314.

25. Goncharova N. D. Age-related changes of the hypotha-lamic-pituitary-adrenal axis: experimental studies in primates. Adv. Gerontol. 2014; 27: 269–274.

26. Grebnev D. Iu., Maklakova I. Iu., Iastrebov A. P. The op-portunity to use combined stem cells transplantation for haemo-poesis activation in the old and mature laboratory animals under the conditions of ionizing radiation. Adv. Gerontol. 2014; 27: 348–352.

27. Imyanitov E. N. Use of elderly tumor-free subjects as a “supercontrol” for cancer epidemiological studies: pros and cons. Mech. Ageing Dev. 2009; 130: 122–127.

28. Karyukhin E. V. Care on the Elderly, Dobroe Delo, Moscow: Dobroe Delo, 2008.

29. Khavinson V., Shataeva L., Chernova A. DNA double-helix binds regulatory peptides similarly to transcription factors. Neuroendocrinology Lett. 2005; 26: 237–241.

30. Khavinson V. Kh. Peptides, genome, aging. Adv. Gerontol. 2014; 27: 257–264.

31. Khavinson V. Kh., Goncharova N., Lapin B. Synthetic tet-rapeptide epitalon restores disturbed neuroendocrine regulation in senescent monkeys. Neuroendocrinology Lett. 2001: 22: 251–254.

32. Khavinson V. Kh., Malinin V. V. Gerontological aspects of genome peptide regulation. Basel (Switzerland): Karger AG, 2005.

33. Kolosova N. G., Stefanova N. A., Korbolina E. E. et al. The senescence-accelerated oxys rats — a genetic model of premature aging and age-dependent degenerative diseases. Adv. Gerontol. 2014; 27(2): 336–340.

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Gerontology and gerontological practice in Slovenia

1. Historical perspective

In Slovenia, the beginning of gerontological theory and practice dates back to the second half of the 1960s. It was the period when it became obvious that anticipated demographic changes, and particu-larly the increase in the population of older people, would soon aff ect this region too. As a result, numer-ous activities were undertaken and these encouraged the development of gerontology. The starting point was the defi nition of gerontology as a discipline that comprehensively tackles the problems of the ageing population (Acceto 1968), so in addition to geriatrics and social gerontology it also includes experimental gerontology. The three disciplines are so intertwined that it is not possible to draw a dividing line among them. This is especially true of social gerontology on the one hand, and the medical-clinical gerontology on the other. These two disciplines must be consid-ered side by side — as equally important, by every na-tion and every society (Acceto 1968: 14). At the same time, Perat (1972: 14) recognized that the problems of old age can be effi ciently tackled by combining knowledge about the biological, psychological, social and economic phenomena related to aging.

In 1964, the socio-medical board of the Slovenian National Assembly passed a set of core guidelines for social gerontology, based on the models found in the practice of many other countries. The guide-lines were reasserted by the participants at the fi rst Yugoslav symposium on gerontology and presented in three clauses:

• Society must take care of its older members in a variety of ways, in order to ensure that they are able to continue to live in the same environment where they lived and worked in their most active years when they were most capable of working. To implement this guideline, diff erent «external gerontological ser-vices» must be organised to deal with, for instance,

the housing issues, pension regulation, the establish-ment of gerontological clinics, clubs for older people, the involvement of humanitarian organisations and the arrangements for a health care service for older people within the national health care system.

• Those older people who are no longer capable of living in their households should have the option of residing in homes for older people. According to international criteria, such institutions should be able to accommodate at least 5 % of the country’s pop-ulation over 65. In 1964, homes for older people in Slovenia had capacity to accommodate only 1.3 % of this population group. The proposed capacity could only be suffi cient if supplemented by well-developed external services (services outside homes for older people and community services) and social geronto-logical activities.

• The third guideline is highly intertwined with medical gerontology or geriatrics and relates to the question of whether the treatment of older people should take place in specialised geriatric hospitals. The principle that was adopted was that «older people should receive treatment in the hospitals specialised for their illness» (Acceto 1968: 33).

Since all the guidelines sought to integrate older people into society, they have been considered to be modern, created for the purpose of preventing the exclusion of older people from society. On the other hand, the guidelines pertaining to the institutionalised care for older people reveal a heavy infl uence of the biomedical model. Homes for the older people were defi ned as institutions which resolve not only the so-cial problems, but medical ones as well, which situates their activity in the area of geriatrics. The primary function of these institutions, which had previously been intended to meet the existential needs of older people and involved a strong social component, was expanded to cover the geriatric issues. Their activi-ties were rooted in medicine, or rather in gerontology of the time that was itself rooted in medicine (Mali 2008; 2010).


GERONTOLOGICAL ASSOCIATION OF SLOVENIA (GDS)

J. Mali*, PhD, D. Hrovatič**, MSc

* University of Ljubljanja, Faculty of Social Work, ** Institute Pleiades

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The development of homes for older people can be divided into three distinct periods characterized by three models (1) the social-gerontological model (1965–1990), (2) the hospital model (1991–2000) and (3) the social model (from 2000 on). Mali (2008, 2010, 2011) uses these historical models to demonstrate the shifts in the expert approach to care for older people, which are refl ected in the nature of care that changed from medical to social. The initial, social-gerontolog-ical model established the approach that was heavily infl uenced by the medical fi eld, characterized by the employment of a large number of medical profes-sionals with varying levels of education and with a variety of specialisations (medical assistants, medical technicians, nurses, physiotherapists, occupational therapists, doctors). It was only in the 1980s that so-cial workers secured positions in these homes bring-ing with them a diff erent work doctrine. They put emphasis on the importance of interpersonal rela-tions, pointed out individual specifi cities as contrasted to the collective ones, and argued for the autonomy of residents. Unfortunately, they were still too few in number to fully implement their views, so medical ap-proaches were dominant in such institutions all until 2000. Work roles were clearly defi ned and the work was highly routinized. Relations between the staff members and residents were becoming formalised and ceremonial, refl ecting the lack of cooperation between the two groups. In the last decade, the char-acteristics and needs of residents in homes for older people changed so radically that the institutions set on a more social path. This change is visible in individual care that caters to residents’ individual needs and in-volves an egalitarian cooperation between the medi-cal and social staff . This approach enabled more fl ex-ible methods of institutional care, the development of services suited to residents’ needs and the commence-ment of the de-institutionalization processes. (Mali 2008, Mali 2014).

A prominent characteristic of gerontology throughout its presence in Slovenia has been its inter-disciplinarity, which was the corner stone of resulting interdisciplinary activities. In the early 1970s, Slovenia was not trailing behind other nations with respect to gerontology — the country had a Gerontological Institute in Ljubljana which was globally considered one of the best and leading institutes in the fi eld (Ramovš 2003: 320). Its conceptual leader was Dr Acceto, so the institute was medical-gerontological in nature. Nevertheless, it was characterised by a com-prehensive, interdisciplinary approach to old age, thanks to Dr Acceto’s balanced concept that attached

due importance to both physical health and psycho-logical and social life of older people. In the early 1990s, the institute closed down. Voljč (2009: 11) be-lieves that with the abolition of the institute, geriatrics in Slovenia lost its professional leadership, specialised research into geriatrics, nationally coordinated un-dergraduate and postgraduate medical education in geriatrics, and scientifi cally supported knowledge about the medical needs and life of older people. It was not until 2004 that an academic programme in geriatrics was re-introduced at the Medical Faculty of the University of Maribor.

The role of the fi rst institute was partly carried on by the Anton Trstenjak Institute for Gerontology and Intergenerational Co-Existence. Over the last fi fteen years, it focused a large part of its resources on geron-tology and intergenerational relations and established modern development programmes in the area (Mali 2008: 53). The institute publishes a scientifi c journal entitled Quality Life in Old Age. It deals with old age and intergenerational relations, presenting the latest fi ndings in various fi elds and sciences related to old age, aging and intergenerational co-existence

2. Gerontological Education

Gerontological Association of Slovenia was founded at almost the same time as the Gerontological Institute. Over the past years it has published nu-merous publications, organised seminars, courses and public debates on various questions relating to aging and old age. The two institutions closely co-operated throughout the period of existence of the Gerontological Institute, encouraging a radical move in the medical and social approach to older people (Ramovš 2003: 480) and importantly contributing to the development of gerontology in general, given that many foreign specialists in the fi eld were educated in Slovenia.

While medical education in geriatrics suff ered a setback with the closure of the fi rst gerontological institute, the development of gerontology in general continued thanks to various other non-medical fac-ulties and schools (Voljč 2009: 11). Public and pri-vate higher education institutions off er a range of courses in gerontology, which can be broadly divided into social gerontology and gerontological medical care. For years, social gerontology has been part of the educational programme at the Faculty of Social Sciences at the University of Ljubljana, which, apart from research, took on a large part of postgraduate education (Mencej 1998). Today, two higher educa-

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tional institutions — the Faculty of Social Work at the University of Ljubljana and Alma Mater Europea at the European Centre Maribor — stand out for the number of courses in gerontology.

In the last few years, the Faculty of Social Work has been off ering specialised academic course in so-cial work with older people. Miloševič-Arnold (1999: 16) writes that gerontological issues had been part of education in social work in Slovenia ever since the 1970s, even before social work with older people be-came a basic subject at the Faculty of Social Work. In 2009, the Faculty introduced a specialised undergrad-uate course entitled Social Work with Older People and a post-graduate course with the same name, the fi rst post-graduate course of social work in Slovenia dealing with the issues of old age. Even though the programme has not been named gerontology, it in-cludes gerontological topics and enables in-depth and independent study of work with older people. Students are trained for specialised social work with older people in the community and institutions, and for counselling the generation that is now approach-ing old age on the topics of aging (Mali 2013 a: 31).

Alma Mater is an academic community organised as a non-profi t NGO, which fulfi ls the academic re-quire ments for providing higher education and research programmes (http://www.almamater.si/index.php/sl/o-ameu-ecm/poslanstvo-vizija-in-strategija).

Accredited programmes include higher education and university courses in social gerontology, a master course in social gerontology and a doctoral course in social gerontology. Students acquire socio-medical, organisational, social and communication skills ap-plicable to working with the older people. The post-graduate programmes focus on research and applica-tive work.

3. Medical and Socio-Political Trends in the Care for Older People

The care for old people’s health and wellbeing must be considered simultaneously, as the two areas are complementary. Unfortunately, in Slovenia, the two areas have been traditionally divided between two sectors and such arrangement was taken as the point of departure when organizing social and health care, fi nancing care for older people, planning human resources and providing services. The establishment of anew pillar of social care and a new range of ser-vices creates a possibility for a new area of long term integrated care, one that will not be divided into the

medical and the social sphere. Diff erent fi elds could come together to form strategies for help and solidar-ity (Flaker et al. 2008: 22). In the traditional system of care, the provision of care is also divided between the informal sector (family members, neighbours, acquaintances, friends etc.) and the formal sector (people employed in the care-giving fi eld). People thus have two options: either to take care of themselves in their homes, or to be taken care of in an institution. Long-term care will radically change this black-and-white picture of the care system, by off ering a range of new services that will strengthen the informal sec-tor (Mali 2013 b).

The state, with its regulatory (laws etc.) and productive (services) role is an important actor in Slovenia; apart from ensuring care for Slovenia’s population of older people, it also supplements the role of families and the non-profi t and private sector (Filipovič Hrast et al. 2014: 8). After 2000, a series of socio-political documents that plan and regulate care for older people were adopted. During the last few years, the initial, distinctly social attitude to care has changed, with the focus increasingly shifting towards a broad, multidimensional perspective that has intro-duced into the care fi eld various state sectors, ranging from the medical and educational sector to the scien-tifi c, cultural and traffi c sector.

The principles of medical and social care for the older people in Slovenia are not radically diff erent from the early ones adopted in the 1970s. Provision of help to the older people is still the core principle and the aim is to enable them to remain as long as possible in their home environments which they know well and where they feel comfortable. However, it is a responsibility of the state and its social policy to en-gage all available mechanisms to enable and facilitate independent lifestyle for older people (Mencej 1998: 59).

In the last decade, Slovenia actively developed services and programmes for the elderly who need help with everyday activities and jobs. In accordance with the socio-political directives, formal help has been formulated within the three sectors of social se-curity: (1) the public sector, where care is provided by the centres for social work, centres for help at home, and other providers of public services in home en-vironment, for instance, providers of assisted living facilities; (2) the private sector, where institutionalized protection and home help services are dominant, and (3) the non-governmental and volunteer sector, for instance a retired people’s association and self-help groups (Mali 2012).

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With the dispersion of social care across diff er-ent sectors, the state attempted to ensure a variety of ways to help the older people, but its success was only partial. Even a quick overview of the methods of help in various sectors shows that there is no radical dif-ference between the public and the private sector. In fact, when it comes to the manner and nature of help, the private sector is no diff erent than the public sector. What is diff erent are formal requirements for service provision and the funding method. Although private institutions provide institutional care in accordance with the same criteria that are observed in public in-stitution, meaning that their services and programmes are identical, they have to secure a concession from the Ministry of Labour, Family and Social Aff airs. (Hlebec et al. 2014). The same is true for the provid-ers of home care.

4. The Role of Gerontological Association of Slovenia in the Development of Gerontology

Gerontological Association of Slovenia celebrates its 45th Anniversary in 2014.

In 2014, the Gerontological Association of Slovenia celebrates its 45th anniversary. It was estab-lished in 1969 on the initiative of Dr Bojan Acceto, the founder of gerontology in Slovenia. From the very beginning, the Gerontological Association attracted various experts in gerontology and geriatrics, contrib-uting importantly to the development of gerontology and geriatrics in Slovenia. Today, it is a general hu-manitarian organization that operates on the national level, with its programmes mainly focusing on the older population and the issues of old age and related diffi culties.

The symbolism of the logo of the Gerontological Association of Slovenia

«Long time ago, feeling powerless in the face of mighty elementary forces in which they recognized the struggle of good and bad forces, the Chinese had an urge to estab-

lish harmony with the cosmos. In the 4th century BC they depicted this harmony as a sign that represents two basic forces enclosed in a circle. One is Yang, the male element, standing for activity, and the other is Yin, the female element, standing for passivity. They recognized that everything proceeds from these two forces, that everything is refl ected in them and that everything has their characteristics manifested in vari-ous forms: hard-soft, light-dark, positive-negative etc.

In the same way, one could say that youth and old age are two opposite poles. We borrowed this ancient Chinese sign and encircled it in G, having in mind the gerontological principle of equal treatment of all people regardless of their age.» These are the words of the architect and a long-time member of our Association, Marija Vovk (GDS 2014), describing the logo of the Association (protected by copyright).

The development of the Association during the period 2013–2016

During the early stages of operation, the Asso-ciation closely cooperated with the Ljubljana Institute of Gerontology and Geriatrics in an eff ort to secure for gerontology its due place in Slovenia. It has always striven to encourage professionals in various fi elds, ranging from doctors, nurses, social workers, physio-therapists, occupational therapists to architects and legal experts, to enhance their professional knowledge about the issues of gerontology and geriatrics. The Association consisted of two divisions, the medical and the social. The attempt to establish an experi-mental division has failed, but in 2005, the senior di-vision was formed, consisting of retired experts who represent an important connective element in the in-tergenerational transfer of knowledge.

During the past ten years, the Association has reg-ularly participated in the development of community care network off ering home help to families (Hrovatič 2011). It organized a series of workshops with a view to promote home assistance to families and contrib-uted to the professionalization of social home care in Slovenia (Hrovatič 2010).

As to the period 2013–2016, the Association con-tinues to be a volunteer organization operating in the public interest in the area of health and social care, and it has preserved the status of a humanitarian organization. It is involved in care for professional education of employees who work with older peo-ple. In addition to the new vision of Gerontological Association of Slovenia (GDS 2013) based on the intergenerational cooperation, it engages several gen-erations, off ers training to the students of social work and strives to acquaint young experts with geronto-logical issues. It has strengthened its humanitarian ac-tivity, participating in the programs for the prevention of poverty and social exclusion, joining in this way the European Agenda 2020.

Humanitarian activity:

• Lectures and discussions on the topical issues related to healthy aging, acceptance of old age and care in old age.

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• Advocacy for non-discriminatory approach to and the exercising of the rights of older people in the areas of health and social care, and for a better intergenerational coexistence.

• The spreading of knowledge about old age and aging and other topics of gerontology; bringing to the public eye the problems encountered by older people; coop-eration with various publics with a view to raising aware-ness about the issues of old age.

• The publication of popular texts about everyday issues and healthy life in old age intended for older people and their families.

• Participation with lecturers and experts, pensioners’ as-sociation and other groups concerned with the prob-lems of old age.

The Association continues to play an important role in professional education and training of employ-ees working in the fi eld of social care and medicine, although the educational activity has recently intensi-fi ed and now involves a number of education provid-ers. By exploring the crucial topics, for example, care for older people with dementia and their families, nu-trition in old age, healthy lifestyle, use of medicines, the strategies for old people in crisis living on limited resources, the Associations fi lls the gaps left out by other organizations. Furthermore, it alerts various actors in society to the problems and needs of older people, for example, the issues relating to interior ar-rangements and architectural adjustments of apart-ments, or paperwork relating to property issues, or the need for more friendly banking services, or limitations regarding the use of IT and the like.

Professional education and training:

• Organization of thematic professional conferences and the publication of professional journals dealing with gerontology and geriatrics.

• The encouragement and directing of research work in the area of gerontology.

• Cooperation with professional and other organizations with the aim of providing an argument for gerontology and placing it within the context of study and research programs in Slovenia, while taking into account its inter-disciplinary character.

• Educational base for the students of social work with the aim of strengthening their competences for work with older people.

The Association’s consulting activity makes it part of the national program for social care until 2020. Along with similar organizations it participates in the establishment of intergenerational centres across Slovenia, which are also part of the development strategy for the period 2013–2020 (Resolution 2013–2020). In so doing it assists the intergenerational cen-tres in establishing expert contents. From 1993, the Association has been a member of the international organization I. A. G. G. It attended the 19th Congress in Paris where it presented a contribution on the in-

clusion of social home care in the national system of professional qualifi cations (Hrovatič 2009).

Cooperation with other organizations at home and abroad

• Establishment of links with similar organizations in order to ensure more coordinated gerontological activities in Slovenia.

• Initiatives and cooperation relating to normative regula-tion of the situation of older people.

• Exchange of experiences and work methods with for-eign associations and participation in I. A. G. G.

What path has been taken by Slovenian gerontology?

The above question has been posed to Slovenian experts on gerontology and geriatrics on the occasion of the Associations 45th anniversary. The renowned experts who have contributed to the development of Slovenian gerontology will present the assessments of their contributions so far as well as future plans.

The seven major topics of discussion:

• The way in which social work takes care of the needs of older people within the framework of institutional care and its new forms — assisted living, day care, living with another family.

• What needs to be done to bring home care closer to the users?

• How well are the hospitals prepared for holistic geriatric care?

• Is the network of physiotherapeutic and occupational therapy services suffi ciently developed to help older people, both those living in an institution and those liv-ing at home, recover and regain independence?

• Do the practical problems of old age receive suffi cient attention within politics?

• Do educational programmes still introduce novelties and strengthen the competencies of employees work-ing with older people.

• Are the academic and expert texts in Slovenia suffi cient-ly widespread and has the bridge to the professional public and practitioners been built?

5. A Look at the Future

In Slovenia today, old age, aging and intergenera-tional coexistence are the topics that attract experts from diff erent academic fi elds. While the support for the development of gerontology is evidently diverse and strong, a better overview of gerontological activi-ties would be needed. Mencej (2009: 62) argues that this can be achieved through the coordination of sci-entifi c and the educational activities and through the monitoring of research fi ndings in the medical and social gerontology on the national level.

