resources in egypt for geriatrics care

8/3/2019 Resources in Egypt for Geriatrics Care

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*Dr.DoHA RASHEEDY ALY

*Lecturer of Geriatric Medicine

*Department of Geriatric and Gerontology

*Ain Shams University

*Available services forthe elderly in Egypt


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*Thereare currently 4,400,000 persons aged 60 and over representing6.9% of the total population in 2006. The expected percentage of olderpeople may reach 8.9% in 2016 and 10.9% in 2026.

* Illiteracy in geriatric population in 81% in females and 64% in males in2006.

*Most males are married (86%) and most of females are widows (36%).

*Working males are 28% and working females are 3% in 2006.

*Life expectancy in females was 63.5 years in 1986 increased up to 73.6years in 2006.

*Life expectancy in males was 60.5 years in 1986 increased up to69.2years in 2006.

*Elderly abuse according to WHO is 4-6%

*Elderly populations are at higher risk than adult population as a wholefor health problems. The greatest risks for health problems are forpeople over the age of 75.

*Demography of geriatric population in

Egypt


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*Health problems

* Psychological problems

*Socioeconomic problems

* Problems facing the geriatric populationin Egypt


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*


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*

*As the prevalence of most chronic disease increases with age, so

does the prevalence of definite disability. The prevalence of

functional impairment increases with age from 13% among persons

aged 65 to 69 years to 35% among those aged 85 years and older.

*The rates of functional disability are even higher amonginstitutionalized elderly persons.


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*

*heart disease, cancer and cerebrovascular disease account for75% of all deaths for both men and women aged 65 years andolder.

*Cancer is the second leading cause of death after heart diseasesnow, primarily because of the increased incidence of lung

cancer for men aged 65 to 84 years while for men aged 85 yearsand older, prostate cancer is the most common cause of deaths.Breast cancer causes the most cancer death among women aged65 to 74 years, but in women aged 75 years and older, coloncancer causes the most cancer deaths

*Infections, especially influenza and pneumonia are still a majorcause of mortality for frail older persons. Vaccination programsfor influenza and pneumococcal disease have probably beeneffective in reducing the number of pulmonary deaths.

*Accidents; with falls being the leading cause of accidental

deaths


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*


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*Psychological disorders are common among

the elderly, especially depression .

*Dementia is the most serious disorder and

it shows much progression with aging


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*Socio-economicproblems


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*Elderly people also have a higher risk than the adult population

for social losses, including loss of income and loss of self-

esteem(after retirement) loss of loved one (through death of

the spouse), loss of social roles (through death of the spouseand friends.

*Most elderly have no economically productive work, but the

existing cultural and religions patterns of caring for the aged

parents and grand parents is presumably the main reason for

their acceptance in families.

the source of the income of the elderly:

1) Pensions in 53%.

2) Sons/daughters Help in 21.5% .3) Assets revenue in 11.5% .

4) Help from other relatives in 6.4%.

*Many older people in Egypt lives in poor conditions (60% of less

than 150 Egyptian pounds).


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*Needs of the elderly


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*Needs of the elderly

1.Social needs:*The need for independenance is a result of discomfort experienced by the

elderly within their families. To meet these needs, special houses have beenestablished by the government.

2. Economic needs:

*Senior citizens need a financial system which secures a balance betweentheir income and the increasing cost of commodities and services.

3. Psychological needs:

*As relevant pre-retirement orientations programs, introduction of courseson family relations and the right of senior citizens in schools.

4. Health needs:

*Focus on primary prevention rather than disability management.*Focus on chronic diseases follows up rather than episodic and acute care.

* Increased awareness about medical problems .

*They also need a suitable rehabilitation system according to their mentaland physical capabilities


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*


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*the services available for the elderly in Egypt in comparison to

their needs are inadequate both in quantity and quality. In

addition, many essential needs are neglected especially those

related to the functional and psycho-social aspects of the

elderly.

*Those services are introduced in isolation from one another

resulting in a decrease in efficacy and an increase in the cost of

services.

*Services are both governmental and non governmental.


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*


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*Governmental sector:

A. Ministry of health and population(MOHP):*Primary, secondary and tertiary services. 80% of services

provided by MOHP are free and 20% paid. All Egyptian Citizensare eligible.

*267 urban health care centres and 3595 rural health care

centres.

*The health services were distributed all over the country. Ineach governorate, there are the three levels of health care,primary, secondary and tertiary; but the geriatric specialty ispresented mostly in Cairo, and a few big cities.

