MARC EVANS M. ABAT, MD, FPCP, FPCGMInternal Medicine-Geriatric Medicine

Head, Center for Healthy Aging, The Medical City

These are the ones expected to be retiring

These are the ones expected to support the

retirees

As the years go by, more retirees will have to be

supported by relatively finite resources

Biochemical composition

changes Physiologic capacity

decreases

Decline in homeostasis

Susceptibility to disease increases

Mortality increases with age

The Elderly (age 65 and over)

• 13% of the U.S. population in 2002

• 36% of total U.S. personal health care expenses

• average health care expense was $11,089 per year for elderly people but only $3,352 per year for working-age people (ages 19-64)

Healthcare is a major factor affecting decisions regarding retirement.

Where does the Philippines stand with regard to geriatric care?

Outline

• Doctors

• Levels of Care

• Geriatric Services

• Medical Facilities

• Nursing and Caregiving Staff

• Allied Professionals

• Summary

There are about 100 recognized geriatricians or specialists for the elderly in the Philippines!

As of 2007, for the 5.8 million senior citizens in the Philippines (6.5% of the total population), there would be….

1 geriatrician for every

58,000 senior citizens!

Geriatricians come from different backgrounds

• Internal Medicine

• Family Medicine

• Other specialties

• General practitioners

Specialization in Geriatrics

Hospital-Based Fellowship Program

Hospital-Based Fellowship Program

Modular Program

Accreditation as a Geriatrician

Complete Residency Training in Internal Medicine

• 3 years

Pass Internal Medicine Specialty Board Exams

• May be completed during Geriatrics Fellowship

Geriatric Medicine Fellowship

• 2 years

Pass Geriatric Medicine Specialty

Board Exam

How about the non-geriatricians?

• Recognition of the uniqueness of the elderly physiology and disease process

• Need to modify and tailor specialty knowledge

• Acceptance of interdisciplinary care and the role of geriatricians

Geriatrics in Medical Training

• Gradual incorporation of geriatric medicine in the medical curriculum– University of the Philippines-College of Medicine

– Ateneo School of Medicine and Public Health

– St. Luke’s Medical Center-Quasha College of Medicine

– University of the East College of Medicine

• Proposed incorporation of questions in the Medical Board Examinations

Regional Partnership in Geriatrics

• Involvement in the Asia-Pacific Geriatric Network

– Philippines, Hong Kong, Malaysia, Taiwan, Indonesia, Australia and New Zealand

In-patient or hospital-based geriatric care

Out-patient or clinic-based geriatric care

Levels of Care

Home Care Nursing Facility

Chronic Care Settings

Geriatric Services

• Acute disease-based geriatric care

• Chronic care

• Executive check-ups

• Longevity medicine vs. anti-ageing medicine

• Cosmetic medicine

• Instrumentation and Procedures

Other Facilities

• What we have

– Assisted living facilities

– Nursing care facilities

• What we do not have

– Sub-acute or transitional facilities

• There is no clear agency for accreditation and monitoring of facilities for chronic care.

• Currently, the Philippine College of Geriatric Medicine and the Philippine Society for Geriatrics and Gerontology is advocating for this.

Nursing Staff

• Some degree of specialization, although not as structured as in other countries– Gerontology nurses

– Oncology nurses

– Wound Care and Stoma nurses

• “private duty nurses”– Home care

– Procedures and instrumentation

Nursing Education and Accreditation

• Incorporation of topics on geriatrics and gerontology in nursing curriculum– University of the Philippines-College of Nursing

• Nursing associations– Philippine Nursing Association

– Gerontological Nurses Association of the Philippines

– Association of Private Duty Nurse Practitioners

Caregivers

• Technical Education and Skills Development Authority (TESDA) mandate on caregiving industry– School accreditation,

monitoring and auditing

– Minimum program competencies

– Graduate assessment and certification

Allied Professionals

• Growing interest in application of geriatric and gerontologic principles in the practices of

– Physical and Occupational Therapy

– Speech and Swallowing Therapy

Geriatrician

Geriatrician

Summary

• There is a growing population of retirees abroad• Healthcare is an important factor in decisions

regarding retirement• The Philippines IS capable of providing good

geriatric care– Personnel– Levels of Care– Facilities

• Further enhancements regarding accreditation and monitoring have to be instituted