Gerontology in Slovenia will continue to adhere to interdisciplinarity and devote attention to the sys-tematic monitoring and research into the needs of the

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older people, the education of experts who can fi nd the answers to the needs of the older people and a socio-political environment that will enable the sat-isfying of these needs. The inclusion of older people into the development of gerontology and gerontologi-cal activity is essential, and the options and possibili-ties for it are good.

ReferencesAcceto B. Starost, staranje in starostno varstvo. Ljubljana:

Rdeči križ Slovenije, 1968.Alma Mater, http://www.almamater.si/index.php/sl/o-ameu-

ecm/poslanstvo-vizija-in-strategija (Viewed 9. 10. 2014).Filipovič Hrast M., Hlebec V., Knežević Hočevar D. et al.

Oskrba starejših v skupnosti: dejavnosti, akterji in predstave. Ljubljana: Fakulteta za družbene vede, 2014.

Flaker V., Mali J., Kodele T. et al. Dolgotrajna oskrba: očrt potreb in odgovorov nanje. V Ljubljani: Fakulteta za socialno delo, 2008.

GDS (2013), Vizija razvoja Gerontološkega društva Slovenije 2013–2016. (Internal documentation).

GDS (2014), Ob 45. obletnici Gerontološkega društva Slo-venije. (Internal documentation).

GDS, http://www.gds.si, Gerontološko društvo Slovenije. (Online documentation 2013–2014).

Hlebec V., Mali J., Filipovič Hrast M. Community care for older people in Slovenia. Anthropological notebooks. 2014. 20, 1: 5–20.

Hrovatič D. Social home care as National vocational Quali-fi cation. Longevity, health and wealth. The 19th World Congress of Gerontology and Geriatrics, Paris, 2009.

Hrovatič D. Perspektiva razvoja socialne oskrbe na domu z vidika organizacije storitve in strukture kadrov. Bolezni in sindromi v starosti, 4, 137–157. Ljubljana: Gerontološko društvo Slovenije, 2010.

Hrovatič D. Socialna oskrba v skupnosti. Profesionalizacija iz-vajanja socialne oskrbe na domu. Bolezni in sindromi v starosti, 5, 245–254. Ljubljana: Gerontološko društvo Slovenije, 2011.

Mali J. Od hiralnic do domov za stare ljudi. Ljubljana: Fakulteta za socialno delo, 2008.

Mali J. Social work in the development of institutional care for older people in Slovenia = Razvoj socialnega dela v slovenskih domovih za stare ljudi. European journal of social work, 2010. 13, 4: 545–559.

Mali J. An example of qualitative research in social work with older people : the history of social work in old people’s homes in Slovenia. Coll. antropol. 2011. 35, 3: 657–664.

Mali J. Deinstitutionalisation as a challenge for the development of community-based care for older people = Dezinstitucionalizacija kot izziv za razvoj skupnostne oskrbe starih ljudi. Dialogue in prax-is. 2012. 1(14), 1/2 (22–23): 57–69.

Mali J. Social work with older people: the neglected fi eld of so-cial work = Socialno delo s starimi ljudmi: zapostavljeno področje socialnega dela. Dialogue in praxis. 2013a. 2(15),1/2(24/25): 23–40.

Mali J. Dolgotrajna oskrba v Mestni občini Ljubljana. Ljubljana: Fakulteta za socialno delo, 2013 b.

Mali J. Social work in residential care facilities for older people as a protagonist of changes in community care for older people in Slovenia. In: Arnold E. N., ed. Social work practices: global per-spectives, challenges and educational implications, (Social issues, justice and status). New York: Nova Science Publishers, 2014 (133–151).

Mencej M. Slovenska gerontologija včeraj in danes — kaj pa jutri? Zdravstveni vestnik, 1998. 37: 57–60.

Mencej M. Poslanstvo, pogoji in okoliščine delovanja Geron-tološkega društva Slovenije. Kakovostna starost. 2009. 12, 1: 59–63.

Miloševič-Arnold V. Razvoj in značilnosti socialnega dela s starimi ljudmi. Kaljenje, 1999. 1: 8–24.

Perat J. Socialna gerontologija. Vestnik sveta za socialno varstvo LRS, 1972. 11, 3/4: 12–19.

Ramovš J. Kakovostna starost. Socialna gerontologija in ge-rontagogika. Ljubljana: Inštitut Antona Trstenjaka and SAZU, 2003.

Resolucija o razvoju nacionalnega programa socialnega varst-va za obdobje 2013–2020. Uradni list Republike Slovenije 39/2013.

Voljč B. Pregled gerontoloških in geriatričnih aktivnosti v Sloveniji in po drugih državah Evropske unije. Kakovostna starost. 2009. 12, 3: 5–15.


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1. Developmental Milestones — From 1953 until Today

The Swiss Society of Gerontology (SSG, www.sgg-ssg.ch) was established by medical professionals treating older patients as one of the fi rst gerontologi-cal associations of Europe in 1953. One of the found-ers of the SSG was one of the fi rst pioneers of geriat-ric concepts: Dr. A. L. Vischer, who from 1924 to 1956 worked as senior consultant at elderly homes in Basel and is an author of diff erent books on aging. Other founding members of the SSG — in its fi rst years fi -nancially supported by pharmaceutical fi rms — were Prof. Fritz Verzar who undertook fi rst experimental research on ageing in the 1950s and Prof. Bernhard Steinmann, holding one of the fi rst chairs in geriat-rics in Switzerland in 1955. In 1966, Prof. Jean-Pierre Junod founded the second Swiss chair in geriatrics in Geneva. Within the French-speaking universities the fi rst geronto-psychiatric research units were estab-lished in the late 1970s (Prof. Jean Wertheimer). Thus, the development of research on ageing had a major infl uence on the development of the SSG. Therefore, during the fi rst decades of its existence, medical and geriatric professionals dominated the membership of the SSG. While geriatric teaching and research were well established from the 1970s onwards at the Swiss Universities of Basel, Geneva and Lausanne (while the University of Zurich — as largest University of Switzerland — lacked a chair of geriatrics until 2014), other fi elds of gerontology (for example ge-rontopsychology, social gerontology) found their way into the SSG by the evolving need for interdisciplin-ary cooperation. This process lasted until the end of

the 1970s when ideas and concepts of gerontology as interdisciplinary science got more attention in the sci-entifi c community. The conclusion that, besides the physical, psychosocial aspects also play an important role for the understanding of the ageing process was followed by the fi rst interdisciplinary congress of the SSG in 1980, which was initiated by Dr. Fritz Huber as president of the SSG. The success of this pioneer-ing interdisciplinary exchange was the basis to open the SSG for other gerontological professionals (care, psychology, sociology, education, theology and ethics, etc.). 1985 the fi rst female and at the same time the fi rst non-medical president (Rachel Hauri) was elect-ed and in 1990 the SSG established a professional offi ce (Pia Graf-Vögeli). Just recently, a fi rst textbook on gerontology with explicit focus on its potential for interdisciplinary cooperation was published (Becker, Brandenburg, 2014).

Today, the 1700 members of the SSG comprise both, medical and social professionals, in the same organisation. Even as gerontological specialisation is increasing, there are strong and institutionalised links between geriatric and social-gerontological profes-sionals.

This history of the development of an interdis-ciplinary approach to gerontology in the SSG is a success story. Starting with 10 out of 10 members of a medical background in 1953, today (2013) 1200 out of 1700 members of the SSG aren’t physicians. Nowadays, the SSG is among the fi ve biggest geron-tological societies in Europe (in absolute numbers) and — referring to the Swiss population — one of the biggest worldwide.


THE SWISS SOCIETY OF GERONTOLOGY AND THE DEVELOPMENT OF GERONTOLOGY

IN SWITZERLAND

F. Höpfl inger, S. Becker, M. Steiger

www.sgg-ssg.ch

70


2. Vision, Mission and Organisation of the Modern SSG

The vision of the SSG is to contribute to a society for all ages and to achieve cohesion between the gen-erations in Switzerland. As an interdisciplinary, pro-fessional organisation, the SSG fosters the network between people and diff erent institutions committed to research on ageing processes and institutions in-volved in care and practical work related to old age. It is a professional body focusing on the subjects of «old age» and «ageing». The SSG provides a nation-al platform for gerontological knowledge, exchange and opinion making in the fi eld. Additionally the SSG aims at the stimulation and promotion of ge-rontological education and research, the transfer of the research results into practice and broadening the competences and standing of experts in gerontology.

The promotion of interdisciplinary cooperation occurs in diff erent specialist groups. They represent their specifi c interests within the SSG and draw the attention of their professional bodies on matters of gerontology (physiotherapy, applied gerontology, geropsychology). The specialist groups elect their own council, pursue their professional aims independently and are fi nanced by additional subscriptions from their own members.

The committee initiates working groups to deal with specifi c subjects in-depth. Four diff erent work-ing groups are active at present (fi gure). The interdisci-plinary committee, in which the chairpersons of the specialist groups are represented together with the chairpersons of the Swiss Society for Geriatrics, the Swiss Society Swiss Society of Old Age Psychiatry

and Psychotherapy sets the budget, the strategic goals, and specifi c tasks.

Together with the diverse experts in the commit-tee as well as in cooperation with the specialist and working groups, the SSG initiates diff erent projects in order to provide in-depth knowledge to the geronto-logical community. In the last few years topics such as «guidelines for the handling of autonomy restricting measures», «the spiritual dimension», «age-friendly communities» and «assisted suicide of the elderly» were promoted comprehensively. The results of the projects are published in special brochures or position papers in order to support political as well as scientifi c reasoning.

3. Internationality — Roots and Outreach

While medical research, teaching and policy in-terventions on ageing were well established, research and teaching on psycho-social questions of ageing re-mained underdeveloped for a long time. Academics interested in gerontological knowledge had to study in France, Germany or the USA. Organisations — like Pro Senectute — supporting the interests of the elderly imported theoretical concepts from Germany or France, resulting in an interesting situation where gerontological practice was developed through a strategy of importing research knowledge (Höpfl inger 1999). Until now the links between French or German research and Swiss academics remain very strong. The relations with the German and the French Societies (Deutsche Gesellschaft für Gerontologie und Geriatrie (DGGG), www.dggg-online.de; Societé Française de Gériatrie et Gérontologie (SFGG), www.sfgg.fr) are fostered through diff erent cooperations. As a national society, the SSG represents Switzerland on the European level and worldwide in the International Association of Gerontology and Geriatrics (IAGG). Moreover the biannual congress of the SSG off ers best opportunities for networking on a national as well as international level.

In 1986, the fi rst European Memory-Clinic — an important milestone — was initiated by Prof. Hannes Stähelin and in 1995, Swiss researchers created the European Academy for Medicine of Ageing (EAMA, www.emam.eu) to improve geriatric knowledge with-in an international network of experts.

4. Development of Gerontology in Switzerland

Geriatric research and interventions were — at least in parts of Switzerland — well established from the late 1980s onwards (Michel, Stuckelberger, Grab

Swiss Society of Gerontology — SGG SSG society, general meeting, committee

1700 members, interdisciplinary, national

Working GroupsSpecialised GroupsSFGP

Gerontopsychology Old Age Delegates

Care Apartments

Gerontechnology

FPGPhysiotherapy in Geriatrics

FGAGApplied Gerontology

Ethics and Spirituality

Swiss Society for Geriatrics (SFGG) Swiss Society for Gerontopsychiatry and -psychotherapy (SGAP)

Committee’s

(140%)

Structure of the SGG (status December 2014)

71


1993). In 1985, the SSG organized the fi rst post-graduate training in geriatrics. However, the formal acceptation of geriatric medicine as specialisation («Schwerpunkttitel für Geriatrie») succeeded only in 2000. Today more and more medical professionals are interested in knowledge and formation concern-ing the medicine of ageing.

At the beginning of the 1980s the fi rst large so-cio-gerontological studies on the social conditions of the elderly were undertaken, particularly in the French-speaking part of Switzerland (Gugrispa 1983, Tuggener, Morf-Rohr 1984). A national study on pov-erty amongst the elderly (Schweizer, 1980) resulted in a strong political controversy as the fi rst published results indicated lower poverty rates among retired people than among younger persons. This conclu-sion was angrily refuted by politically organised re-tirees and also by social policy researchers looking more closely on sampling problems (Gilliand, 1983). The political controversy surrounding research on ageing resulted in a ten-year hiatus of gerontological research. Nonetheless, a national report on questions of ageing in 1979 (Eidgenössische Kommission für Altersfragen, 1979) gave important political impulses to reorganize social security for the elderly. In 1985, a pension system based on three pillars (basic pension system, capital-based pension funds and private sav-ings) was institutionalised.

During the diffi cult period of the 1980s Prof. Hans-Dieter Schneider (University of Fribourg) helped the Swiss gerontologists to survive by initia-ting diff erent local studies and international contacts (Höpfl inger, Stuckelberger 1992). Through his activities — also within the SSG — and the ini tiative of French-speaking professionals (like Prof. Chris-tian Lalive d’Epinay from Geneva) a large and inter-disciplinary national research programme on ageing (NFP 32,www.snf.ch/en/researchinFocus/nrp/nrp32-ageing/Pages/default.aspx) in 1991 contri-buted to a renaissance and fi nally to a stronger insti-tutionalisation of research on ageing and of geron-tological formation in Switzerland.

In addition to smaller research projects on impor-tant topics (images of age among young and old re-spondents, use of technological instruments for the el-derly, social activities within organizations of retirees, living after bereavement, comparing social security systems, cognitive therapies for depressed elderly, sup-porting family members of Alzheimer patients etc.) fi ve larger research studies (with strong scientifi c and social-political impact) were organized (Höpfl inger, Stuckelberger 1999; 2000). All these studies indicat-

ed — in addition to specifying measurement proce-dures — the important impact of psychosocial condi-tions and social networks of the elderly for successful geriatric interventions.

The results of these studies were internationally and nationally widely publicised and, in strong col-laboration with the SSG, discussed with professionals working in diff erent fi elds (care, architecture, econo-mists, psychologists, social policy-makers etc.). The national programme on ageing — together with the political realisation of the increasing consequences of demographic ageing of the Swiss society — had an impact on four levels:

First of all, gerontology was taken seriously by politics and science alike and in 1995 a national age report introduced new gerontological concepts in po-litical discourse (Eidgenössische Kommission ‘Neuer Altersbericht’ 1995). After 2000, the SSG became of-fi cially an accepted coordinating association on ques-tions on ageing subsidised by the federal state. The increased legitimisation of gerontological concepts helped in applying new results within communal and regional policies. The establishment of fi nancially strong foundations was underscored for example by the Age-Foundation that supports new forms of housings for the elderly (www.age-stiftung.ch). An increasing number of networks — like the Geneva International Network on Ageing (GINA, https://sites.google.com/site/ginagenevaintlnetworkon-ageing/what-is-gina) or the World Demographic & Ageing-Forum (WDA, www.wdaforum.org) — are helping to link research and policy-makers in fruitful collaborations.

Secondly gerontological trainings and forma-tion were introduced at diff erent levels, for example a School of Applied Gerontology — until its closure 2010 fi nanced by the Pro Senectute — introduced people working with the elderly to new concepts, theories and research results. 2006 the University of Applied Science in Bern introduced a master of advanced studies in gerontology and in the fol-lowing years other universities of applied science (Zurich, Lucerne) followed with their own training programmes as well as some universities (Geneva, Zurich). As mentioned earlier, the formal acceptation of geriatric medicine has resulted in an increasing number of post-graduate geriatric courses.

Thirdly, university research was institutionalised also outside the French-speaking part of Switzerland, for example in 1998 with the foundation of a multi-disciplinary centre of gerontology at the University of Zurich (2002 formally institutionalised through a pro-

72


fessorship in gerontopsychology (Prof. Mike Martin, www.zfg.uzh.ch) and the International Normal Aging and Plasticity Imaging Center (www.inapic.uzh.ch). Gerontological research was strengthened by the Swiss National Centre of Competence in Research LIVES — Overcoming vulnerability: Life course per-spectives (NCCR LIVES), which started operations in January 2011 at the University of Lausanne with a subproject at the University of Berne (Pasqualina Perrig-Chiello, www.lives-nccr.ch/en/page/innova-tive-interdisciplinary-and-comprehensive-approach-n9). Also the establishment of the Institute on Ageing at the University of Applied Science in 2012 (Prof. Stefanie Becker, www.alter.bfh.ch) indicates the recent awareness of gerontological topics in the fi eld of applied research and education in Switzerland.

Fourthly, the subject of ageing and the situa-tion of the elderly were systematically linked with the subject of intergenerational relations (Perrig-Chiello, Höpfl inger, Suter 2008). The demographic ageing and individual ageing of parents also aff ects the younger generations and the elderly are integrat-ed in intergenerational relationships (own children, grand-children). In a fi rst phase, this linking of age-ing and generational research was organized within the institute ‘Age and Generations’ (INAG) in Sion and, after the closure of the institute (2008), within universities (Prof. Valerie Hugentobler Lausanne, Prof. Marc Szydlik, Zurich), for example by analysing inter generational relationships of the elderly within the data-set of the Survey on Health, Ageing and Retirement in Europe (SHARE).

In all these initiatives and networks the SSG — as multidisciplinary gerontological association — is permanently and strongly involved. Thus, two of the most prominent organisations in Switzerland who en-gage in the provision of multiple off ers for the elderly (ProSenectute Schweiz, www.pro-senectute.ch) and the umbrella organisation of the long-term nursing homes in Switzerland (curaviva, www.curaviva.ch) are key partners of the SSG. The SSG links both geronto-logical and geriatric research and knowledge as basic

research and professionals dealing with the challenges of individual ageing and societal changes in later life phases.

ReferencesBecker S.; Brandenburg H. Lehrbuch Gerontologie —

Gerontologisches Fachwissen für Pfl ege und Sozialberufe — Eine interdisziplinäre Aufgabe. Bern: Huber. (Textbook Gerontology — Specialised Knowledge in Gerontology for Professionals in Nursing and Social Occupations — An Interdisciplinary Task). 2014

Eidgenössische Kommission für Altersfragen. Die Altersfrage in der Schweiz, Bern, 1979.

Eidgenössische Kommission ‘Neuer Altersbericht’ (1995) Altern in der Schweiz. Bilanz und Perspektiven, Bern. (Federal Commission for Questions on Ageing (1979) Ageing in Switzerland. Bilance and Perspectives).

Gilliand P. Rentiers AVS: Une autre image de la Suisse. Iné-galités économique et sociales, Lausanne: Réalités Sociales. (Pensions: Another Image of Switzerland. Economic and Social Disparities), 1983.

GUGRISPA (Groupe universitaire genevois de recherche interdisciplinaire sur les personnes âgées). Vieillesses. Situations, itinéraires et modes de vie des personnes âgées aujourd’hui, St.Saphorin: Georgi. (Ageing: Situations, Directions and Modes of Living of Elderly Persons Today). 1983.

Höpfl inger F. Soziale Gerontologie in der Schweiz. In: B. Jan-sen, F. Karl, H. Radebold, R. Schmitz-Scherzer (Hrsg.) Sozia le Gerontologie. Ein Handbuch für Lehre und Praxis (Social Geron-tology in Switzerland. A Handbook for Teaching and Practice). Beltz-Verlag: Weinheim, 1999. 65–76.

Höpfl inger F., Stuckelberger A. Vieillesse et recherche sur la vieillesse en Suisse (Old Age and Ageing Research in Switzer-land). Lausanne: Réalités Sociales, 1992.

Höpfl inger F., Stuckelberger A. Demographische Alterung und individuelles Altern (Demographic and Individual Ageing). Zürich: Seismo. 1999.