*In 2007 the Egyptian Ministry of health & population (MOHP)announced its plan to establish the geriatric medicine specialityby recruiting 89 doctors in 2008 to work as geriatricians in thevarious elderly health care units, Geriatric Medicine specialitywas put in the urgently needed specialities:


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*Cairo Boulaq Dakrour Geriatrics Unit Giza (10 beds)

Secretairate of Mental Health (2007)

*Alexandria

*Port Said Port Said Geriatrics Center (25 beds)

* Ismailia Ismailyia General Hospital-Geriatrics Unit (4 beds)

*Suez Suez Geriatrics Center (35 beds)

*Matruh Matrouh General Hospital (10 beds)

*Sharqia Geriatrics Unit - Hehyia Central Hospital

*Dakahlia*Monufia Berket El-Sabaa Central Hospital - Geriatrics Unit (10

beds)

*Asyut Al-Eman General Hospital - Geriatrics Unit (12 beds)

*North Sinai Al-Arish General Hospital

*South Sinai El-Tor General Hospital

*Minya

*Kafr el-Sheikh

*Luxor Luxor International Hospital


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*Al-Matariyyah teaching hospital and Elsahel teaching hospital

are establishing its departments.

*Boulaq Al-Dakror Hospital opened a new department in 2007.

*Elderly rehabilitation & treatment center in Helwan (26 beds)one of the single speciality centers of ministry of health and

population.

*The national institute of neuromotor disabilities also contain a

geriatrics outpatient clinic.

*Egyptian fellowship of family medicine & Egyptian fellowship of

Internal medicine curricula includes a training module on

Geriatric medicine as a part of the Egyptian fellowship programs

provided by the Ministry of health and Population.

*Government Medical Insurance healthcare: Covering the cost ofhealthcare is another major challenge for seniors. Currently, 62

percent of elderly men have health insurance compared to 35

percent of elderly women.


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*The MOHP started from 2001 to develop health programs

for older people that include the following:

1) Short term training program for family physicians by experts

from Ain Shams university and Helwan university.2) The family doctor also know much about health of the

spouse and about health of the spouse and about the local

services and environment .

3) Short term training program for community nurses withcollaborations of experts from Ain Shams University.

4) Clinical diagnostic service to the dementia patients (memoryclinic in the hospitals).

5) Geriatric center for rehabilitation: This unit has outpatientsassessment service, recreational activity units, long stay unit

as well as rehabilitation units.


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B.Teaching hospitals and institutes organizations (THIO) Serve onlysmall proportion of population.

9 general teaching hospitals and 10 research institutes located mostly in

Cairo.C. Health insurance organization (HIO).

*Provides insurance to workers in the formal sector.

D. University hospitals

*Provides high quality care mostly in Cairo area and generates

significant resources through user fees.

*Primary, secondary and tertiary treatment.

*University hospitals are used predominantly by the non-poorpopulation

E. Other Ministries

*Ministry of interior provides free health and medical care for policeand prisoners.

*Ministry of transport provides services for railway employees.

*Ministry of defence provides services for the armed forces as well as

local civilians.


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*


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*

*Provide primary health care medicine and raise public

awareness and public health care.*Religious organization have the capacity to carry out such

activities.

*Primary health care activities are mainly through grants and

donations from international NGOs.*In Egypt only 106 organizations out of 17,000 NGOS provide

services to elderly which revealed that care of elderly had low

priority in NGOS preference.

*These 106 organizations are mainly located in Cairo andAlexandria, also it is noted nearly all of them are located in

urban areas .


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*Foreign donors*International aid paid to government and government

employees as population and capital investments. It falls under

the authority of the ministry of international cooperation

*Foreign donors multilateral donors: mainly WHO, world bank,

African development bank, social fund for development.

*Bilateral donors: mainly Finland, Holland, and European union.


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*


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Private insurance

*Private or involuntary health insurance is small.

*Many companies make their own arrangements to provide medicalcare to their employees.

Occupational syndicates

*Several groups of professional and workers organized into occupationalassociation (syndicate).

*Major syndicates are medical, commercial, agricultural andengineering.

*All members of associations and family are eligible to use servicesprovided by relevant syndicate.

*Membership is voluntary and is increasing very quickly.

Private hospitals and pharmacies

*Owned by individual and are operating in the private sector.

*All citizens are eligible to use services.

*Costs of drugs are expensive compared to public pharmacies.