Michel J.-P., Stuckelberger A., Grab B. Switzerland. In: Erd-man B. Palmore (ed.) Developments and Research on Aging. An International Handbook, Westport: Greenwood Press, 1993. 299–315.

Perrig-Chiello P., Höpfl inger F., Suter Ch. Generationen — Struk turen und Beziehungen. Generationenbericht Schweiz. Gene rations — Structures and Relationships. Zürich: Seismo, 2008.

Schweizer W. Die wirtschaftliche Lage der Rentner in der Schweiz (Economic Situation of Retirees in Switzerland). Bern: Haupt., 1980.

Stuckelberger A., Höpfl inger F. Ageing in Switzerland at the Dawn of the XXIst Century. Bern: Swiss National Science Foun-dation, 2000.

Tuggener H., Morf-Rohr U. Dabei oder nicht dabei? Jungsein und Altsein in der Schweiz: Ergebnisse aus dem Nationalen Forschungsprogramm 3: Probleme der sozialen Integration (To be Present or Not? Being Yound and Old in Switzerland: Results of the National Research Programme 3: Problems of Social Integration). Bern: Haupt, 1984.


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Introduction

Demographic trends suggest that population age-ing is a universal phenomenon, and Europe is poised to be at the frontier. In fact, many European countries such as Italy, France, Spain and Malta include some of the highest proportions of older persons in the world, with more than 20 % of their populations now aged 60 years and over (UN-DESA, 2009). However, popu-lation ageing is occurring at a higher pace in low- and middle-income countries where currently two-thirds of the world’s older populations live, and this estimate is projected to rise to close to 80 % by 2050 (Chatterji et al., 2014). This growth in the older population in developing countries is taking place in parallel with rapid urbanization, changing health profi les, declin-ing family resources and other unique socio-political challenges. In Tunisia, a small-middle income coun-try on the southern shore of the Mediterranean, pop-ulation ageing has been underway for the past several decades and has been met with several encouraging demographic and social indicators (Gouiaa and Sibai, 2013). Yet, these steps forward are accompanied with changing epidemiological profi les, risk behaviors and the recent context of socio-political changes in the country. This chapter begins with a detailed account of trends in the demography of ageing in Tunisia with projections made for the period 2025–2050. The chapter then reviews laws, policies and programs governing older adult health and social care in the country as well as emerging geriatric and gerontol-ogy training programs, and ends with a description of ageing research in the country and the health profi le of the older population in Tunisia.

Ageing Indicators and Driving Factors

Demographic transitionsPopulation ageing in Tunisia has been underway

for the last four decades. As a result of national health and social reforms, signifi cant declines have been achieved in fertility and death rates and remarkable

increases in life expectancy at birth as well as at older age groups. Total fertility rate per woman decreased from 6.2 in the 1970s to 2.3 in 1990s and 2.04 in 2004 (UNDP, 2001), and this is expected to reach below replacement level (between 1.5 and 1.9) by 2035 (INS Tunisia, 2007). These changing fertility trends are credited to urbanization, improvement in living con-ditions, better education, empowerment of women, delayed age at marriage, as well as the implementa-tion of clear and well-designed family planning and birth control programs, and an increased use of con-traceptives. Importantly, government interventions and economic progress have resulted in changes in marriage behavior with signifi cant rise in age at fi rst marriage from 19 years in 1956 to 27 in 2004 (INS Tunisia, 2007). This was supported by legislations which abolished polygamy and legalized divorce and abortion, all of which received political support at the highest levels (Saxena, 2009).

Similarly, declines in mortality rates have been consistent since the middle of the past century. Infant mortality was reduced from 200 per thousand in 1950s and 175 per thousand in 1975 to 35 per thou-sand in 1990 (UN–ECA, 2006) and then to a lower value of 22 per thousand in 2006 (Ben Brahim, 2004; UN–DESA, 2006). Also, total mortality rates dropped from 19.5 per thousand in 1956 to a value of 6.0 in 2004 and this is expected to further decrease to 5.6 per thousand by 2024 (INS Tunisia, 2007). These trends have been attributed to wide diff usion of na-tional immunization and vaccination programs and the introduction of public health policies which pro-moted primary healthcare infrastructure in all urban and rural regions of the country.

Concomitantly, the Tunisian population has ex-perienced dramatic increases in longevity during the last several decades. Life expectancy at birth was 44.6 years in the 1950s, increased to 60.0 in 1980 and 70.9 in 2005, a fi gure which is projected to reach 76.2 by 2025–2030, and 78.8 by 2045–2050 (UN–DESA, 2001). These results are higher than the world aver-age and the African continent (67.2 and 52.8, respec-


DEVELOPMENT OF GERONTOLOGY IN TUNISIA

Dr. R. Gouiaa, Dr. S. Hajem, Prof. A. M. Sibai, Prof. M. Hsairi

74


tively, in 2005–2010) but remain lower than those in Europe (74.6 for the same period) (UN–DESA, 2007). Life expectancy for older age groups will also increase by 2045–2050 to reach 21.8 years at the age of 60, 17.7 at the age of 65 years, and 8.1 at the age of 80, compared with current values of 17.7, 14.1 and 5.9, respectively (UN–DESA, 2001). Older women at the age of sixty tend to outlive older men by an average of 3 years (UN–DESA, 2009).Growth in number and proportion of older people

The above transitions translate into a narrowing of the population pyramid base, an increase in the percentage and absolute number of older people, and shift towards an ageing population. In Tunisia, the legal cut-off point for defi ning an older person is set at the age of 60 years, the time by which one would be considered eligible for old-age benefi ts (Offi cial Gazette Republic of Tunisia, 1994). Currently, the proportion of older adults in Tunisia constitute 10 % of the total population (i.e. around a million of the total 10 million), and this is projected to reach 28 % in 2050, the highest among the southern Mediterranean countries (UN–DESA, 2009). In 2030, and for the fi rst time in the history of Tunisia, the proportion of el-derly aged 60 and over will approach that of children aged 14 and less (expected to represent 17.7 % and 17.3 % of the total population, respectively). Whereas the growth factor for the total Tunisian population is expected to decrease from 1.1 to 0.3 during the fi rst half of this century, that of the older population is expected to grow during the same period, notably for the older age groups (from 1.0 to 1.9 for the 60 years and older, from 1.6 to 2.7 for the 65 years and older, and from 1.9 to 4.1 for the 80 years and over (UN–DESA, 2001).

The ageing index, calculated as the number of persons 60 years and over per hundred children un-der 15 years, is similarly rapidly increasing in Tunisia, from 28.4 in 2000 to 58.8 by 2025 and 125.6 by 2050 (UN–DESA, 2001). With a projected increase in the total population of Tunisia from a current estimate of 10.5 million in 2010 to between 12.0 and 12.5 mil-lion by 2030, the absolute number of older people 65 years and over will increase from close to one million in 2010 to around 1.5 million in 2030 (WPP, 2012). During the period between 2008 and 2040, the num-ber of people above the age of 65 will more than dou-ble in Tunisia (215 %) (US DHHS DC, 2009). Studies have shown that the speed of population ageing in developing countries is higher than that of developed ones, for example, while France required 115 years

(from 1865 to 1980) to double the percentage of its population aged 65 and over from 7 to 14 %, Tunisia will need only 24 years (from 2008 to 2032), a single generation, to achieve this same rate (US DHHS DC, 2009).

Tunisia has adopted a decennial (2003–2012) plan of action for the elderly (MSAS Tunisia, 2004), according to the Madrid International Plan of Action on Ageing 2002, the Arab Plan of Action on Ageing to the year 2012 (ESCWA, 2002) and the specifi c needs and values of our society and culture. The plan of action covers areas as diverse as legal protection, welfare, national solidarity, health management, and training and research. The following sections high-light the main components of this policy and review the role of associations in the protection of needy older persons without family support.

Social Protection of the Elderly: the role of the government and civil society

Laws and Policies: Principles of social protectionAmong its neighboring Arab countries, Tunisia

has been a pioneer in formulating policies, legislation and plans of action in support of its older people. A number of population policies have been set since the 1990s to safeguard older people through the funda-mental principle of ‘ageing in place’, which aims to help older people remain at home and in their natu-ral environment for as long as possible (Gouiaa and Sibai, 2013).

Social protection for older people in Tunisia is le-gally assured through Law 94–114 passed in October 1994 which aims to strengthen intergenerational solidarity and family integration (Offi cial Gazette Republic of Tunisia, 1994). The law denotes the re-sponsibility of the family in protecting older relatives and attending to their needs (Article 2) and follows fi ve main pillars of social protection, namely, to en-sure that older persons are able to live in their homes and in their usual social environment, to reduce so-cial inequalities and mitigate social exclusion through ensuring a minimum income for poor older persons, to facilitate access to health care and social assistance in case of illness or disability, to strive for a dignifi ed and decent life for seniors, and to promote encour-age active participation of seniors in social, economic and educational developmental activities. This law also states that the government shall take the neces-sary measures to facilitate access of older people to health care, housing, public transport, administrative services and integration in social life. Law 94–114

75


was also followed by a series of decrees in 1996, all of which collectively serve to improve the conditions of older persons:

• Decree No. 96–1016 (May 1996) laid down the conditions and arrangements for families support-ing elderly in need, and defi ned benefi ts for the ‘host families’,

• Decree No. 96–1017 (May 1996) attended to the housing conditions of elderly institutions, and

• Decree No. 96–1767 (September 1996) set down the conditions for which older persons and their fami-lies are entitled to government sponsored home-based health and social services and associated costs.

Tunisia operates a number of programs in or-der to off set social exclusion and marginalization and strive towards social protection of older persons. These include providing free care for older persons without family support through the «Free Medical Aid» system, assigning a monthly ‘solidarity allow-ance’ for poor older adults to ensure that basic needs are met, and supporting families in precarious situa-tions who take care of dependent older persons with fi nancial and in-kind support. Finding a ‘home’ for older persons without family support is also promoted through a ‘hosting family’ in order to prevent insti-tutionalization, subject to the older person’s and the hosting family’s agreement and the availability of rea-sonable living conditions including income and basic amenities (MSA Tunisia 2002). The hosting family receives regular fi nancial compensation and benefi t from social and material aid.

In order to aff ord older persons the opportunity to improve their quality of life, both education and employment are promoted in later life. Education and literacy for seniors is made available through the National Education Program for Adults, which advo-cates «the right to education for all throughout life». Furthermore, voluntary activities and community work are encouraged in order to ensure older per-sons have opportunities to remain active in later life. For this purpose, a national database was created to identify individuals who are willing to maintain social and economic utility. Such action has the purpose to promote, as far as possible, the autonomy and social integration of seniors (MSA Tunisia 2002).

Role of associationsInstitutions that care for older persons are man-

aged under Tunisian law. Generally, Tunisian asso-ciations play a vital role in the national strategy for social promotion and improvement of well-being and quality of life among population groups with specifi c

needs. Associations that provide home-based assis-tance occupy a prominent place in reducing institu-tionalization and making it possible for older persons to stay in their homes, which remains a top national priority. Mobile medical and social support teams are a primary vehicle for the delivery of home-based care and support and, given the nature and mag-nitude of this mission, it now ranks as a major and indispensable player in the personal services sector for older persons as it off ers them the opportunity to continue to live in their usual surroundings, enhance their autonomy and allow them to age with dignity. Additionally, associations off er services such as assis-tance with administrative and legal procedures as well as guidance and counseling. The Ministry of Women and Family Aff airs, for example, has contributed to-wards establishing day clubs for older persons under the management of ageing associations.

Regional Associations of Protection of Older People play a fundamental role in home-based health and social services of older persons. Tunisia has 25 associations in 24 governorates for the protection of older people provided they are poor and lack forms of social and fi nancial support. Most of these associations have mobile teams that include doctors, nurses and social workers and are regulated by both the Ministry of Women and Family Aff airs and the Tunisian Social Solidarity Union affi liated with the Ministry of Social Aff airs. Among these mobile teams, the SOS Elderly Unit established by the Association of Protection of Older People in Manouba stands out for providing a free-of-charge emergency call number to facilitate the reporting of social or medical emergencies. Among these regional associations, 11 also provide accommo-dation possibilities and host nearly 720 people who meet very strict selection criteria. Other, more spe-cialized, associations have also developed to cater to older people with special needs as well as make ser-vices in gerontology and geriatrics available.

The Tunisian Association of Gerontology (ATUGER), with more than four hundred members, was created in 2002 and is very active in the fi eld of gerontology, geriatrics and ageing through organizing trainings, seminars and meetings. ATUGER often collaborates with other institutions such as the Faculty of Medicine or the Graduate School of Science and Technology of Health at Sfax and the International Institute on Ageing — United Nations (INIA–UN). ATUGER is also recognized as a full member in the International Association of Gerontology and Geriatrics (IAGG) representing Tunisia, as well

76


as a member of the International Francophone Association of Geriatrics and Gerontology (AIFGG).

Although not specialized in the protection of old-er persons, some associations provide benefi ts through family support and disability services. Additionally, scientifi c associations are active in contributing to the medical and social care of older people with special needs by organizing training and guidance programs in the fi elds of gerontology and geriatrics, family medicine, and Alzheimer’s disease. The private sec-tor, however, does not mirror the public sector in its support for older persons in Tunisia. Private nursing homes are still nascent in Tunisia and the few avail-able homes are small and play a limited role in making accommodation available and accessible. However, the private sector may be undergoing a haphazard and unregulated proliferation, with new companies emerging which off er support and home-based ser-vices. As ‘ageing in place’ is one of the main pillars of ageing policies in Tunisia, home-based health and social services are fundamental vehicles for this un-derlying principle. Within this general framework, the Ministry of Public Health has taken the lead in developing new regulations which aim to structure, organize and secure specialized home-based services (Hajem, 2011), which are reviewed in the following sections.

Health Care

In this section, we review the most signifi cant measures with the greatest impact on facilitating ac-cess to preventive and curative care for older persons in Tunisia, in particular the vulnerable and disadvan-taged segments.

Regulatory measuresBefore reviewing the various initiatives undertak-

en by the Ministry of Public Health, it is important to make reference to the law № 94–114 of October 1994 that affi rmed the right of the elderly for health and health care. As such, the Ministry has taken several leads in drafting and disseminating several ministerial circulars related to health care provision in the public sector. These circulars were directed at improving and strengthening the quality of services in public hospitals and healthcare facilities, covering all aspects of care including admission, counseling, prevention, diagnosis, treatment and health manage-ment (Circulars № 38/91 of May 1991, № 92/92 of October 1992, and № 52/08 of June 2008). The latter, issued in 2008, is exemplary in integrating all levels and dimensions of care.

Furthermore and within the overarching theme of the ‘the right to healthcare to all citizens’, provid-ing free access to care to the most disadvantaged and vulnerable segments of the population is a funda-mental tenant of the health care system in Tunisia. In this context, the Ministry of Public Health has imple-mented a plan of free access to health care for the poor, including older people, treated in public health facilities.

Creation of specialized units for elderly careThe Ministry of Public Health has advocated

and supported the integration of Geriatrics Units in departments of internal medicine, enhance seniors’ access to specialized health care and ensure eff ective and adequate response to specifi c needs. Examples of geriatric units include those in the Department of Internal Medicine at Habib Thameur Hospital and at La Rabta Hospital in Tunis, each with seven spe-cialized geriatric beds, and the creation of a geriatric unit at Charles Nicolle Hospital in Tunis. An outpa-tient geriatrics unit at the Mahmoud Matri Hospital in Ariana has also been established where two geri-atricians are employed in an outpatient geriatric unit. These experiences are being extended to other re-gional and local hospitals. Several other projects are provided to consolidate and strengthen the geriatric network at public health facilities.

Training and Research

Geriatrics and Gerontology TrainingWorldwide, geriatric medicine emerged during the

1990s in order to prompt multidisciplinary approach of care by health and social professionals attending to the intricate and complex needs of older persons. In Tunisia, geriatrics is not yet recognized a specialty on its own. Yet, medical personnel may receive special-ized two years of competnecy-based curiculum and training, and paramedical workforces have the op-portunity to obtain additional training in gerontology (Hajem, 1999). This is organized through institutions such as Faculties of Medicine, Graduate Schools of Sciences and Technology of Health, Institutes and Schools of Nursing, which have integrated geriatric training into their curricula. The Graduate School of Science and Technology of Health at Sfax has also created a diploma for «Senior Technicians in General Care for the Elderly». Furthermore, the Faculty of Dentistry of Monastir has advanced gerontology con-cepts included in the basic training of future dentists.

77


Medical schools have also developed post-gradu-ate training in geriatrics and have off ered post-gradu-ate diplomas in geriatrics (at the Faculties of Medicine in Sfax, Tunis and Sousse) as far back as 1995. The Faculty of Medicine of Monastir off ers a certifi cate of supplementary studies in geriatrics as well as a specialized Masters degree in psychogeriatrics. For medical doctors who do not intend in specializing in geriatrics, training programs in gerontology are or-ganized consistently by the National Fund of Social Security (CNSS), in collaboration with the Tunisian Association of Gerontology (ATUGER) and the International Institute on Ageing — United Nations (INIA–UN). Furthermore, some doctors have also participated in Advanced Postgraduate Courses in Geriatrics at the European Academy for Medicine of Ageing (www.eama.eu).

Continuing education in geriatrics is compel-ling to develop, update and adapt the knowledge and skills of all professionals, and a necessary tool to improve the quality, effi ciency and safety of ser-vices and care for older adults (Hajem, 2002a). To this end, the Ministry of Public Health has worked to include geriatrics training for all health profes-sionals organized through the National Institute of Public Health (Unit for Research and Information on Aging), the Department of Basic Health (under the National Health Program for the Elderly) and Regional Directorates of Public Health through con-ferences, seminars, forums and regional, national and international conferences (Hajem, 2010a).

The status of geriatrics and gerontology programs in Tunisia

GERITATRICS

Geriatrics curriculum in Medical Schools Yes

Geriatrics courses in Medical Schools Yes

Geriatrics residency programs No

Geriatric module in family medicine training Yes

PhD programs in Ageing studies No

Geriatric programs for nurses Yes

Geriatric programs for physical therapists Yes

GERONTOLOGY

Gerontology programs for social workers Yes

Training /Continuing Education

Short courses/diplomas in geriatrics or gerontology to physicians

Yes

Continuing Education to workers in primary health care centres

Yes

Set under a comprehensive, integrated and multi-disciplinary program, a broad scope of other activities that aims at promoting and safeguarding the welfare of older people are designed and led by the Ministry of Public Health. These activities are designed as a strategic tool for sustainable health promotion of the elderly population, and include among others, train-ing health professionals in geriatric medical and nurs-ing care to information and education of the older people themselves, their caregivers and their families.

Similarly, associations have initiated programs to train caregivers in Tunisia, an important contribution towards alleviating the drain of daily support to older persons at home (Hajem, 2010a). Such trainings were spearheaded by the «Association for Assistance of the Heavily Disabled at Home» and later incorporated into programs at Institutes of Nursing organized by the Central Unit for Management Training, under the Ministry of Public Health. This training addi-tionally provides candidates with a graduate diploma (Hajem, 2010b).

Research activities and fi ndingsGerontology research has undeniably played a sig-

nifi cant role in identifying fundamental determinants of poor health among the older population and, con-sequently, in the development of preventive strategies. Tunisian research articles focusing on geriatrics and social gerontology are increasingly published and oral and poster presentations in national and international congresses and seminars are gaining momentum.

In order to contribute to research and promote evi dence-based program development and policy-making, the Ministry of Public Health has, through a specialized unit at the National Institute Public Health, also undertaken research on ageing through several initiatives, such as conducting a national med-ical and social survey of health and living conditions of people aged 65 and above living at home, estimat-ing life expectancy of the Tunisian elderly popula-tion, studying the prevalence and determinants of dementia and the loss of independence among older Tunisians as well as the current situation and future prospects of ageing in Tunisia.

These studies highlight the characteristics and so-cial and health needs of older persons and have found that, for most Tunisians, the years after the age of 65 are free of severe disability and that life expectancy without disability at age 65 is as high as 12.9 years for men and 13.7 years for women, respectively (Hajem, 2002b). Only about 5 % of the population aged 65 and over are dependent for their activities of daily

78


living (Hajem, 2006). Studies have also shown that only a small proportion of people aged 65 and over live alone (6.5 %) and that approximately six out of ten seniors have spouses, albeit men more often than women (78.4 % versus 35.1 %) (Hajem, 1997; Hajem, 2003).

As elsewhere, non-communicable disease risk factors remain the most prevalent conditions among older adults in Tunisia. Close to 32 % of seniors aged 65 and over are hypertensive (41.3 % of women and 22.6 % of men) and the prevalence of obesity is esti-mated to be 15.6 % of the Tunisian population aged 65 and over living at home (Hajem, 1997; Kamoun et al., 2006). Diabetes is estimated to be 11.6 % among those aged 65 years and over. Furthermore, studies have found that the prevalence of dementia is 3.7 % (4.6 % for women and 2.8 % for men) while Alzheimer’s disease makes up nearly 70 % of the all cases of dementia (Hajem, 2008). Almost 21 % of older adults have depressive symptoms and dissat-isfaction of past and present lives is high, aff ecting around 30 % of the Tunisian population aged 65 and over (Hajem, 1997).

Conclusion

When compared to several neighbouring coun-tries, the achievements made so far in Tunisia in terms of policy and practice in the fi elds of medical and social gerontology are remarkable. The good news is that both the governmental and the civil society are working towards achieving a better quality of life of the Tunisian older population. However, the ques-tion remains whether this is sustainable following the Tunisian revolution in 2011. A new constitution was recently adopted but no special chapter was dedicated to the older adults despite several requests. National economy in the country has experienced a signifi cant decline thus impacting on the purchasing power of its citizens, with most adverse eff ect being felt on the vulnerable older people (Chiraz and Frioui, 2014).

Furthermore, demographic realties, socio-eco-nomic challenges and the rising burden of chronic non-communicable diseases among the older gen-erations will require us to focus healthcare workers’ training on early detection, treatment and care, while considering a life-course approach to prevention and control. There is also a need to expand on the devel-opment of geriatrics in university hospitals, rehabili-tation and long term care centers, homecare, and to transition from competency-based training to a for-mal geriatric specialty programs. Research on ageing

in Tunisia remains limited and there is a need to en-courage knowledge production by earmarking fund-ing opportunities in this fi eld and creating a journal of gerontology/geriatrics for the region.

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Cooperation in National Research in Demography) Seminar February 2004 Age-Structural Transitions: Demographic Bonuses, but Emerging Challenges for Population and Sustainable Development. Paris, February 23–26, 2004.

Chatterji et al., 2014. Chatterji S., Byles J., Cutler D. et al. Health, functioning, and disability in older adults—present status and future implications. The Lancet, Volume 385, No. 9967, No-vember 2014, 563–575.

Chiraz and Frioui, 2014. The impact of infl ation after the revo-lution in Tunisia. Procedia-Social and Behavioral Sciences, 109, 246–249.

ESCWA (Economic and Social Commission for Western Asia), 2002. The Arab plan of action on ageing to the year 2012, February 2002.

Gouiaa and Sibai. Ageing in Tunisia. In: Ageing in the Medi ter-ranean, Troisi J., von Kondratowitz H. J. (eds). UK: Policy Press, 2013. P. 345–357.

Hajem, 1997. Tunisian survey about the health and conditions of life of the elderly aged 65 and over living at home, National Institute of Public Health, National Offi ce of Family Planning, Ministry of Health (Tunisia) and World Health Organization. [In French]

Hajem, 1999. Geriatrics: training and care coordination. Document edited by National Institute on Public Health (Tunisia). 1 Vol., 112 p., June 1999. [In French]

Hajem, 2002a. Future of Geriatrics teaching and home care in Tunisia. Document edited by National Institute on Public Health (Tunisia). 1 Vol., 83 p., June 2002. [In French]

Hajem, 2002b. Life expectancy without disability for Tunisian elderly. Document. edited by National Institute on Public Health (Tunisia). 1 Vol., 60 p., July 2002. [In French]

Hajem, 2003. Health status and medical consumption of Tunisian population in 2000–2001: national survey on health and caring. Tome I: Health Status. Document edited by National Institute on Public Health (Tunisia). 1 Vol., 525 pages, December 2003. [In French]

Hajem, 2006. Said HAJEM, Noureddine MEJRI. Dependency among aged tunisian population: Causes and consequences of a sanitary issue and a social risk. Document edited by National Institute on Public Health (Tunisia).1 Vol., 210 pages, March 2006. [In French]

Hajem, 2008. HAJEM S, MRABET A. Epidémiology of de-mentias in Tunisia. La Tunisie Médicale 2008; Vol 86 Supp. (n°07): 744–745. [In French]

Hajem, 2010a. Current situation and future prospects of train-ing in Geriatrics. Document edited by National Institute on Public Health (Tunisia).1 Vol., 22 pages, mai 2010. [In French]

Hajem, 2010b. Current situation and future prospects of spin-neret of social carer. Document edited by National Institute on Public Health (Tunisia). 1 Vol., 13 pages, Mai 2010. [In French]

Hajem, 2011. National stategy to develop homecare. Document edited by National Institute on Public Health (Tunisia). 1 Vol., 25 pages, September 2011. [In French]

INS Tunisia, 2007. INS Tunisia (National Institute of Statistics, Republic of Tunisia) (2007) Population projection 2004–2034, Ministry of Development and International Cooperation, pp 108–110 [in Arabic].

Kamoun N., Hajem S., Gueddana N. et al. Diabetes, hy-pertension, obesity in the elderly: survey about 981 tunisian el-derly aged 65 and over. La Revue de Gériatrie. 2006. T. 31, n°7, September 2006, 477–486. [In French]

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MSA Tunisia. The Elderly in Tunisia. Increased Solicitude and Spontaneous Contribution to Development Efforts. Document ed-ited by the ministry of social affairs. 1 Vol., 39 pages, April 2002 [in French].

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Global aging is the result of health policies ad-opted throughout the world aimed at increasing life expectancy. The demographic transition, which, un-til recently, was mostly viewed as a phenomenon of the more developed countries, has started becoming a feature of many developing countries like Turkey (1, 2).

Challenging social and economic conditions in daily life increase in the number and the severity of health problems in older ages, and this rationale end-ed with the perception of aging as a «problematic» phase of life although it is simply a biological process.

Maintaining wellbeing and quality of life in an aging population is often accompanied by signifi cant social and economic diffi culties. Hence the growing need to create new policies and strategies aimed at increasing the level of welfare, especially considering that; there is a very signifi cant diff erence in terms of life expectancy at birth between developed and devel-oping nations in the current century.

Developed and developing region diff erences should also be taken into consideration for both pre-vention of health including early diagnosis and treat-ment, and rehabilitation services and promotional activities. Maintaining independence and preventing disability of the aged people are closely related to re-habilitation and ensuring the quality of life. All these activities need inter- and multi-sectoral collaboration while organizing, planning and implementation phas-es of solution strategies prioritize the social determi-nants of health (3).

Scientifi c work on biogerontology

Aging is characterized by the progressive accu-mulation of damage at the molecular level caused by environmental and metabolical factors, by spontane-ous errors in biochemical reactions and by nutritional components. Damages in the maintenance and repair

systems and other pathways lead to age-related mo-lecular heterogeneity, cellular dysfunctioning, reduced stress tolerance, diseases and fi nally ultimate death.

In Turkey, basic researches to enlighten specifi c mechanisms of aging on various animal models start-ed in early 1970s when Bozcuk and his colleagues started to publish many scientifi c articles concerning protein turnover, DNA synthesis, age related enzymat-ic changes and genetics of longevity in Drosophilia (4). Henceforth, studies conducted in various tissues trying to elucidate the underlying mechanisms of ag-ing and possible links between metabolic pathways are underway. In the following section, only fi ndings of some recent studies will be given.

Studies on oxidation and aging

One of the most popular investigation areas on aging, which Turkish scientists seem to work on, is the changes in oxidant and anti-oxidant systems in diff er-ent tissues. The increased glyco- and lipo-oxidation events are considered one of the major factors in the accumulation of non-functional damaged proteins. Study results regarding the roles of reactive oxygen species (ROS) and oxidative stress support the free radical theory of aging.

Oxidative stress can be broadly defi ned as an im-balance between generation of ROS and degradation or metabolism of ROS by the various antioxidant de-fense mechanisms, leading to excessive levels of ROS. The overall eff ects of ROS depend on local concen-trations, subcellular localization and the proximity of ROS to other target molecules. The ROS that are generally of most interest in the present context in-clude the superoxide radical (O2–), hydroxyl radical (OH•) and hydrogen peroxide (H2O2).

In recent studies, D-galactose-induced aging has been the preferred study model. Çakatay et al. focused on protein oxidation mechanisms and protein-bound


GERONTOLOGY IN TURKEY

Prof. Y. Gokce Kutsal*, Prof. C. Kabaroglu**, Prof. D. Aslan*, Instructor Dr. M. Sengelen*, Assoc. Prof. S. Eyigor**, Prof. B. Cangoz*

* Hacettepe University-Ankara, Turkey (www.hacettepe.edu.tr); ** Ege University-İzmir, Turkey (http://www.ege.edu.tr)

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sialic acid levels in liver tissue in D-galactose induced aged rats (5). They concluded signifi cantly higher PCO (Protein Carbonyl Groups), P-OOH (Protein Hydroperoxides) and AOPP (Advanced Oxidation Protein Products) levels in 20-week old rats when compared to young control groups. Sialic acid levels in D-galactose-induced aging rats were signifi cantly lower compared to control groups. Their results dem-onstrated greater susceptibility to hepatic oxidative protein damage and desialylation of hepatocellular proteins in D-galactose-induced aging rats.

Studies on dietary interventions to ameliorate oxidative stress

The free radical theory of aging posits that the accumulation of macromolecular damage induced by toxic reactive oxygen species plays a central role in the aging process. The imbalance between reactive oxygen and nitrogen species and antioxidant defenses is crucial in the aging process over the lifespan. Due to high oxygen uptake and low antioxidant defenses an increase in the vulnerability of many cells to oxi-dative damage may occur. Therefore consumption of dietary antioxidants appears to be of great im-portance. Recently, eff ects of some antioxidants and age-related oxidative stress have been investigated by several groups.

Blueberry related studiesÇoban et al. investigated the eff ect of whole fresh

blueberry (BB; Vaccinium corymbosum L.) treat-ment on oxidative stress in D-galactose induced liver injury in rats (6). Rats received D-galactose (300 mg/kg, s.c.; 5 days per week) alone or together with 5 % (BB1) and 10 % (BB2) BB-containing chow for 2 months. Malondialdehyde (MDA) and protein car-bonyl (PC) levels increased, but glutathione (GSH) levels, CuZn-superoxide dismutase (SOD1) and glu-tathione peroxidase (GPx1) activities decreased to-gether with histopathological structural damage in the liver in D-galactose-treated rats. Although there was no change in hepatic mRNA expressions of SOD2 and GPx1, SOD1 and GPx4 expressions decreased. BB1 and BB2 caused signifi cant decreases in serum ALT and AST activities together with the ameliora-tion in histopathological fi ndings in GAL-treated rats. Both BB1 and BB2 reduced MDA and PC levels, and elevated GSH levels, and SOD1 and GPx1 activi-ties. However, hepatic mRNA expressions of SOD1, SOD2, GPx1 and GPx4 remained unchanged in D-galactose-treated rats.

Carnosine related studiesCarnosine (β-alanyl-L-histidine) is a dipeptide

with antioxidant properties. Çoban J et al., investi-gated the antioxidant eff ects of carnosine (CAR) + vitamin E and betaine treatments on age-related oxi-dative stress in liver, heart and brain tissues of aged rats (7). CAR (250 mg/kg; i.p.; 5 days per week) and vitamin E (200 mg/kg; i.m.; twice per week) or beta-ine (1 % w/v) were given to 22 months old Wistar rats. CAR+ vitamin E treatment decreased MDA and di-ene conjugate (DC) levels in examined tissues of aged rats. Both CAR+E and betaine treatments increased hepatic GSH and vitamin E levels. However, neither CAR+E or betaine treatments did not aff ect antioxi-dant enzyme activities in the examined tissues.

The established link between cardiovascular dis-ease and lipid peroxidation emerged a new investiga-tion area, thus lipid peroxidation in various tissues has been the focus of diff erent studies. Aydın AF et al., investigated the eff ect of carnosine supplementation on oxidative stress in serum, apoB-containing lipo-proteins (LDL + VLDL) and erythrocytes of young and aged rats (8). Malondialdehyde (MDA) and di-ene conjugate (DC) levels and endogenous DC and copper-induced MDA levels in the LDL + VLDL fraction were increased in aged rats, but there was no change in plasma antioxidant activity. Endogenous DC and H2O2-induced MDA levels were also higher, but glutathione (GSH) levels were lower in erythro-cytes of aged rats. Administration of carnosine de-creased levels of MDA and DC in serum, the LDL + VLDL fraction and erythrocytes and increased levels of GSH in the erythrocytes.

Curcumin related studiesTurmeric has been used commonly as a spice, food

additive, and an herbal medicine worldwide. Known as a bioactive polyphenolic extract of Turmeric, cur-cumin has been shown to be antioxidant, anti-infl am-matory and neuroprotective. Recently, active research on curcumin with respect to aging has demonstrated that curcumin and its metabolite, tetrahydrocurcumin (THC), increase mean lifespan of at least three model organisms: nematode roundworm, fruit fl y Drosophila, and mouse (9).

Starting from this point, Belviranlı et al. evalu-ated their hypothesis that curcumin would have an infl uence on cognitive functions in aged female rats (10). Curcumin or vehicle (corn oil) were given once daily for a period of 12 days, beginning 7 days prior to and 5 days during the behavioral tests. Behavioral assessment was performed in Morris water maze.

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During the training session, curcumin supplementa-tion decreased latency to reach to the platform and the total distance traveled. During the probe trial, curcumin supplementation increased the number of platform crossings. The authors concluded that cur-cumin supplementation improved cognitive functions by decreasing the lipid peroxidation in brain tissue of aged female rats.

Melatonin related studiesÖztürk G et al., evaluated the age-related changes

in mitochondrial GPx, glutathione reductase (GRd) and SOD activities, and mitochondrial GSH pool in the brains of young (3 months) and aged rats (24 months) (11). They also investigated whether subcu-taneously administrated melatonin infl uences brain mitochondrial enzyme activities and GSH levels in young and aged rats. Their results showed that GPx activity increased with age, whereas melatonin treat-ment decreased GPx activity in the aged rats. The activities of GRd and SOD did not change with age. Furthermore, although melatonin treatment in-creased SOD activity in the aged rats, increased GSH levels were not modifi ed. They concluded that the re-ductions in the SOD/GPx and GR/GPx ratios with age were prevented by melatonin administration.

Amino acid related studiesIt has been suggested that variations in the pro-

portions of some dietary amino acids can slow down aging. In the study of Tanrıkulu-Küçük S and Ademoğlu F, the infl uence of amino acids other than methionine on aging was investigated in rats fed ei-ther with normal (ND) or except methionine, protein restricted diet (PREMD) for 4 months and oxygen radical production, oxidative protein and DNA dam-age along with telomere length and telomerase activ-ity were measured in the liver (12). The authors con-cluded that long-term restriction of the amino acids other than methionine may decrease oxygen radical generation and oxidative damage of cellular constitu-ents, and may also prevent telomere shortening in rat liver.

Studies on mitochondrial DNA and agingDuring the aging process, a wide spectrum of al-

terations in mitochondria and mitochondrial DNA (mtDNA) has been observed in somatic tissues of hu-mans and animals. This is associated with the decline in mitochondrial respiratory function; excess produc-tion of the ROS; increase in the oxidative damage to mtDNA, lipids and proteins in mitochondria; accu-mulation of point mutations and large-scale deletions

of mtDNA; and altered expression of genes involved in intermediary metabolism. Although human organ-ism is well equipped with DNA repair systems, mtD-NA lacks histones and has less effi cient repair systems, which makes it more prone to oxidation. Interestingly, apart from free radicals, some other mechanisms like the increase of mitochondrial NADH/NAD+ and ubiquitinol/ubiquinone ratios may be considered. A recent opinion written by Olgun should be exciting for readers of interest (13).

Studies on genetics of cellular senescence

Genetics of cellular senescence is another promis-ing fi eld. Telomere shortening in mitotic somatic cells may contribute to their senescence and it has been suggested that if telomere shortening could be slowed in dividing cells in vivo, this could lead to an increase in replicative lifespan, which may enable these cells to carry out their normal cellular functions for a longer period of time. Olgun has used mitochondrial defi -cient models trying to elucidate the genetic mecha-nisms of aging (14).

Recommendations for future studies

Human aging should be viewed as the result of the accumulation of somatic damages, owing to lim-ited investments in maintenance and repair systems. Two major focuses are geriatric medicine (trying to reduce the incidence and severity of age-related dis-eases) and biogerontology (trying to decrease the ag-ing process and to increase the average human life span).

The emerging fi ndings from genomics experi-ments emphasize the need for research using human samples to uncover aging mechanisms. If we are in-terested in the extension of healthy lifespan in hu-mans, there is a need to pay more attention to human studies. As a country, we are not aged yet, but will be becoming aged in the coming years. Considering environmental and nutritional aspects, perhaps we should concentrate on studies focusing on elucidating the biochemical and molecular basis of longevity in very old people living in Turkey. These kinds of stud-ies, especially with international synergy, may provide us with new and important knowledge in a very short period of time.

Our journey in the fi eld of aging, as Turkish scien-tists, has started with works done in foreign countries. As observed from scientifi c publications, it is pleasing to see that Turkish scientists now have chances to use

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the newest technologies in their homeland and are following recent trends in the fi eld of aging.

Biogerontology is a new emerging fi eld in our country and geriatric departments are being set up. Although the scientifi c progression is impor-tant, spreading the notion of biogerontology among Turkish scientists to increase both public and scien-tifi c awareness is essential. At this point, the eff orts of Turkish Geriatrics Society, scientifi c journals and research centers in universities should not be underes-timated. In this way, the forthcoming well-organised meetings and education programs will implement col-laborations between Turkish scientists ending up in promising studies.

Public health and aging

Public Health (PH) is a very broad discipline fo-cusing on preventive measures all around the world. The discipline of PH was described as «the science and the art of preventing disease, prolonging life, and promoting physical health and effi ciency through organized community ef-forts for the sanitation of the environment, the control of com-munity infections, the education of the individual in principles of personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of dis-ease, and the development of the social machinery which will ensure to every individual a standard of living adequate for the maintenance of health; organizing these benefi ts in such a fash-ion as to enable every citizen to realize his birthright of health and longevity» by CEA Winslow in 1923 (15).

Prof. Winslow’s very precious defi nition arisen from his addressed needs for those days is still valid in today’s world. Public health today is based on this context and is improving in more than one branch including community, academia, etc.

Aged people are one of the major study groups of PH as the elderly population is increasing both in Europe and in the world. Turkey is a part of the European Region of the World Health Organization (WHO) (16). And parallel with the change in the population structure, aged individuals are increasing in the country since decades. The percentage of the aged population has been 7.7 % of the total which equals to 5 891 694 individuals by the end of 2013 (17).