*All citizens (100%) can access these services offered provided they canafford to meet the costs.

*Operates: 1202 private hospitals.


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*Private based geriatrics services

*Ain Shams University specialised hospital has a Geriatrics outpatientclinic.

*Geriatric Medical Center at Downtown, Cairo

*Palastine hospital established a long term care unit in 1994.]

*American Hospital in Tanta Has a Geriatrics department.

*Wadi El-Nile hospital has a geriatrics outpatient clinic.

* Italian Hospital in Cairo has a Geriatrics department.

*Abdel Kader Fahmy hospital has a geriatrics clinic.

*Hasabo Hospital has a Geriatrics outpatient clinic.

*Arab Contractors Medical Center has a Geriatrics consultation Service.

*El-Gouna Hospital at Hurgada has a Geriatric Rehabilitation service.

*Geriatric Medicine department at The International Medical centre atCairo-Ismalia road.

*Police Hospital of Alexandria
http://en.wikipedia.org/wiki/Geriatric_medicine_in_Egypthttp://en.wikipedia.org/wiki/Geriatric_medicine_in_Egypt


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*


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*Most of Psychiatry departments in Egyptian Universities

have or are establishing its psychogeriatrics section and

also other non-governmental private services exist.

*Psychiatric unit at Ain Shams University has a geriatricpsychiatry unit with a dementia and memory clinic (twice

weekly since 1996).

*Several private Psychogeriatrics Units are available in

Egypt.*Psychogeriatrics Clinic at Maadi Military Hospital.

*Gamal Mady Aboul Azayem Hospital has a Psychogeriatrics

clinic.


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*Geriatric carePhysicians in Egypt


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*categorized into 3 Categories:

*Geriatricians :Postgraduate studies Carrying a valid

certificate/degree in Geriatric Medicine

*Family Medicine and Internal Medicine Practitioners: Carrying aContinuous medical education (CME) credit in Geriatrics.

*General Practitioners


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*Geriatricssocieties


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*The Egyptian society of Geriatric medicine was established in

the 1982, First President was Prof Mohammed Sabbour, but is

frozen now.

*The Egypt Alzhiemer association is active in the field ofDementia and also in geriatric care, it was established in 1998

by Professor Abdel Moneim Ashour. It a member of the

Alzheimer's Disease International Associations


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*Conferences and

workshops


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*Many conferences about geriatric medicine were held in Egypt.

*1st conference Ain Shams Faculty of medicine conference of Geriatrics& Gerontology in 1988

Ain Shams University During the 1990s

*First Annual Egyptian Conference on Aging, Ain Shams University, Cairo,Egypt, January 1993.

*Fifth International Geriatrics Congress: The Egyptian Elderly in theTwenty-First Century, Cairo, Egypt, February, 1998

*1st Ain Shams University conference and condensed geriatrics andgerontology course July 2009

*2nd Ain Shams University conference and condensed geriatrics andgerontology course for Physicians March 2010

*2nd Ain Shams University conference and condensed geriatrics andgerontology course for Non-Physicians March 2010

Suez Canal University

*Conference on Geriatrics and Gerontology, Suez University School ofNursing, Port Said, Egypt, February, 1998

*First annual national meeting of rheumatology "GeriatricRheumatology", In Ismailia Mercure hotel.67 July 2006

Helwan University during 1990s (6 conferences 1990 2005)


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Helwan University during 1990s (6 conferences 1990 - 2005)

*First Regional Conference for Elderly Care. The Center of Elderly

Care-Helwan University April 2000

Al-Azhar University

*Faculty of medicine conference 2006

Alexandria university:

*Faculty of medicine conference 2006

*Geriatric Unit Conference April 2010

Cairo University aging conference 2009

Tanta University

*Faculty of Medicine Annual Conference Geriatrics health &

Prevention conference 2009


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*Health expenditures

*Investments implemented in the program of health servicesduring 2002-2004 showed about L.E 5 billions, including L.E 3.3

billions accounting for 66% by the government sector and the

rest by the private sector.

*Investments implemented in 2004-2005 hit L.E 2.4 billions

including L.E 1.7 billions implemented by the government andeconomic agencies, accounting for 70.8% of total investment


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*Education

I - Geriatric education:Started in 1988, at the post graduate level as master degree in

geriatric medicine and a doctorate degree in geriatric medicine.Moreover, the study of the geriatrics is introduced at theundergraduate level.

II - Geriatric nursing education:In many universities, there is a module in geriatrics nursing both

at the undergraduate level as well as postgraduate.