The rapid increase in the aged individuals in our country highlights the «new» needs for the near fu-ture. In this age group, increase in the prevalence of chronic diseases and disability is quite a «new» issue for Turkey, which is in transition of demographic change. To struggle with this burden, focusing on

eliminating major risks causing chronic diseases, etc. may be a priority. Due to the WHO data, major risks are known to be underweight, unsafe sex, high blood pressure, tobacco and alcohol consumption, and un-safe water, sanitation and hygiene (18). In this context, improvement of healthy nutrition, tobacco free life, adequate physical activity, avoiding excessive amount of alcohol use should be promoted in the community in a strategic manner (19).

From PH perspective, good health should be promoted through the life course, in other words; from birth to death. Thus, this basic concern needs a couple of priorities such as meeting all the needs of aged population including health by the states, conti-nuity of the social and health care facilities/policies for every individual without any discrimination, etc. The wellbeing of aged population could have been achieved with the policies based on such compre-hensive perspective. As an extension of these works, many «new» approaches have been carried into the agenda of both science and social work. «Active ag-ing» is one of these approaches, which the WHO has defi ned. According to WHO, «aging allows people to real-ize their potential for physical, social, and mental well-being throughout the life course and to participate in society, while providing them with adequate protection, security and care when they need» (20). When looked at the defi nition carefully, it can clearly be seen that the term «active aging» has been based on the PH perspective.

The European Region of WHO which Turkey is a member country has given priority to the facts like enjoying supportive, adapted social environments, having access to high-quality, tailor-made, well-coor-dinated health and social services, giving support to maintain the maximum health and functional capac-ity throughout life, and empowering individual while living and providing dignity through the entire life (21).

On one hand, all movements around the world and Europe are for sure contributing to aging related attempts and developments in Turkey. On the other hand, the actual experiences and needs of the aged population determine the agenda. The recent devel-opment topics in this context could have been classi-fi ed as research, professional training, public educa-tion, preventive priorities, etc.

Research

Research on aging issues is developing in Turkey. As a refl ection of this development, number of the published articles in both national and international

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databases is increasing. With the key words «aged» and «Turkish», there were recorded 2552 articles be-tween 2008 and 2013 whereas, the number was 2114 for the period from 2002 to 2007 (22).

This is for sure a very «simple» analysis done to have an idea on the current situation quickly. Since 1998, an aging specifi c international journal, Turkish Journal of Geriatrics, which is indexed by both Social Science Citation Index and Science Citation Index Expanded has been published by Turkish Geriatrics Society regularly every three months (23).

The content of the research is broad enough to include all preventive, clinical and social aspects of aging. Thus, public health related issues and preven-tive measures were more frequent on individual be-haviors rather than comprehensive approach. As a last point in research topic, research/study popula-tions are recommended to be enlarged to national da-tabases to have nationwide and generalizable results.

Training and education

Professional training on aging is not systematically or-ganized in Turkey. Although many disciplines try to update their curriculum(s) based on the requirements of aged population, there is not a strong collabora-tion and continuity between them and this «weak-ness» may end with the disunity of those disciplines’ targeted refl ections in real life. The qualifi ed health and social professionals keen on aging need to be de-veloped in the short and middle run. Nevertheless, the organizational structure and the technical capacity of the higher education system is thought to be not enough to cover all these lack in the short run.

Governmental and non-governmental organi-zations carry out certifi cated training programs on various topics giving priority to prevention. Medical doctors, nurses, social workers, etc. can join these ac-tivities via their professional occupational associations or the state bodies. Nevertheless, «benefi t» from cer-tifi cated professionals is not enough due to the lack in national occupational policies.

Public/community education is very crucial and ac-cepted as one of the basic tools both to maintain health and wellbeing of the population and in order to increase the awareness on aged related issues and to improve the quality of life.

Educated health professionals, governmental bodies’ facilities and resources, TV channels, press media, books, booklets, offi cial websites of the aging focused associations, societies, etc. are good resourc-es in this regard. There are many good information

resources for the population in Turkey, however, the communication challenges with elderly due to various reasons including diseases, hearing problems and illit-eracy, etc. may be a block to reach these data sources. Majority of aged population has low education sta-tus compared to younger generations. Data of 2012 shows that percentage of the primary educated el-derly has been 51.4 % among males and 30.0 among females (24). In such a «low» educated group, public education should be planned very carefully to achieve intended goals.

How to cover all needs of aged population?This is a very basic question, which should be an-

swered in PH perspective. A number of answers are existing for both developing and developed world (25):

1. Universal health coverage should be provided.2. No discrimination in terms of accessing to

health care is a «must».3. Preventive measures should be strengthened.4. Principles of health promotion concern focus-

ing on quality of life should be internalized.5. Disability should be prevented.6. Dignity of aged population should be given pri-

ority.7. Systematic approach to support solidarity be-

tween generations will provide active participation of aged people into the society and social life.

Clinical issues

It is estimated in the population projections of the Ministry of Health that the percentage of the popula-tion of those 65 years of age and older will be 8.5 % in 2020 and 12.1 % in 2030. This data indicates that the number and percentage of older people have an increasing trend in the world and in Turkey (26).

In the process of aging, a person becomes unpro-tected against diseases and injuries due to cellular and non-cellular changes such as a decrease in the reserve capacity of organs and systems, a decrease in homeo-static control mechanisms, examples of which include thermoregulation system defects and decreased baro-receptor sensitivity, a decrease in the ability to adapt to environmental factors, and a decrease in the capac-ity to respond to stress (27, 28).

Since the primary aim of treatment in aged peo-ple is to improve quality of life and to reduce mortal-ity and the percentage of using healthcare services, quality of life and the factors aff ecting it should be taken into consideration in our clinical practices (29).

Although risks such as disease and disability show an apparent increase in aged people, impairment of

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health is not a natural result of aging. Disability and death, most of which are associated with chronic dis-eases, can be decreased through protective measures. The most important critical problem at this point is the lack of adequate knowledge on meeting the health needs of the elderly.

Many old people have to face health problems and disability due to chronic diseases and their quality of life is aff ected negatively. This may be associated with relatively defi cient physical activity. However, the relationship between co-morbidity and quality of life is still vague. As there is no full recovery from chronic diseases in most cases, the purpose becomes to eliminate the problems annoying the individual and to improve their living conditions. Relatively common diseases such as diabetes, asthma, arthritis and chronic obstructive lung disease impair physical functions and have a negative eff ect on healthy aging. This relationship seen especially between diabetes and healthy living is reportedly linked to the fact that cardiac, podiatric and visual problems occur more frequently in these people. It has been reported that in the presence of chronic diseases increased physi-cal activity improved quality of life. However, it is not clear to what extent chronic conditions have negative eff ects on quality of life. It is not even possible to com-ment on the level of positive eff ect caused by physical activity, but the only thing we are certain of is that all of the predictive factors explained above have close relationships with each other (29).

The researches made in our country have shown that the chronic diseases most frequently seen in the elderly were hypertension, osteoarthritis, heart fail-ure, diabetes mellitus, coronary artery disease, chron-ic obstructive lung disease, osteoporosis and cerebro-vascular disorders. In the study made by Arslan et al. on 1944 nursing home occupants from 23 provinces, they reported that the prevalence of chronic diseases in the population of old people in Turkey was 30.7 % for hypertension, 20.4 % for osteoarthritis, 13.7 % for heart failure, 10.2 % for diabetes mellitus, 9.8 % for coronary artery disease and 8.2 % for osteoporosis (30). Looking at the prevalence of these diseases by gender, diabetes, hypertension, osteoarthritis and os-teoporosis were more common in women and coro-nary artery disease was more common in men.

Frequently seen diseases

Cardiovascular problemsThe European Society of Cardiology has con-

ducted three surveys under the name EUROASPIRE

(European Action on Secondary and Primary Prevention by Intervention to Reduce Events) in order to investigate the eff ects of lifestyle and risk factor modifi cations and pharmaceutical therapies in patients with cardio-vascular diseases (CVD). EUROASPIRE I was conducted in 1995–1996, EUROASPIRE II in 1999–2000 and EUROASPIRE III in 2006–2007 in 22 countries with the inclusion of Turkey (31).

EUROASPIRE III was planned to investigate whether or not patients with coronary heart disease (CHD) have been monitored in line with the rec-ommendations of the new European Guidelines on CVD Prevention and whether or not there were any improvements in these patients’ protective cardiology practices when compared with EUROASPIRE I and II. Similar to the other countries in Europe, the re-sults of EUROASPIRE III for Turkey indicate that the lifestyle, risk factor and treatment targets speci-fi ed in the cardiovascular prevention guidelines have not been achieved in many of the coronary patients. Moreover, looking at the patient discharge notes, the insuffi ciency of knowledge on histories and measure-ments of risk factors appears to be much more dis-tinctive in Turkey. Smoking continues to be an im-portant problem in both men and women in Turkey. While the frequency of smoking had a declining trend in western countries in the last decade, it increased approximately 20 % in our country (32). As in many EUROASPIRE III countries, directing patients to smoking cessation clinics remained seldom in Turkey. In conclusion, the EUROASPIRE III survey showed that Turkey, like the rest of Europe, remained behind the cardiovascular prevention targets. The most im-portant diff erences when compared to Europe were that there were more young patients with myocardial infarct, the rates of continuation with smoking and sedentary living were higher, low HDL-cholesterol levels were a more signifi cant factor, and the rates of failure by the physician to monitor and educate after the index event were higher (33). During the 2009 screening of TEKHARF Survey, coronary and cerebrovascular diseases were found to account for more than a half of the deaths in general mortality. Coronary-related deaths continue to be as high as 5.2 per 1000 persons a year in the 45–74 age segment (34).

These studies demonstrated that the major things that need to be done in our country for prevention of cardiovascular diseases are modifying eating habits, raising awareness in people about the health prob-lems involved in a sedentary life and educating them

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about cardiovascular diseases as well as giving more support to individuals to reduce smoking and using smoking cessation clinics more eff ectively.

Respiratory system problemsThe most frequently developed respiratory sys-

tem diseases by the elderly in our country are chronic obstructive pulmonary disease (COPD) and pneumo-nia. In a regional study where 1270 people over 18 years of age were screened, the prevalence of COPD was found as 11.5 % among those older than 45 years. Age, gender, living in rural areas and low income were found to be the risk factors (35). An old person, even if healthy, is more vulnerable to respiratory sys-tem infections due to the changes in immune system with aging. Respiratory system infections (pneumonia in particular) are an important cause of mortality in individuals over 65 years of age in both developed and developing countries (36).

Musculoskeletal system problemsChronic conditions associated with aging of the

musculoskeletal system lead to severe functional and economic burdens. The problems most frequently causing chronic disability in people over 65 years of age are the musculoskeletal system diseases. This may arise from the fact that the prevalence of musculo-skeletal system diseases is high in the elderly and the musculoskeletal system constitutes the foundation of physical function. Osteoarthritis (OA) and osteoporo-sis (OP) are two of the chronic musculoskeletal system diseases that cause a high rate of disability in the old-er population (37). Another signifi cant condition that causes disability in the elderly is sarcopenia. Other than these, posture problems, muscle weakness, con-tractures, post-polio syndrome, rheumatological dis-eases other than OA, arthroplasty (hip–knee), spinal problems, trauma and similar musculoskeletal system problems in the advanced age group cause problems in the person’s daily living activities and may aff ect their ability to live independently in their community. Yet, some of musculoskeletal system diseases are of preventable nature (36).

It has been reported that the mortality rate was 12–20 % within a year after an OP-related fracture. Morbidity and cost are associated particularly with hip fracture. A hip fracture at age 80 reduces life expectancy 1.8 years and increases nursing services; serious amounts of hospital and care expenses are incurred. In the FRACTURK study where 26 424 people older than 50 were screened, it was found that the incidence of hip fracture was still lower than in Europe, but had an increase as compared to the last

20 years. According to our new data, the incidence of hip fracture is 3.5 % in men and 14.6 % in women (38).

Nervous system problemsThe most frequently seen diseases in old age due

to changes in the nervous system in our country in-clude cerebrovascular event, cerebral hemorrhage, Alzheimer’s, dementia, Parkinson disease, delirium, and depression.

Death as a result of a cerebrovascular event is common in people over 40 years of age in our coun-try and it appears to be the number 3 cause of death. It is held responsible for 14.5 % of deaths in men and 15.7 % in women in Turkey. Being a woman is consid-ered to be one of the poor prognosis criteria in terms of recovery (39, 40).

Dementia, which can begin as paranoid disorders and psychoses at early stages, is a disorder that is seen frequently in individuals older than 65. Alzheimer’s disease is the most frequent cause of dementia in the elderly and studies have shown that its incidence in people older than 65 increases twofold in every 5 years. In a study carried out in Turkey on 1 019 old patients older than 50, the prevalence of dementia was found as 20 % and the prevalence of Alzheimer’s as 11 % (41).

In another study made in our country, vascu-lar dementia was reported to be the most common type with a rate of 51.1 %, dementia associated with Alzheimer’s was seen at a rate of 48.8 % and the oth-er causes associated with B12 defi ciency and tumors at a rate of 0.1 %. The risk factors were enumerated as being female, low level of education, age, family history and living in rural areas (42).

Gastrointestinal system problemsThe most frequently seen diseases due to gastroin-

testinal system changes in old age in our country have been reported to be gastrointestinal system bleedings, constipation that can progress as far as ileus, atrophic gastric, peptic and duodenal ulcers, colorectal can-cers, loss of appetite, and malnutrition (43).

In a study on patients presenting to primary healthcare institutions in our country, the prevalence of gastroesophageal refl ux was found to be 33.9 % and it was seen more in women. While gastroesopha-geal refl ux was seen most frequently at ages 25–35 (25 %), the prevalence of refl ux was found to be 9.2 % above 55 years of age (44).

The general prevalence of constipation problem, which can be defi ned as diffi culty in defecation, solid defecation, insuffi cient elimination or defecation less

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than 3 times a week, is around 15 % on the average. Constipation is not a natural result of aging, but its prevalence increases with aging (50 %). This rate in-creases in nursing homes reaching 74 %. It is seen 2–3 times more in women than in men (45). In a study made by Uz et al. in our country, the prevalence of constipation was found to be 20 % and 73 % of the patients were women and 30 % of them were 60 years old and older (46).

Urinary system problemsUrinary incontinence is a clinical condition that

is quite frequently encountered in the advanced age group, but often overlooked as compared to oth-er geriatric syndromes. It is reported to be seen in 15–34 % of women and in 7–15 % of men (47, 48). Incontinence is a condition that signifi cantly aff ects a person’s life in clinical, psychological and social terms. It involves anxiety, depression, and social iso-lation risks. It was shown to be associated with falls. Abnormal sleep during the day increases the risk of falling 2 times and urge urinary incontinence 1.76 times (49). The cost calculations related to this clini-cal condition yield quite high fi gures since the person becomes needy of care (pad, diaper, medication, de-vice, surgery) and due to complication expenses and decreased productivity (50). Urinary system infections are also common in the advanced age group. They are seen in 34 % of the inpatient elderly. The urinary system is responsible for 25 % of the infections found in older people (50). This should defi nitely be borne in mind in terms of mortality and morbidity.

Besides urinary incontinence, other urinary ail-ments most frequently seen in our country due to old age are urinary system infections, acute and chronic kidney failure, active bladder retention and prostate cancer (51).

Activities of daily livingIn a study performed by Gokce Kutsal et al., it was

found that basic activities of daily living and instru-mental activities of daily living scores of the elderly people aged 85 and over were lower. Due to increase in alterations of musculoskeletal system, degenerative joint diseases, osteoarthritis, osteoporosis, chronic dis-eases, visual disorders and the use of multi-drug in old age compared to other age groups, restrictions in activities of the elderly were seen more (52).

Drug useAge-related physiological changes aff ect pharma-

cokinetic and pharmacodynamic processes of drugs. These situations bring about the need for modifi ca-

tion in the choice of drugs, dosage, and administra-tion intervals in older individuals. With aging, there is an increase in systemic diseases and in the frequency of using drugs (53). In a study made in Turkey to in-vestigate the amount of drug use in the elderly, the results of a total of 11 studies made between 1998 and 2005 were analyzed and the average drug use per person was found to be 3.25 in the elderly, the most frequently used drugs being cardiovascular sys-tem drugs, NSAI drugs and hematologic drugs (54). Another study made in our country reported that the rate of polypharmacy was 24.3 %. The study also re-ported that side eff ects associated with drug use were seen in 5.5 % of the elderly (most frequently GIS side eff ects) and this had a positive correlation with poly-pharmacy (55).

Compliance with prescribed medication is diffi -cult for patients most of the time and is more so for the elderly. This may be associated with many factors such as chronic diseases, polypharmacy, complicated regimens, incorrect beliefs about drug eff ects, fear of side eff ects, the therapy being expensive, forgetfulness, cognitive disorders and vision/hearing defects (56). The rate of treatment incompliance was found to be 17 % in a study made by Özbek et al. on 55 patients in a nursing home (57). Gürol Arslan and Eşer have shown that medication compliance can be increased in the elderly through education (58).

Appropriate prescription of drugs is one of the most basic parts of patient care. The comprehensive criteria related to this which were published by Beers et al. in 1991 and revised by them in 2003 for the last time (Beers’ criteria) should be taken into con-sideration in clinical practice (59). Various screen-ing tools such as STOPP (Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions), START (Screening Tool to alert Doctors to the Right Treatment), IPET (Inappropriate Prescribing in the Elderly Tool) and MAI (Medication Appropriateness Index) may also be used for this purpose (56). Inappropriate prescription is not only associated with unnecessary use of healthcare institutions and increased care expenditures, but also with increased side eff ects and total mortality. In the studies made in our country, it was reported that the rate of potential inappropriate drug use in the elderly was 9.8 % (60), the rate of using non-prescription drugs was quite high with 14.4 % (61), physicians did not inform their patients adequately, they wrote prescriptions without examining 75 % of their patients and did not apply the necessary side eff ect rules adequately when writ-ing prescriptions (62). There may be various types

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of drug interactions in the older population. These include «drug-to-drug», «drug-to-disease», «drug-to-food», «drug-to-alcohol», «drug-to-herbal product», and «drug-to-nutritional status» interactions. «Drug-to-drug» interaction may occur through (1) inhibition of drug absorption, (2) a decrease of hepatic blood fl ow, (3) inhibition of renal elimination, (4) inhibition or stimulation of drug metabolism, (5) mutation of binding albumin, or (6) pharmacodynamic eff ects. «Drug-to-drug» interactions are of special signifi -cance for older patients and the most important pre-dictor of it is the number of drugs prescribed. Risk factors and predictors for adverse drug reaction in the elderly are given in Table I.

The pharmacokinetics and pharmacodynamics of some drugs (e.g. paracetamol, metaclopropamide, theophyline) seem to have mutated in the frail elderly group. As a result, it is not surprising to see falling, injuries, immobilization, hospitalization, side eff ects and mortality at a higher rate in this group of old-er individuals. In a study made on 274 male outpa-tients aged >60 in a geriatric policlinic, the number of average comorbidity was reported to be 2.6 (most frequently hypertension) and the average number of drugs used to be 4.5 (55 % of which ≥4) (63).