III -The Higher Institute for Public Health AlexandriaUniversity:

This is a postgraduate institute for public health. There are 9academic departments from which one is especially for thedepartment of health at old age. This department offerspostgraduate training in geriatric health at the diploma level,master degree level and Ph.D. degree level in public health.


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IV. Geriatric Physical therapy education:

*Physical therapy education is available in three universities, for

undergraduate.

*Higher degree studies are available in geriatric Internalmedicine and geriatrics.

V Faculty of Social service and faculty of Art (department ofpsychology):

Their curriculums contain Some lectures about elderly.
http://en.wikipedia.org/wiki/Geriatric_medicine_in_Egypthttp://en.wikipedia.org/wiki/Geriatric_medicine_in_Egypt


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*Clinical services for older people:

I. Geriatric department Ain Shams University*This clinical service started as the geriatric unit in Ain Shams

University in 1990. This academic department is the only

academic department in the Egyptian universities.

*The geriatric unit has change to be academic unit in 1996.

*Clinical unit:The clinical unit has around 23 acute assessmentbed which accept patients from the out-patients departments.

*Geriatric ICU unit:This unit has 8 beds and is offering a clinicalservice for the seriously ill elderly patients.

*Osteoporosis unit

Alexandria University


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Alexandria University

*Faculty of medicine contain a Geriatrics Unit since the 1970s.

*A biweekly geriatrics Outpatient clinic is also available

*The department have a cooperation with the Geriatric Nursing

department of the Faculty of Nursing.

*Elder health section of the family health department of the High

Institute of Public Health of Alexandria University.

*Postgraduate Program in Geriatric Nursing in the Faculty of Nursing.

Mansoura University

*Has established its own Geriatrics Unit.

* Inpatient department consists of 2 beds affiliated to the

Endocrinology Unit.

*Geriatric Medicine Residency Program has started since 2006 inMansura University in Cooperation with the Ain Shams Geriatrics &

Gerontology department. Three residents has joined the program

until 2009.

*The department has started a weekly geriatrics outpatient clinic.


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Cairo University

*Faculty of Medicine has the geriatrics speciality included in the publichealth department, but geriatrics is not a separate entity. It is included inthe family medicine curriculum & Family medicine M.Sc.

*Psychogeriatrics Unit is being established in the Psychiatry department.Assuit University

*Faculty of Medicine is currently establishing a Geriatric Medicinedepartment.

Tanta University

*A Psychogeriatrics Unit was established in 2008.

*The Tanta Faculty of Medicine has organised a conference on GeriatricMedicine in 2009.

*The Faculty of Nursing has a Post-Graduate Program for Geriatric Nursing.

Suez Canal University

*Faculty of Medicine has a family medicine department that teachesgeriatric medicine course in the undergraduate curse of the first year.

*Also the Geriatrics module is taught in the postgraduate course of themaster degree and the Doctorate degree in family medicine.

Sohag University

*Has a Geriatric Health Curriculum taught in the Faculty of Nursing, in the

Program of Geriatric

II


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II. Center of Elderly Care, Helwan University (CEC):*The center of elderly care has been established in 1996. This center is a

self-financed unit for community development in Helwan University.

* The main objective of the center is to provide both the clinical service as

well as trying to develop a geriatric care.*Out-patients service:

* In which the center runs out patient clinics. Also, there is an outpatientclinic which is held twice monthly in one of day care centers for olderpeople. Core team runs this service which includes a geriatric specialistand a nurse.

*Dementia service in the CEC:

* The center also runs a special dementia memory clinic for dementiapatients in collaboration with MOHP.

*Home care service:

*This service is delivered to the frail older patients who are house bound.

*Long-term unit in CEC:

*This is mainly for frail older people who are functionally dependent onother for their ADLs and IADLs.

*The center provides long term facilities for both the physical dependent(post stroke physical disabilities, severe Parkinson's disease) andcognitively impaired (dementia).

*Respite care is also provided for such group of patients.


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*SERVICES PROVIDED BY

MINISTRY OF SOCIALSOLIDARITY


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a. Provides support to the meeting of the higher committee of theelderly welfare (established by ministerial decree in 1997).

Ministry of Social Solidarity programs and services are wide

ranging:1. Elderly homes:

*An increasing trend for new homes can be observed over the last four

decades. in 1978 was 28, in 2006 was 84 (serve 4000 elderly)BUT the

number of geriatric homes cannot be called sufficient.