Table I

Risk factors and predictors for adverse drug reaction in the elderly

Risk Factors • 40 % decrease in hepatic blood fl ow (decreased fi rst pass effect)

• 50 % decrease in renal blood fl ow at age 80

• 10 % decrease in CrCl in every decade after age 20

• 50 % of older population have chronic kidney disorders

• Congestive heart failure (40 % at age 80)

• Changes in drug distribution (↓protein binding, ↓fat-free mass)

Predictors • ≥85 years of age• Multiple chronic medication (≥6)• CrCl <50 ml/min• Low BMI• Polypharmacy (≥9 drugs or >12 daily

drug dose)

Age-related physiological changes, presence of comorbidity and polypharmacy in the elderly are important factors that complicate pharmaceutical therapies. Inappropriate drug use and prescription is another important issue that triggers, together with other factors, adverse drug reactions and resulting morbidity and mortality in the elderly. As in many is-

sues related to the health of the elderly, education of both health professionals and patients is an essential part of optimal care also in rational drug therapies. Following the guidelines for safe drug usage and pro-liferating computer-aided automatic systems, geriat-ric treatment services and certainly multidisciplinary approaches seem important. The golden rules of pre-scription to achieve maximum benefi t with minimum risk are (1) think carefully before prescribing any drug, (2) write your prescription after obtaining the maxi-mum information about your patient and the drugs you intend to prescribe, (3) monitor your patient with respect to the effi cacy and potential side eff ects of the drugs, (4) consider cessation of the medication and decreasing or changing the dose (56).

Morbidity and mortality

It is important to know the morbidity rates in a country by age groups, gender and regions. Exami-nation of morbidity rates will make it possible to prevent widespread diseases before they appear espe-cially with respect to preventive medicine and to early diagnosis and treatment methods for frequently seen diseases. The disease rates that show an increasing or decreasing trend by years will be an indicator of whether or not the practices followed in relation to a particular disease have been successful.

The Turkish Health Survey, which was performed by the Turkish Statistical Institute (TSI) for the fi rst time in 2008, is being carried out once in every two years now. The survey aims at obtaining information on health indicator, which has a major share among the development indicators showing development lev-els of countries, and closing the information gap in the present structure (Table II) (64, 65, 66).

One of the life events that is dealt with most fre-quently in demographic studies is the instances of death. Calculation of life expectancies of individuals in a certain age group living in a society is an impor-tant aspect of demography. Looking at the latest data published by TSI, we see that the number of deaths was 375 367 in 2011 and this number became 374 855 in 2012. 55 % of those who died were men and 45 % were women.

While the crude mortality rate was 5.1 %o in 2011, this rate declined to 5.0 %o in 2012. According to Level 1 of the Nomenclature of Territorial Units for Statistics (NTUS), the region where the crude mortal-ity rate was the highest in 2012 was West Marmara with 7.3 %o and where it was the lowest was Southeast Anatolia Region with 3.4 %o. In 2012, the age group

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in which deaths were the highest was the age group 75 years and older with 46.2 % and the age group

in which deaths were the lowest was the age group 10–14 years with 0.5 %.

Table II

The percentage of diseases/health problems diagnosed by a medical doctor by sex and resident, 2012 [15≥age]

Diseases/health problemsTurkey Urban Rural

Total Male Female Total Male Female Total Male Female

High blood pressure (hypertension) 12.8 8.5 17.1 11.3 7.5 15.1 16.2 10.6 21.3

Back musculoskeletal system disorders (lumbago, back hernia, other back defections)

10.9 8.0 13.8 9.9 7.5 12.3 13.2 9.2 16.8

Rheumatismal joint disease (romatoid artrit)

7.9 4.2 11.4 6.6 3.5 9.7 10.6 5.9 15.0

Gastric ulcer 7.2 5.8 8.7 6.5 5.3 7.7 8.9 6.8 10.8

Diabetes 6.7 5.5 7.9 6.5 5.2 7.7 7.2 6.1 8.3

Osteoartrit (artrosis, joint degeneration) 6.0 3.1 8.8 4.9 2.4 7.4 8.3 4.5 11.8

Neck musculoskeletal system disorders (neck pain, neck hernia, other neck defections)

5.0 2.4 7.5 4.9 2.4 7.4 5.1 2.3 7.7

Anaemia (iron defi ciency anaemia) 5.3 1.1 9.5 5.3 0.9 9.6 5.5 1.4 9.2

Sinusitis (infl ammation of sinus) 4.8 4.2 5.4 4.9 4.3 5.6 4.5 4.1 4.9

Migraine and severe headache 4.2 1.7 6.7 4.3 1.6 6.9 4.1 1.7 6.3

Asthma (allergic asthma included) 4.9 3.4 6.3 4.2 2.9 5.6 6.3 4.7 7.8

Coronary heart disease (angina pectoris, chest pain, spasm)

4.1 4.0 4.2 3.7 3.5 3.8 5.1 5.2 5.1

Allergy, such as rhinitis, eye infl ammation dermatitis, food allergy or other (allergic asthma excluded)

3.1 2.4 3.9 3.2 2.3 4.0 3.0 2.4 3.4

Thyroid disease 3.4 0.9 5.7 3.4 0.9 5.9 3.2 0.9 5.3

Chronic obstructive pulmonary disease (chronic bronchitis, emphysema)

2.9 2.7 3.0 2.4 2.3 2.5 3.9 3.6 4.1

Urinary incontinence, problems in controlling the bladder

1.8 1.2 2.4 1.4 0.9 1.8 2.7 1.8 3.5

Chronic depression 1.9 0.9 2.9 1.8 0.8 2.7 2.2 1.2 3.3

Other psychological health problems 1.6 1.2 1.9 1.4 1.0 1.8 1.9 1.5 2.2

Chronic heart failure 1.2 0.9 1.6 1.1 0.8 1.4 1.6 1.1 1.9

Infarct (heart attack) 0.9 1.2 0.6 0.9 1.2 0.6 1.1 1.4 0.8

Stroke (cerebral hemorrhage, cerebral thrombosis)

0.9 0.9 0.9 0.8 0.7 0.8 1.2 1.3 1.2

Hepatitis 0.8 1.0 0.7 0.9 1.1 0.7 0.7 0.9 0.6

Permanent injury or defect caused by an accident

0.8 1.1 0.5 0.7 0.9 0.5 1.0 1.4 0.6

Intestinal ulcer 0.7 0.5 0.9 0.6 0.5 0.7 1.0 0.6 1.3

Cancer (malignant, leukemia and lymphoma included)

0.6 0.6 0.7 0.7 0.5 0.8 0.6 0.7 0.6

Chronic anxiety 0.4 0.2 0.6 0.4 0.2 0.7 0.4 0.1 0.6

Cirrhosis of the liver, liver dysfunction 0.4 0.4 0.5 0.3 0.3 0.3 0.6 0.6 0.7

Turkstat, Turkish Health Survey, 2012

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When deaths are examined by age group and gender, we see that the gender diff erence between the age groups is apparent. The number of deaths in men is more than the number of deaths in women in all age groups other than the age group 75 years and older, which is the oldest generation. This diff erence in deaths between men and women increases as age advances after the age group 15–19 years and reaches its highest level in the age group 60–64 years.

Looking at the rates of diseases causing death in 2010, 2011 and 2012, we see that the most com-mon cause of death is circulatory system diseases. Malignant neoplasms come the second. These two causes of death constituted 59.0 % of total deaths in 2012.

The fi rst six disease groups that caused deaths in 2012 were circulatory system diseases with 37.9 %, malignant neoplasms with 21.1 %, respiratory system diseases with 9.7 %, diseases associated with endo-crine, nutrition and metabolism with 6.0 %, nervous system and sense organ diseases with 4.3 % and trau-matic injuries and poisoning with 4.1 %.

31.2 % of the deaths that occurred due to circula-tory system diseases in 2012 were caused by ischemic heart disease, 25.7 % of them by cerebro-vascular dis-ease, 25.7 % by other heart diseases and 11.8 % by hypertensive diseases.

When the causes of death were examined by age groups, it was found that the group where circulatory system diseases and malignant tumors were seen most frequently was the age group 65 years and older. When the causes of death were examined by residences, the fi rst fi ve provinces where deaths resulting from circu-latory system diseases were seen most frequently were Burdur, Gümüşhane, Artvin, Trabzon and Bolu and the fi rst fi ve provinces where deaths resulting from malignant tumors were seen most frequently were Istanbul, Kocaeli, Ankara, Rize and Edirne (67).

Rehabilitation

Geriatric rehabilitation is the entire services provided to prevent, delay, minimize or reverse the functional deterioration that develop in the elderly due to physiological loss or a disease. This concept does not only include the health services, but realistic treatment approaches well designed in terms of time-environment-intensity are the most basic components of geriatric rehabilitation. Although not very diff erent from classical rehabilitation, it includes aspects specif-ic to the age group. It is possible to decrease disability caused by chronic diseases, which impair quality of

life and involve serious economic burden, and death through preventive measures (26). It is well known that impairment of health is not a natural result of aging and people, especially those in developed coun-tries, seek a healthier, better quality and longer life (68). In general, the basic philosophy of rehabilitation is associated with the issues of manifesting the dignity and signifi cance of older people. This type of an ap-proach advocates the right of the elderly to improve their potential and use it to the end (69). What should be remembered in geriatric rehabilitation is that each patient has unique needs. Success increases if a reha-bilitation plan is prepared specifi cally for that person. The prerequisite for this plan is to make a compre-hensive assessment of the geriatric patient. The tar-gets set for the patient after functional assessments are specifi ed considering the patient’s physiological, so-cial, economic, family, cognitive, and cultural statuses as well as the facilities available. The basic principles of geriatric rehabilitation are presented in Table III (70).

Table III

Principles in geriatric rehabilitation

1. Determining functional level

2. Keeping an eye on the changing physiological capacity

3. Identifying family expectations

4. Determining psychological status

5. Identifying the patient’s targets and motivation

6. Knowing that patients may have many disorders that affect each other

7. Focusing on the treatment and function, not the diagnosis

8. Knowing that function can be regained

9. Knowing that improvement will occur slowly

10. Making use of available sources and options

11. Using minimum amount of drugs

12. Preventing inaction

13. Focusing on a workout program unique to the duty, keeping the program simple

14. Encouraging for social life

Following these principles, the social and eco-nomic statuses as well as the health status of the older person are evaluated. A rehabilitation schedule is pre-pared for the older person. This schedule covers not only the individual’s needs for treating diseases but also his/her entire needs.

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Unlike other groups, there are points in Geriatric Rehabilitation that should be focused on more; fam-ily and older person training, specifi c exercise programs, posture training, walking training, balance training, prevention of falls, rearrangement of daily living, occupational therapy.

Most of the patients in physiotherapy and reha-bilitation policlinics are older population. In a study made in our country, the most frequent reasons for complaint were reported to be joint pain, malaise-fa-tigue and general body pain. Spinal deformation, spi-nal pain, urinary incontinence, vision problems, dif-fi culty in swallowing, hearing loss, balancing problem and dental problems were seen more in those over 75 years of age and this was statistically signifi cant. While 30.1 % walked, 15.4 % exercised only at home. 16.5 % of the elderly who consulted had a history of falling. It was seen in the study that the rate of regu-larly exercising was low, there was not a signifi cant diff erence between the age groups when the rate of exercising and intensity of exercising were compared, and the frequency of exercising at home and walking was more in men than in women. When evaluated according to their education levels, the rate of regu-larly exercising, exercising at home or in a sports hall and walking was seen more in the educated elderly. In relation to these, the number of falls was higher in women than in men, but did not increase at more advanced ages (71).

Presence of comorbid diseases, increased number of drugs used, and increased frequency of OP and falling in this age group indicate that care should be taken both at the stage of planning the medical treat-ment and when preparing a rehabilitation program. It is obvious that a comprehensive and multidimen-sional geriatric rehabilitation program should be pre-pared by assessing not only the musculoskeletal com-plaints but also the entire organ systems, so that older individuals can become more independent and active in their daily lives (71). It is known that approximately 1/3 of individuals over sixty fi ve years old experienced falling at least once every year. Studies made in vari-ous sites in Turkey have reported that the rate of ac-cidents was higher in older women (over 75 years old) and in the elderly who lived alone and who had low level of education. It was also demonstrated that not exercising, vision and tension problems, dizziness, us-ing four and more drugs, and physical inadequacies constituted risk factors for home accidents (72).

Presence of problems with respect to social struc-ture and environment in the advanced age group is also an important problem. Considering the socio-cultural and economic status of our country, older

people seem to be unluckier than the general popula-tion as their education and income levels are lower. One should also know that the environment in which they live is important in having access to health servic-es and benefi ting from the facilities of social services. It was found in a study that the rate of literacy and income level fell, the number of workers increased and the use of green cards went up as one went to the eastern regions of our country. It is necessary that old people are made to benefi t equally from healthcare and social services, services are made easily accessible and continuity is ensured, and preventive medicine is emphasized (71).

The major places where rehabilitation is prac-ticed are hospitals, rehabilitation centers, specialized healthcare centers, nursing homes, out-patient ser-vices of hospitals and home environment. Patients are usually hospitalized in the starting period of their diseases to carry out their diagnostic and other as-sessments and their short-term treatments, to pre-pare a treatment and follow-up program after their discharge and to provide training to their families. Bedding and treatment periods are generally short in hospitals due to facilities and health payment systems. One of the most important decisions to be made here is where the elderly will be sent after leaving here, in other words, where his/her rehabilitation will be car-ried out. After hospital-based rehabilitation services, it is decided whether the patients will be monitored at home, through out-patient services or in special-ized healthcare centers. Usually two types of patients are admitted to healthcare centers. The fi rst group is those who stay for «a short time». Such patients ei-ther need intensive rehabilitation or they are at the terminal stage of a disease. The second group is those who stay for «a long time», spending the rest of their lives in healthcare centers. Nursing homes are board-ing social service institutions, which are established to protect and care for older people and to meet their social and psychological, needs in a peaceful environ-ment (72, 73).

Out-patient rehabilitation programs are usually carried out by hospital policlinics. Such programs have the advantage of monitoring patients while they live at home. Patients do not lose their social rela-tionships; they can even socialize by communicating with other patients and their relatives. Patients spend certain days of the week in hospital according to a programmed schedule. The most important problem that needs to be solved in such programs is transport-ing to the hospital. The mentioned basic places will change and develop as expectations increase in the so-

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ciety, as technology and communication improve and as targets become attainable. A very small portion of the elderly in our country is able to receive geriatric rehabilitation and care services in their true sense. It is recommended to provide services to the elderly in their living environment without removing them from the setting they live in. Institutional care, on the other hand, should target provision of a high quality geriat-ric care service with modern physical conditions (70).

Increasing expenses for treatment and rehabili-tation of aging-related disabilities and diseases, in-tensifying problems due to increased prevalence of diseases in the elderly and increasing knowledge of the structural and functional mechanisms underly-ing aging cause to augment not only the need for but also the interest in sciences relating to health at old age. Unless necessary measures are taken, the cost of social problems arising from chronic diseases is pre-dicted to increase rapidly and the issues of geriatric patient approach being provided both in primary healthcare institutions within the scope of preventive medicine and by physicians who are specialized in the relevant fi elds and making it easier for those who are at an advanced age to have access to healthcare ser-vices are being kept on the agenda.

It should be kept in mind that rather than chron-ologic age, physiologic age should be considered in choosing treatments for the diseases seen frequently in the elderly. Preventive approaches should primar-ily be put into practice by also considering morbidity, mortality and healthcare system expenditures and it should be taken into consideration that early diagno-sis and eff ective treatment methods will improve qual-ity of life in the advanced age group.

Social and psychological aspects

At the population level WHO posited 6 main de-terminants of active aging: Behavioral styles, personal biological and psychological conditions, health and social services, physical environment, and social and economic factors. Determinants of active aging dis-tinguish long-term determinants such as education, socioeconomic status, profession, life styles, health status, personality factors, or cognitive aptitudes. In other words, an active age framework, policies and programs that promote mental health and social con-nections are as important as those that improve physi-cal health status. Geropsychology as a subfi eld of psychology developed a natural result of above pro-gression in the world. The fi rst, European research (consisting of 30 European countries) in geropsychol-

ogy had been published by Pinquart, Ballessteros and Torpdahl (74).

This research shows us: 1) The most important three topics were felt to be dementia, general cogni-tive development, and caregiving. 2) The percent of European publications (2001–2005) from European researchers in the fi eld of geropsychology was average (21.6 %) for psychopathology (depression, anxiety, de-mentia 30.9 %), cognitive aging (29.7 %), psychologi-cal assessment (26.3 %), caregiving (23.6 %9), aging in nursing homes (23.4 %), and average for death, dying, and bereavement below average with regard to lon-gevity (18.3 %). The results of this research show us dementia, cognitive aging, and psychological assess-ment were important application areas for European and also Turkish gerontologists.

Social aspectTurkish population is getting older and older day

by day. When we look at the Turkish welfare system overall, it is quite limited and does not cover those who are outside of the formal job market effi cient-ly. Until the 1980’s, the Turkish state has made only limited provisions with pension and health schemes. After this date, it is in parallel to the changes in the world. The welfare system in Turkey has a strong ba-sis on the family mutual help mechanism. This is an informal networking of intra-generational transfers and reciprocity in kinship networks which are domi-nant in social organisation of welfare of the house-holds and the individuals (75).

According to offi cial sources, our society main-tains its feature of looking after the elder. As a re-sult of a survey held in Ankara among 1 300 elderly people, the observance was made that the Turkish family structure has not lost its positive aspects es-pecially in terms of elderly people and that elderly people are still respected and esteemed in the fam-ily. Although the survey was held in the urban sector, it is evident that the tradition approach still remains. Majority of the elderly people that participated in the survey (84.4 %) perceive being old as being respected. Meanwhile 64.4 % of the elderly people, who stated that they felt old, maintained a positive attitude to-wards being old (76).

In Turkey, the service providers claim that the public life is not prepared and organized for the el-derly. Because of this, in order to prevent injuries and harm, they suggest that elderly should stay at home, and should not come out especially in rush hour times. On the other hand, they claim that the elderly persons are very stubborn, do not listen to others and

93


diffi cult to cope with. In Turkey, according to service providers, ‘being old’ is being disabled, not being able to ‘do things as the young do’. They are vulnerable, frag-ile, sick all time, and cannot think properly. On the other hand, culturally they think that is not proper to leave the elderly in nursing homes. Nursing home is a place of isolation, it means to be neglected by the family and the society too. Most of the service pro-viders share the view that ‘elderly is something to be sorry about and nobody wants to be old especially in this society’ (77).

Due to changes in the structure of society and family consequent to the industrialisation processes, the number of traditional nuclear families increased and considerable number of elder persons started liv-ing independently especially in the big cities. So that, the social and economic support from relatives and children declined in Turkey. Due to the decrease in income following upon retirement or lack of a job to be retired from, mainly due to their becoming unable to work.

Both in the west and in our country, living in their own houses seems to be the best solution for elderly people. However, there are no enough examples of special dwellings for elderly people in Turkey. The state nursing homes were not modern enough and suitable to the old age requirements, private ones were modern and suitable but their prices were so ex-pensive. The elder persons lived in low income levels, which were inadequate in providing the basic require-ments. In our country, especially elder persons found diffi culties in living up to the social, cultural, recre-ational, sports, voluntary activities and technological changes.

Research fi ndings showed that, 65–69 ages Turkish elderlies spent a lot of money sequentially on food, household, clothing and 70+ ages spent for medical care. Social and cultural activities such as cinema, theatre, touristic trips and spending home appliances have not been encountered at these age groups. While the percentage of those who watched TV was higher (77 %) than read newspaper (18 %) and book (8 %) (78). According to the same research, during old age there were no dramatically changes in the relationships with the children, spouses, and relatives. This fi nding is a proof that Turkish society is bounded traditional values whereby elder persons continue to enjoy strong relations with their children and relatives. Fifty six percent of the Turkish elder-lies declared they faced diffi culties in their daily liv-ing activities. The diffi culties were sequentially, using ATM machines of banks and credit cards (56 %), un-derstanding instructions of use for medicine, goods

etc. In one study (N=578, 50+ ages), to determine the factors constituting life satisfaction (LS) in old age in Turkey it was shown that social relationships have not gained signifi cant meaning as a dimension of LS in Turkey. There can be two reasons of this situation: a) The absence of a cultural capital that supports social participation and organization, b) compensation of social services/support with traditional mechanisms. According to this research fi ndings, in our country persons above 55+ ages, 99.5 % of them is not mem-ber to any trade unions, 99.3 % to any associations related to the environment and 99.3 % to any neigh-borhood associations, 95.2 to any political parties. Although there is a huge gap between the poor and the rich on the issue of physical and psychological services raised from deprivations in Turkey. Sum up, average happiness level and also average satisfaction level of physical health between poor and rich groups were statistically signifi cant (79).

Psychological aspectAccording to Pinquart, Ballessteros and

Torpdahl’s fi ndings, the most important topics were felt to be dementia, general cognitive development, caregiving (80). In addition, the most important topics in European publications (2001–2005) from European researchers in the fi eld of geropsychology were psychopathology (depression, anxiety, dementia 30.9 %), cognitive aging (29.7 %), psychological as-sessment. Same trend is valid for also in Turkey.

Neuropsychological assessment of dementia. Defi nitions of dementia vary enormously due to the multifaced nature of the illness. There are diff erent types of dementia, presenting with similar basic symptoms (Alzheimer, Vascular, Lewy Body, Frontal Lobe, and Mixed types). Dementia, particularly Alzheimer type dementia (ATD), was one of the major public health problems last 30 years. This led to development of widely accepted two diagnostic criteria for use in clin-ical settings and scientifi c researches in dementia:

1) Off ered by the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s Disease and Related Disorders Association (NINCDS–ADRA) (81).

2) The Diagnostic and Statistical Manual of Mental Disorders: 4th Edition (DSM-IV) of the American Psychiatric Association (82).

These two criteria are generally consistent of each other. According to these diagnostic criteria: 1) The dementia is progressive and multiple cognitive decline in elderly persons in the absence of consciousness, presence of disturbances of neurological, or psychi-

94


atric conditions that might in and of themselves ac-count for these progressive impairment, 2) Presence of dementia established by clinical exam and con-fi rmed by neuropsychological testing (82, 83).

Neuropsychological assessment of mild cognitive impair-ment (MCI). Cognitive complaints, particularly mem-ory complaints, are common in elderly people. Some of these elderly people experience changes severe enough to seek medical help and, indeed, have objec-tive evidence of cognitive impairment, even though they do not have dementia (84).

Mild cognitive impairment (MCI) is a clinical syndrome to represent the transition between normal cognitive function and dementia. In this stage, the person doesn’t yet meet diagnostic criteria for demen-tia. Considerable evidence supports the argument that there is a transitional phase between normal function and dementia. Neuropsychological researches of per-sons defi ned as neither normal nor demented demon-strate progressive declines in cognitive functions and/or processes over time. These are particularly striking in the area of episodic memory, but other domains appear to be aff ected as well (85). These results are consistent with the clinical criteria for dementia re-quiring impairment in two or more cognitive func-tions. The MCI criteria provided by Petersen were as follows: 1) Subjective memory complaint, 2) objective memory impairment for age and education (standard deviation of 1.5 adjusted mean score of standard-ized memory test), 3) preserved general cognition for age, 4) intact basic activities daily living, and 5) not demented. The MCI criteria were revised to clinical subtypes (amnestic MCI, non-amnestic MCI, multi-ple-domain MCI) (86).

The revised criteria also acknowledged the possi-bility that more than one cognitive area might be im-paired within each of these subtypes. The increasing information about MCI as a heterogeneous syndrome carries with it the need to clarify the nature of what is normal (85).

The neuropsychological tests and/or test batter-ies need to focus on main cognitive areas or functions as the core features of dementia and memory as a supplemental domain, in order to genuinely identify all cases of dementia. This needs to be incorporated into both the detailed neuropsychological assessment used for to diagnose and to evaluate or to monitor the eff ects of drug therapy (87). Brief mental status examinations, screening tools and laboratory tests are not adequate for diagnosis of MCI and demen-tia. Comprehensive neuropsychological assessment consists of diff erent cognitive functions like attention,

memory, visuo-spatial functions, language, executive functions (86).

Assessment of cognitive functions in healthy aging. Dec-lines in memory and other cognitive abilities are a normal consequence of aging in humans. In aging, fl uid intelligence performance (performance tests e.g. reaction time, reasoning tests) declined but crystal-lized intelligence performance (verbal tests e.g. vocabu-lary tests) preserved. This is the typical pattern of age related change in cognitive functions (87). The term of ‘Age-Related Cognitive Decline’ is used in the DSM-IV (82). In this context, who shows a normal test perfor-mance (standard deviation of mean score of their age and education group in standardized memory test) on neuropsychological tests is ‘normal’ or ‘Age-Related Cognitive Decline’.

According to ‘Use it or lose it’ hypothesis that is reg-ularly engaging in mentally demanding activities (e.g. reading, playing cards, chess, crosswords) maintains good cognitive functioning. Wilson et al. (88) showed that ‘using it’ was associated with subsequent reduced risk of ATD. This point of view has got an important role of scientifi c cognitive training programs and/or products for a better quality of life with age. Scientifi c based cognitive training programs or familiar com-puter and/or tablet-based products are so new for Turkey yet. But this area is susceptible of develop-ment.

The role of geropsychologist in assessment of dementia, mild cognitive impairment and healthy cognitive aging. ‘Neuropsychological testing and assessment is very important procedures in dementia, MCI and healthy cognitive aging’. Geropsychologist can play an im-portant role in evaluation of the memory complaints and changes in cognitive functioning that frequently occur in the later stage of life. APA Presidential Task Force on Assessment of Age Consistent Memory Decline and Dementia Guidelines in 1998 in APA online (see. www.apa.org/practice/dementia.html) were developed for psychologists who perform evalua-tions of dementia and age-related cognitive impair-ment and conform to the APA’s Ethical Principles of Psychologist and Code of Conduct (82).

According the Task Force Guidelines: ‘Psychologists are uniquely equipped by training, expertise, and the use of spe-cialized neuropsychological tests to assess changes in memory and other cognitive functioning and distinguish normal changes from early signs of pathology. Although strenuous eff orts are being exerted to identify the physiological causes of dementia, there are still no conclusive biological markers short of autopsy for the most common forms of dementia, including Alzheimer’s disease. Neuropsychological evaluation and testing remain the

95


most eff ective diff erential diagnostic methods in discriminating dementia types from age-related cognitive impairment, form de-pression related cognitive impairment, and other related disor-ders. Even after reliable biological markers have been discovered, neuropsychological assessment and testing will still be necessary to determine the onset of dementia, the functional expression of the disease process, the rate of decline, the functional capacities of person, and response to therapies’ in APA Online (see. www.apa.org/practice/dementia.html).

Tasks and responsibilities of geropsycho-logist in dementia and age-related cognitive im pairment in Europe and also in Turkey. Psy-cho logists who want to perform neuropsychological assessment for dementia and age-related cognitive impairment are:

1) To be aware that knowledge are required for as-sessment and they monitor developments in demen-tia, related diseases and normal cognitive aging areas.

2) Competent in clinical interviews (to take a care-ful history) and administering, scoring, and interpret-ing of neuropsychological tests according to standard-ized procedure.

3) To be aware that neuropsychological tests should be standardized, reliable, valid, and normative data referable to the elder population and culture.

4) To prepare and to apply cognitive training pro-grams for healthy and/or patients with MCI and de-mentia.

5) To have education, training, experience and/or supervision in the areas of especially gerontology, neuropsychology, psychopathology and psychothera-py in elderlies.

6) To follow the scientifi c and/or professional developments in accepted clinical and scientifi c stan-dards.

7) To provide a consultation with related physi-cians (Dementia work-up is an interdisciplinary ef-fort).

8) To be aware that depression can mimic the eff ects of dementia in elderly persons. So psycholo-gist has to know administering and scoring to formal mood scales (e.g. Geriatric Depression Scale). These tools can also play important role in exclusion criteria for dementia.

9) To conduct courses/seminars/meetings about age-related cognitive impairment, cognitive processes and the role of neuropsychological assessment in de-mentia.

10) To take part in interdisciplinary scientifi c re-searches and/or research projects related to demen-tia, related disorders and normal cognitive aging.

Sum up

Most Turkish gerontologists work within the fi eld of diagnosis of dementia (especially psychologist). We haven’t got the offi cial guidelines diagnostic for de-mentia but Turkish Psychological Association (TPA) will try to develop this type of document for Turkish Ministry of Health. TPA has represented our coun-try with one member in European Federation of Psychologists’ Associations (EFPA) Geropsychology Task Force (see. http://geropsychology.efpa.eu/). Most Turkish geropsychologists who work with diagnostic tests of dementia use standardized neuropsychologi-cal test battery (for Turkish elderly population 65+ age). Commonly used neuropsychological tests in Turkey are: Montreal Cognitive Assessment (MoCA), Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Functional Activities Questionnaire (FAQ), Trail Making Test (Part A and Part B) (TMT), Enhanced Cued Recall Test (ECR), Clock Drawing Test (CDT), Stroop Test and Benton’s Line Orientation Test (see. www.coglab.hacettepe.edu.tr). These neuropsychological tests were standardized for 65+ ages Turkish culture by Turkish research-ers. These standardization studies showed us, cut-off scores of the neuropsychological tests were lower than scores of western cultures (89). Turkish Psychological Association (TPA) has organized certifi cate courses for these tests (administration and scoring) to their members regularly (see. www.psikolog.org.tr).

Unfortunately, we have not developed unique and original neuropsychological tests specifi c to Turkish culture. Our psychologists and/or gerontologists have preferred to use standardized neuropsychological tests of western origin. Additionally, however clini-cal psychology is the most popular subfi eld in Turkey, psychotherapy with elderly is not commonly used. We have no graduate (master and/or doctoral) pro-grams in Gerontology and/or Geropsychology in Departments of Psychology at state and/or private Turkish Universities. The fi rst and only Georontology Department has been established at Mediterranean University (In Turkish: Akdeniz University) (state university) in Turkey (see. http://proje.akdeniz.edu.tr/Gerontoloji). A few interdisciplinary centers like Hacettepe University Application and Research Center of Geriatric Sciences-GEBAM have co-operated with international aging organisations [e.g. International Association of Gerontology and Geriatrics’ (IAGG)Global Aging Research Network (GARN) and International Institute on Aging-INIA] to organise scientifi c meetings, courses, publications

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and public education activities (see. www.gebam.hacette-pe.edu.tr).

Finally, number of gerontology professionals are little or no help, therefore geropsychologists and/or neuropsychologists practically are employed like del-egate of gerontology in Turkey. It is a challenge for gerontology to provide sound research-based knowl-edge about the diverse psychological and social pro-cesses underlying human aging as well as expertise about training, education and interventions that will help to promote quality of living and subjective well-being both at the individual as well as the social level in Turkey parallel with also other European countries.

Comprehensive geriatric evaluation

An old patient should have received the correct diagnosis and treatment and should have been as-sessed regularly and thoroughly for improving their quality of life and functional capacity. It is agreed that the problems emerging with aging should be dealt with as a whole and the «Comprehensive Geriatric Evaluation (CGE)» should be used when approach-ing the elderly. A comprehensive and interdisciplin-ary approach gives the chance to evaluate the elderly not only in medical terms but also in psychosocial and functional terms. The CGE diff ers from the classical medical evaluation in that it gives priority especially to functional condition and quality of life and uses in-terdisciplinary teamwork and quantitative assessment scales (90).

When geriatric patients are involved in an evalu-ation, there are some diff erences that should be taken into consideration (2):

1 — The presentation of diseases is variable in the elderly. The symptoms may not be the symptoms of the organ system where the disease is present.

2 — The presentation of diseases is non-specifi c. There may be only non-specifi c complaints such as staying in bed and refusing to eat.

3 — Off the record diseases are frequent in the elderly; patients may accept their loss of hearing, in-continence, constipation, nighttime leg pain, confu-sion or some other complaints as a natural course of aging and may not report them in their history.

4 — Older patients may have many pathological conditions at the same time and many drugs may be used or various treatments may be administered for these.

5 — The rate of polypharmacy is high in the el-derly. It is important that all the drugs used by the older patient are seen and recognized by their physi-

cian. The rate of using non-prescription drugs is high and usually there is a diff erence between the type/dose of the drugs taken by the patient and the type/dose of the drugs prescribed for them.

When answering the question who can benefi t more from CGE, the patient’s age, physical diseases, geriatric syndromes, and any decrease in their physi-cal and social capabilities become the determinants (91).

There are also opinions, which state that those in-dividuals who are referred to as the frail elderly will benefi t the most from CGE and the priority should be given to the frail elderly group with respect to CGE. It is emphasized that all older individuals should under-go a CGE in any case, so that those elderly who need further evaluations and special care can be identifi ed. The targets of a CGE include identifying the patient’s basic characteristics, background and treatment re-sults, establishing the correct diagnosis, improving the medical treatment, discovering hidden diseases, ensuring preparation of long-term care plans, reduc-ing the need for staying in a nursing home, reduc-ing the rate of hospitalization, improving functional status, increasing quality of life, reducing mortality, and economize on care costs by avoiding unnecessary expenditures (92).

Diseases, drug use, balance, history of falls, walk-ing, daily life activities and functional status, nutri-tion, hearing-visual problems, pain, and presence of incontinence should be reviewed within the scope of a medical assessment. Cognitive status, mood-anx-iety-depression, and social life should be evaluated for a psychological assessment. Additionally, home and environmental safety, fi nancial status and family support should also be inquired. So comprehensive geriatric assessment should be; multidimensional and interdisciplinary. Diagnostic process should intend to determine a frail elderly person’s; not only medical, but also psychosocial and functional capabilities and problems as well.

Purposes of Comprehensive Geriatric Assessment are:

• Achieving a multidimensional diagnostic evalu-ation,

• Developing an overall plan for primary care and case management,

• Determining long term care needs and optimal placement,

• Making the best use of health care resources.A comprehensive geriatric assessment diff ers from

standard medical evaluation:

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• Concentrates on frail elderly people with com-plex problems,

• It emphasises on functional status and quality of life,

• Frequently uses interdisciplinary teams,• Professional services for elderly are provided in

more settings than with any other population (Because of the great variety of needs, functional defi cits, needs for social supports).

In caring for older patients clinicians should get assistance from; local clinics, acute hospitals, rehabili-tation hospitals, skilled nursing facilities, residential care facilities, geropsychiatric units and home care agencies.

Aging itself does not infl uence quality of life in a negative way. However, wellbeing of the aged popula-tion requires special precautions with all aspects of health and its determinants (93). Older people tend to be poorer, less well housed and socially excluded and therefore more likely to develop physical and mental illness. Living longer and sustaining one’s quality of life can be considered as both a success and a never-ending struggle. This struggle requires not only the capacity for staying healthy, enjoying independence, enjoying social relations, being sociable and having access to aff ordable health care but also having a posi-tive approach towards older persons and old age (1). It should also be taken into consideration that; the key to diagnosis and treatment in a diffi cult situation is «social history», because many elders come to medi-cal attention because of some combination of eco-nomic constrains and social isolation.

The elderly group faces diff erent problems than those of developed countries in terms of economic, social and political considerations. The increasing proportion of older persons in Turkey may lead to a decrease in families’ ability to support them, and new arrangements for taking care of older persons may thus be required. Among the key issues of concern to policy makers are health and social services, home care, social security, social support, and proper educa-tion of those involved in the care of this population (94).

National plan of action on aging

In Turkey, there is a national plan of action on aging since 2007. Many academic, non-academic, civil society representatives together contributed to prepare this national plan those days. Both current situation analysis and proposed solutions for basic problems of aged population including health, social

services, workforce, environmental issues, migration, urbanization, education, elimination of poverty, etc. exist in this document. As proposed in the document, assessment and monitoring parts need to be devel-oped to contribute to the wellbeing of the elderly. Although government has a basic role in this process, non-governmental bodies will be supported to have their fullest contribution systematically (76).

The recommendations are:1 — Organisation of training programs on

healthy aging in order to prepare individuals for old age,

2 — Provision of service units for those older per-sons who have diffi culties in carrying out the activities of daily living,

3 — Provision of consultancy services with regard to the use of health and social service units for the older persons who are not covered by any form of social security,

4 — Formation of models of domiciliary health-care for older persons in order to provide them with the needed service at their own homes.

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The twentieth century has witnessed rapid devel-opment of issues of aging that is caused by known de-mographic changes and based on latest achievements of biology and physiology, namely: concepts about genetic mechanisms, protein biosynthesis, general principles of regulation of metabolism and functions, etc. These concepts underlie modern approaches to-wards study of the mechanisms of aging and life ex-pectancies. On the other hand, research into aging processes, their role in the life of an individual and in the evolution are viewed as a necessary element in dis-closing in-depth mechanisms of vitality, as aging and death present regular (lawful) stages in the life cycle of multi-cellular organisms. Therefore current process of complex aging issues evolvement is connected with a wide spectrum of the scientifi c disciplines. In other words, the gerontology not only uses latest achieve-ments of biology and medicine but, in turn, contri-butes for their further development.

The gerontological researches in Ukraine have long-standing traditions, beginning as far as from the end of XIX century. Its foundations were laid by the world-known researchers: I. I. Mechnikov (elabora-tion of evolutionary ideas about nature of aging and death, concept of «physiological disharmony» as the key principle of aging and its correction as the principle of human life extension), A. N. Severtsov (further development of the concepts about evolu-tionary mechanisms of aging and their interrelation with population size dynamic), I. I. Shmalhausen (the concept of growth limitation at evolutionary deter-mined terms of lifespan and its physiological regula-tion), A. V. Nagorniy (study of metabolic and molecu-lar mechanisms of aging process in relationship with regulatory functions in the organism) and others. The above approach allows understand interrelations be-tween aging at all levels of structural-functional orga-nization — from molecular-genetic to entire organ-ism’s level. It is noteworthy that those regulatory ideas and concepts not only have underlain the formation

and development of the national gerontology but also greatly contributed to aging research in world science.

It is a common knowledge that science of today aims to mobilize as optimally as possible all eff orts and all available means for solution of the key tasks. The elements of such organization were brought into national gerontology at the end of 30-s of XX cen-tury owing to the eff orts of President of the Academy of Sciences of Ukraine Aleksander A. Bogomolets. He convened in Kiev in December 1938 an-all Union conference, fi rst in the former Soviet Union, devoted to the genesis of aging.

In the Institute of experimental biology and pa-thology and in the Institute of clinical physiology, cre-ated by A. A. Bogomolets, he organized at those years the scientifi c groups to do research into physiology of aging. At that conference A. A. Bogomolets managed to bring together specialists of various profi les who were engaged in experimental, clinical and socio-hygienic investigations on aging not only in Ukraine but also in other republics of the former USSR. This conference consolidated creative forces in this new re-search area.

Notably, A. A. Bogomolets was fi rst who showed interest in the aging problem as far as in 1912 in his work, entitled, «About inner causes of death». However the lengthiest period of his research activ-ity in study of the mechanisms of aging was linked with the school of A. A. Bogomolets during 1926–1939 years. All research work of that period was done under the umbrella of conception put forward by A. A. Bogomolets about physiological system of the connective tissue and its regulatory role in the de-velopment of age changes. This marked the beginning of another stage in the formation of the newer ideas about physiological mechanisms of aging, combining cellular and subcellular approaches, on the one hand, and systemic approaches, on the other hand.