2. Elderly clubs:

* These are day care centers providing entertainment, social, health

and mental care services as well as encouraging older persons to

invest themselves in productive activities to use older person's

expertise.

*Elderly clubs are increasing so rapidly, As regards elderly club service,

it is expanding rapidly during the last few years reaching up to 170

clubs in 2007 (serve 33000) compared to 5 clubs in 1978 distributed

over 26 governorates.


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3. Physiotherapy unit:

* This type of service is attached to the elderly clubs and homes.

They provide sessions of physiotherapy to the elderly living in

homes, clubs and to those living within their family. In 2005,their numbers reach 52 units.

4. Elderly service offices (most in elderly clubs and homes):

*It involves social care, home cooked meal, domestic help to the

elderly within their families. In 2005, their numbers reach 27offices.

5. Hosting family project:

*A new project has currently being tested in 5 governorates. A

family hosts the older persons and provides health care,

entertainment, social care and balanced meals for a monthly

fee paid by the elderly according to ministry of social solidarity

conditions.


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6-Elderly sitter program:

* In the last few years, Egypt experienced socio-economic changesrepresented in the participation of women in labor force and change offamily structure from extended to nuclear family.

*Ministry of social solidarity conduct training courses to the elderly sittervia different NGOs (family support association, Egyptian red crescentassociation ) as well as technical and financial support for these services).

*More than 900 persons are trained to provide the required services andcare for 500 senior citizens in Egypt.

*Unfortunately, the negative cultural concepts about the job of the sitterin our oriental society cause embarrassment to the service provider(sitter) as it is considered as a low status job.

7-Higher committee for elderly care:

* It includes all the ministries and organizations (ministry of health and

population, ministry of social solidarity, ministry of transport, ministry oflaw, ministry of media..etc.) that provide services to the elderly, 1997.

* It aims at linking between different authorities in elderly care to controlinvestment in elderly care, rendering them effective.

8. International day of older people:

* In the first of October every year according to United Nations decision


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*Some important services

provided by thegovernment to the seniorcitizens in Egypt

1-Social security programs for the senior citizens


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1 Social security programs for the senior citizens

* In 2003, the government social security budget either pensions or social aids expended fromL.E 88,657,867 in 1999 to L.E 176, 000,000 millions which covers half millions families inwhich the senior citizens represent 11% of the beneficiaries.

2-Advance payment of pensions

* In two cases stated by the law, a pensioner -not exceeding 65 years of age- may request an

advance payment of a sum of money, to be deducted from his pension over a period of 10years.

3-Home delivery of pension

* If the pensioner is 70 years old or more, of if he/she is totally or partly handicapped, he/shewould be entitled to request the delivery of pension to his/her home address. However, in astudy, only 10.5% stated that they knew about this service.

4-Aids and loans though Nasser Bank

* The bank achieves this goal by offering financial aid and by providing loans without interest,to persons who wish to set up small productive projects, and to those who encounter socialan/ or economic difficulties.

5-Reduction in transportation

* Pensioners are entitled to submit a request to the national organization of insurance andpension for a railway travel permit (two return trips per year to any part of the country at areduced rate of 50%). Egypt Air issued a circular in 1983, granting pensioners a reduction infares of 5% on international flights and 10% on domestic flights.

6- Reduction in prices of tickets for recreation

* Pensioners are entitled to apply for permits to attend theatre and cinema performances at areduced rate of 50%. The reductions are valid in theaters and cinema owned but the publicsector only. Very few elderly (3.0%) knew this entitleme

*


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*ADVERTIZING SEVICES

AVAILABLE FOR ELDERLY

TV programs:


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TV programs:

*Rabee3 el omr Program started in 1993. Itintroduces different activites and specific elderly care from

social, psychological and entertainment.Radio programs:

* program: discuss important elderly health, socialand psychological problems. Meeting with famous elderly and

introduce elderly news.

* program: it connect life to religion. And elderlygives advices to youth.

* program: stress on the role of grandma incaring and directing youth.

* program: famous elderly introduces theprogram and speak about his life long experience

* program: introduce some solutions for importanthealth, social and psychological problems.

d ld l


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Radio elderly:

*It considered the main support for elderly in Egypt as it cover

most of activates related to elderly with ensuring the role of

geriatric clubs.Newspaper for elderly:

*Alahram news offer specialized weekly page called main support which started in January 2001. it introduces

advices for elderly and geriatric clubs and nursing homes


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resources in egypt for geriatrics care

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