The ideas of A. A. Bogomolets largely deter-mined the future development of research work into regulation/control over aging processes at the


GERONTOLOGY IN UKRAINE: PAST, PRESENT AND FUTURE

Vladyslav V. Bezrukov, Sergei G. Burchinsky

D. F. Chebotarev State Institute of Gerontology of the National Academy of Medical Sciences of Ukraine, Kiev, Ukraine

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molecular level. Among practical outcomes of his research, mentioning should be made of the anti-reticular cytotoxic serum (ACS). It became known worldwide and introduced into wide medical practice and in particular in the fi ght for human longevity. Investigations to study ACS eff ects on aging-associat-ed immunological disturbances were effi ciently con-ducted by his co-workers Prof. Yu. A. Spasokukotskiy and P. D. Marchuk.

The logic of further development of medico-biological science and its organization in the former Soviet Union was in favor of the formation of a spe-cialized institute that would approach solution of ag-ing problems in a full complex.

So twelve years after A. A. Bogomolets’s death, it was in Kiev that the Institute of Gerontology (KIG), the fi rst and the only one of its nature in the Soviet Union, was founded in May 1958 within the USSR Academy of Medical Sciences. Soon it became well known in the world.

The creation of the Institute was very timely: the demographic trends in the middle of XX century in the developed countries of the world were leading to unprecedented aging of the population. This put for-ward a need to study health of people of older age groups and to assess their needs in various medico-so-cial services. In turn, the investigators were spurred to conduct in-depth studies into biological and clinical issues of aging. Solution of these tasks led to the for-mation of three leading research directions: (1) study of the mechanisms of aging, organism’s adaptability and control (regulation) of these processes; (2) patho-genesis, diagnosis, clinic manifestations, treatment and prevention of diseases commonly occurring in elderly and old people; 3) insight into the role of so-cial and hygienic factors of aging and longevity and, correspondingly, three departments: a Department of the biology of aging; a Department of clinical and ge-riatrics, and a Department of social gerontology and gerohygiene.

The founder and fi rst director of the Institute since 1958 to 1961 had been the well-known patho-physiologist Prof. Nikolai N. Gorev (1900–1993) rep-resenting school of A. A. Bogomolets. Those years were marked by laying down the basis for Institute’s structure and scientifi c/technical personnel. Shortly, the leading scientists in the fi eld of medicine and biol-ogy were invited to run its departments and laborato-ries. This had been considered as a contributory fac-tor for putting research and clinical activities on a high level. In succeeding years the KIG continued estab-lishing collaborative links with other research groups

of scientists inside the country who were engaged in aging studies. During the years of N. N. Gorev’s lead-ership, the research workers of the KIG collected im-pressive/huge amount of data evidencing for close as-sociation between age changes and pathology onset. They also disclosed physiological predispositions for pathological changes which are characteristic of late ontogenesis.

Essential was the launch of huge clinical-socio-logical study of people aged 80+ residing in various regions of the USSR. The survey lasted till 1962–1963 years and included nearly 40,000 people. It was a unique investigation not only for the USSR but it also had given the KIG an international recognition among gerontological community.

Time passed and the year 1961 marked change of the KIG leadership, and Prof. D. F. Chebotarev (1908–2005) trained in the scientifi c schools of A. A. Bogo mo lets and N. D. Strazhesko was ap-point ed Director of the Institute. Professor Che bo-tarev was a wide-profi le clinician that gave him an opportunity to enhance research along studying ag-ing processes in human individuals. Biology of aging remained a priority research area; more attention was given to clinico-physiological aspects; and more eff orts were focused to sustain research into experi-mental, clinical, hygienic and social aspects in full complex.

It is noteworthy that creation of the Institute pro-moted development of a set of organizational forms designed to ensure the unity and coordination of fur-ther research in this fi eld.

Thus the KIG served ground for creating All-Union Problem Commission (1962–1976) and later a USSR AMS Scientifi c Council in gerontology and geriatrics (1976–1991), which together with the sec-tion «Biological and Social Fundamentals of Aging» of the united Scientifi c Council of the USSR AS and AMS on human physiology coordinated research work in all republics. And, fi nally, essential was the design and fulfi llment of the All-Union complex pro-gram «Lifespan Prolongation» which united creative eff orts of the leading research institutions in this fi eld. The problem commission and later the Scientifi c Council coordinated gerontological investigations in around 100 institutions within Academy of Sciences, Academy of Medical Sciences and health ministries in the republics of the USSR.

The highlighting point in strengthening scientifi c-organizational interrelations among national geron-tologists was the convening of the First All-Union conference devoted to the functional and morpho-

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logical aspects of aging in 1963 in Kiev, at which the formation of the USSR Society of Gerontology and Geriatrics was announced. Professor D. F. Chebotarev was elected its president. Since then the Society had taken part in the organization of further scientifi c forums. The Second All-Union conference of ger-ontologists and geriatrists was convened in 1969 in Kiev for discussion of issues concerning the theme «Physiologic systems and organism’s aging». In 1976 the Third All-Union Meeting (given the status of congress) of gerontologists and geriatrists was also held in Kiev. It was followed by 4th congress in Kishinev (1982) and 5th congress in Tbilisi (1988). All of these All-Union forums were attended by the scientists from abroad.

In parallel with the All-Union society, since 1988 the Ukrainian society of gerontology and geriatrics had begun its work. The 1st Congress of Ukrainian gerontologists and geriatrists was convened in 1988 in Dnepropetrovsk, The following forums were held as national congresses of gerontologists and geriatrists (2nd in 1994; 3rd in 2000; 4th in 2005; and 5th in 2010).

Within the years of the Prof. D. F. Chebotarev’s directorship the KIG grew to become a powerful re-search centre. Institute’s merits had been recognized worldwide, and the International Association of Gerontology decided to convene the 9th International Congress of Gerontology in Kiev in 1972. The presi-dent of the Congress was D. F. Chebotarev. He was also elected president of the International Association of Gerontology for three consecutive years.

Since then the Institute served the basis on which several WHO and UN seminars, international, all-Union and republican scientifi c conferences and sym-posia were held. Since 1984 the Institute has been functioning as the WHO Collaborative Centre on aging.

In 1988, Prof. Vladyslav V. Bezrukov, representa-tive of Prof. Frolkis’s school, was appointed Director of the Institute. This period was marked by radical reorganization of the Institute research and scientifi c activity as the country entered transitional economic period after the split of the USSR in 1991. Having received its independence, Ukraine began form new structures of management of science and public health. An important stage in the life of the KIG be-gan since 1993 when the Institute became one of doz-en research institutes included in the newly organized Ukrainian Academy of Medical Sciences.

One of the Institute’s outstanding achievements in the period of the direction of Vladyslav Bezrukov has been the creation of scientifi c schools of V. V. Frolkis (1924–1999) and D. F. Chebotarev (1908–2005)

which continue determining the main national geron-tology research directions of today.

At the present stage, the KIG identifi es (a) the direction of research on aging and (b) organization of medico-social servicing for elderly and old people in diff erent research and practical medicine groups in Ukraine which secure today’s boundaries of the Ukrainian gerontological science.

The key research direction after the organization of the KIG in the area in biology of aging had been and still remains the elucidation of basic mechanisms of aging and age pathology development. Research along this line had been fullest in the department run by V. V. Frolkis and his team. They approached the processes of aging from the positions of physiological and systemic mechanisms.

According the adaptation-regulatory theory of aging proposed by V. V. Frolkis, in the process of ag-ing the adaptive mechanisms are being switched on and, via regulatory changes, maintained vitality of an organism. Such mechanisms operate at various stages of organism’s vital activity and also greatly determine individual’s life terms.

Further the school of V. V. Frolkis made a consid-erable contribution to understanding the regulatory aspects of age changes thus leading to the formula-tion of the gene regulatory theory of aging as a key component of the adaptation-regulatory theory of age development.

In the light of this theory, an important mecha-nism of genome-membrane relations was discovered by the school of V. V. Frolkis to the eff ect that under genome control there occurs the synthesizing of in-tracellular plasma membrane regulators, called inver-tors.

V. V. Frolkis and his school greatly contributed to the understanding of the age pathology interrelations, in particular, in the light of gene regulatory theory of aging, i.e. of the universal mechanism of the onset of diseases associated with the aging, such as athero-sclerosis and its complications (myocardial infarction, stroke), cancer, Parkinson’s disease, Alzheimer’s dis-ease and others.

Practical signifi cance of this theory was demon-strated on the eff ectiveness of gene therapy at ex-perimental atherosclerosis (results of investigations carried out jointly with academician of the NAS Ukraine V. A. Kordium the Institute of Molecular Biology and Genetics, NAS Ukraine).

A characteristic feature of the investigators of the V. V. Frolkis’s school (among them profes-sors Vladyslav V. Bezrukov, Nestor S. Verkhratsky,

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Oleg K. Kulchitsky, Aleksander Ya. Litoshenko, Tatiana Yu. Kvitnitskaya-Ryzhova) is their great in-terest to cover a wide range of research topics, study of the role of regulatory mechanisms in functioning of various organism systems. Here the mentioning should be made of age changes of the central ner-vous, endocrine and cardio-vascular systems, the re-sults of which indicate the priority of disturbances in the regulation processes at all levels of structural-functional organization.

The works of V. V. Frolkis and his followers had placed study of the regulatory aspects of aging on the qualitatively new level and made considerable contri-bution to the modern concept about the nature of ag-ing processes and the possibilities of infl uencing age changes of the organism.

Another national school of gerontological re-search was formed in Kharkov at the Institute of Biology of the National University where research had been done to study metabolism in old age and mo-lecular mechanisms underlying this process. Having been founded by A. V. Nagornyi, the school was fur-ther evolved in the works of Professors V. V. Nikitin, E. A. Lemeshko, E. A. Bozhkov and others. Research workers of this school were positioned to lay basis for modern understanding of the mechanisms of activity of various enzyme systems determining processes of biosynthesis (protein included in aging), role of chro-mosomal mechanisms in cells aging, age-dependent peculiarities of hormonal reception as well as mecha-nisms of connective tissue aging.

The name of D. F. Chebotarev and the works of his school are associated with the formation of the geriatrics as a new branch of medicine in the country.

Under the leadership of Prof. Dmit ry F. Che-bo tarev and his closest follower Prof. Oleg V. Kor-kushko research activities of the Institute staff had been done to resolve many important issues of clini-cal physiology in aging such as: pathogenesis of arte-rial hypertension and its correlation with the age, dis-turbances in functioning of endothelium of coronary vessels as well as the predictors of cardiac rhythm abnormalities in elderly patients with chronic IHD, role of microcirculation in hypoxic conditions in old age, and role of the latter in IHD pathogenesis and therapy.

A signifi cant direction in geriatric cardiology was to seek for means of prophylaxis and treatment in the cases of accelerated aging and cardiovascular diseases in the people of elderly and advanced old age.

A signifi cant contribution to modern gerontol-ogy development had been made by investigations of

immune regulatory mechanisms of aging and possi-bilities of purpose-designed infl uence on the immune system for correction of its age changes. Such inves-tigations had been carried out in the Laboratory of pathophysiology and immunology of the Institute un-der leadership of Prof. Gennadii M. Butenko. The results obtained in this laboratory allowed propose the concept about the existence in old organism of active compounds which determine age changes in the or-gans and systems — immune, connective tissue, sex-ual etc. A close interrelation was established between immune and endocrine systems. Furthermore, the re-search workers of the Laboratory of Pathophysiology identifi ed an important role of the neurohumoral mechanisms in the development of atherosclerosis, arterial hypertension and myocardial infarction.

Of special interest for the Institute staff were re-search projects seeking to elaborate themes of com-parative gerontology, in particular, analysis of age changes in the ontophysiological aspect in the animals with diff erent life spans (V. V. Frolkis and his team). These projects are interconnected with one of the key directions of the fundamental gerontology, namely: the biological age and its markers (V. V. Voitenko). This direction has been evolved in diff erent research centers of Ukraine. In recent wide-scale population surveys/investigations, assessments have been made to establish relationships between biological and cal-endar ages, to fi nd options of using defi nite markers that would ensure higher statistical signifi cance for human biological age assessments.

Intensive research activities have been done to study the ways and methods of experimental lifes-pan prolongation. For this purpose, several wide-scale studies were implemented for the assessment of calorie-restricted diets, protein biosynthesis in-hibitors, enterosorbents and double detoxication of the liver (V. V. Frolkis et al.). During recent years, investigations have been performed to study life ex-tension eff ects of prenatal imprinting of enzymes of the antioxidant systems, aurine tricarbonic acid, etc. (Kh. K. Muradian).

One of the most topical and intensively develop-ing branches of clinical gerontology and geriatrics is the neurogerontology. Research into the specifi cs of human nervous system aging and their role in the de-velopment of neurological and psychiatric pathology, an in-depth analysis of clinical manifestations and the pathways of their target purpose-designed pharma-co-therapeutic regulation has long-standing traditions in Ukraine and currently occupies a signifi cant place

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among research projects undertaken by the Ukrainian gerontologists.

Modern stage of neurogerontology develop-ment is closely linked with the name of the promi-nent national neurologist Prof. Nikita B. Mankovsky. Investigations in this fi eld are aimed to study hu-man nervous system specifi cs and their role in the development of age-dependent neurological and psychiatric pathology like cerebro-vascular diseas-es, Parkinson’s disease, mild cognitive impairments and Alzheimer’s disease and to analyze the specifi cs of clinical manifestations and their pharmacologi-cal treatment. These topics have been further dealt with in the research groups headed by professors Svetlana M. Kuznetsova, Iryna N. Karaban and Natalia Yu. Bachinskaya.

Another key directions of the Ukrainian gerontol-ogy and geriatrics, namely the clinical physiology and pathology of the locomotor apparatus, which were ini-tiated in the 1970es by Prof. Eugenyi P. Podrushnyak, is currently being developed by a school of the ortho-pedics in the Department of Bones and Tissue of the KIG, headed by Professor Vladyslav V. Povoroznyuk. At present, intensive research is being pursued on the osteoporosis and mechanisms of development of dystrophic-destructive age changes of the bone tissue, epidemiology of various clinical forms of osteoporo-sis in diff erent regions of Ukraine, markers of bone remodeling, calcium and vitamin D metabolism, etc.

The third fi eld in aging research affi liated to the KIG is social gerontology and gerohygiene. The over-all tasks in these area have been to conduct research aiming at the realization of one of the key practical tasks of gerontology, namely to ensure the quality of life for elderly and old people.

In recent decade much attention is being paid to analyzing health status, structure and dynamic of the morbidity among older population in diff erent regions of the country (Prof. Vera V. Chaikovskaya). The re-sults obtained serve the basis for further research into medico-social servicing of people beyond working age, and needs of the elderly people in medical, social, daily living and psychological assistance. Assessments of real needs of the population in various kinds of as-sistance and their price orientation were possible after creation of the automated experts’ system of quanti-tative evaluation of the degree of loss of self-servicing abilities by the elderly. Moreover the computer-aided bank of data is being created for studying needs of medico-social services for people beyond working age for diff erent regions of Ukraine, as well by various kinds of assistance, age and sex groups.

During recent years, active developments have been received in studying comparative eff ectiveness of diff erent variants of interaction of the hospital and ambulatory services in providing long-term care for elderly and very old people.

One of the most topical research directions in this area has been analysis of the regularities of the formation of health and working capacity of working population as the key factor of adaptation of labor resources in Ukraine under conditions of transformation in economic relations, i.e. pension-ers’ status, labor market and working capacities of the aged workers, health condition, retirement, etc. (Alexander A. Polyakov). The given direction com-pels to make physiological-hygienic evaluation of the interaction between physiological status and working capacity of the people/subjects of diff erent age. Of today, the results of these investigations allowed de-velop and approbate the methods of occupational/professional training among elderly individuals, for-mulate assessment criteria relative sanitary-hygienic conditions of their labor, and identify age-related specifi cities of developing fatigue and its prophylaxis.

Issues of nutrition in old age are currently being dealt with at the Laboratory of Nutrition (Prof. Gri-gorov and his team). Comparative analysis of nutri-tion rations in the given category of population in Ukraine allowed detect both, objective and subjec-tive factors that form the character of nutrition and evaluate the appropriateness of these rations relative specifi c foods and their components. Concrete recom-mendations on optimization of nutrition were given for institutional and non-institutional elderly people.

In the fi eld of medical demography it is worth single out the monitoring of mortality rates and life expectancy of the Ukrainians as the function of age, with an account being taken of the gender, living con-ditions and causes of death; and creation of the re-spective computer data base (Natalia A. Foigt).

In conclusion, almost all the main basic issues in gerontology have been addressed in Ukraine. The prio rities and tendencies of gerontology development in Ukraine are, in large measure, synchronic with world tendencies of gerontological investigations.

Publications of the Dmitry F. Chebotarev State Institute of Gerontology affi liated with the Natio nal Academy of Medical Sciences of Ukraine, within 1959–2012 years (written in foreign languages):

Monographs and Book-Collections (written in foreign languages)

1. Frolkis V. V. Aging and life-prolonging processes. New York: Springer-Verlag, Wien, 1982.

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2. Frolkis V. V., Bezrukov V. V. Aging of the central nervous system. Basel: Karger, 1979.

3. Frolkis V. V., Muradian K. K. Life span prolongation. London, 1991.

4. Frolkis V. V., Bezrukov V. V., Kulchitsky O. K. The aging cardiovascular system. Physiology and pathology. New York, 1996.

5. Frolkis W. W. Mechanizmen des Alterns. Berlin: Akademie-Verlag, 1975.

6. Handbuch der Gerontologie. Band 1: Grundlagen der Gerontologie / Herausgegeben von: D. F. Čebotarev, G. Brüschke, U. J. Schmidt, F. H. Schulz; Red. I. Kalbe. VEB Gustav Fischer Verlag Jena, 1978.

7. Handbuch der Gerontologie. Band 2: Geriatrische Chirurgie / Herausgegeben von: D. F. Čebotarev, G. Brüschke, U. J. Schmidt, F. H. Schulz; Red. I. Kalbe. VEB Gustav Fischer Verlag Jena, 1978.

8. Frolkis V. V. Physiology of cell aging. Basel: Karger, 1984.

Journal Articles9. Bezrukov V. V., Rushkevich Yu. E. Functional changes in

emotiogenic centres of the hypothalamus in aging. In: A. Viidik et al. (eds) Facultas, Univ. Vitality, Mortality and Aging, Verlag, Wien, 1996, pp. 227–237.

10. Bezrukov V. V., Muradian K. K., Vaiserman A. M. Biogeron-tology in Ukraine: Update. Biogerontology. 2011. 12: 37–45.

11. Butenko G. M. Stem cells technologies in gerontological research. In: Stem cells and their potential for clinical application. New York: Springer, 2008, pp. 77–82.

12. Vaiserman A. M., Koshel N. M., Mechova L. V., Voiten-ko V. P. Cross-life stage and cross-generation effects of Y-irradiation at the egg stage in Drosophila. Biogerontology. 2004. 5: 327–337.

13. Frolkis V. V., Tanin S. A., Gorban Y. N. Age-related chang-es in axonal transport. Exp. Geront. 1997. 32, 4/5: 441–450.

14. Frolkis V. V., Kvitnitskaya-Ryzhova T. Yu. Vasopressin, hypothalamo-neurohypophyseal system and aging. Arch. Geront. Ger. 1999. 28, 3: 193–214.

15. Muradian K. K., Utko N. A., Fraifeld V. et al. Superoxide dismutase, catalase and gluthione peroxidase activities in the liver of young and old mice: linear regression and correlation. Arch. Geront. Ger. 2002. 35, 3: 205–214.

16. Tschebotarjew D. F. Gegenwast und Zukunft der Geron-tologie. Ernüdung und Vorzeitiges Althern. Leipzig, 1973. S. 426–435.

17. Tschebotarjew D. F. Organization und Programm Wissen-schaftlicher Forschungen auf dem Gebiet der Gerontologie in der UdSSR. Aktuelle Gerontologie. 1972. 2, 6: 321–327.

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