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Introduction
The addition of a new agenda
is expected to be added to the working agenda of family
physicians in Turkey. Since as the world is aging, our
country is aging rapidly, too. (1)
Family health centers are the
first point of contact for many patients in our country.
Especially in rural areas, patients do not want to go
to other health institutions. On the other hand, patients
in urban centers are frequently referred to hospitals.
Structural changes such as elderly “low threshold”
practices in hospitals are useful initiatives to remove
some obstacles to elderly people’s health care
services, but it is clear that efforts to address unmet
health needs have yet to be made.(2)
In our country, studies on the
needs of elderly individuals in the practice of family
medicine are still in their infancy. In this context,
“elderly health special interest group” aims
to contribute to this issue.
In this study, it is aimed to
examine the opinions of family physicians, who are concerned
with elderly health in the areas of study and research
related to the elderly health field.
Method
The study covers the opinions
of the members of the Elderly Health Special Interest
Group of Family Physicians, who met during the 20th
WONCA European Congress event held in Istanbul on 22-25.10.2015.
In November 2015, they conducted a questionnaire consisting
of 14 questions with 8 closed- and 6 open-ended questions.
The questionnaire was filled out via the link sent via
e-mail. The findings of the questionnaire were analyzed
with descriptive statistics and the results were shared
with the group members. It is believed that the results
obtained will guide the group’s work.
Results
Sixteen Family Medicine specialists participated in
this study. Nine (56.3%) worked in the university, four
(25%) in an Education and Research Hospital, two (12.5%)
in a Family Health Center, and one (6.3%) in a Community
Health Center.
Answers to the question on their
role on elderly health issues revealed subject headings
like primary prevention (n = 13; 81.3%), secondary protection
(n = 9; 56.3%), tertiary protection (n = 5; 31.3%),
rehabilitation (n = 5; 31.3%), and other tasks such
as treatment and research (n = 2, 12.5%).
Questions on their abilities
of institutional training and research opportunities
revealed these results; (n = 5; 31.3%), elderly health
research (n = 9; 56.3%), elderly health education (n
= 4, 25%), inter-professional training and education
(n = 5; 31.3%), and epidemiological studies (n = 5,
31.3%). Twelve (75%) participants had studies in the
elderly health research field. They had published several
articles.
The participants stated, that
the SIG should focus on geriatric assessment (n = 11;
68.8%), evaluation of multi-centre data (n = 12; 75.0%),
development of an elderly health monitoring conceptin
family medicine (n =15; %93.8), development of an elderly
out-patient concept (N = 9; 56.3%), development of a
protective approach to aging (n = 14, 87.5%), management
of frailty (n = 8; 50%), prevention of geriatric giants
(n = 1; 6.3%), poly-pharmacy (n = 12; 75%), drug prescribing
(n = 9; 56.3%), management of chronic disease (n = 13;
81.3%), nutrition of elderly patients (n = 10; 62.5%),
palliative care and hospice (n = 4, 25%), caregiver
problems (n = 8, 50%), comorbidity (n = 6; 37.5%), aging-friendly
primary care (n = 11; 68.8%), acute geriatric care (n
= 2, 12.5%), non-acute geriatric care (rehabilitation)
(n = 6; 37.5%), the development of quality of life improving
programs (home health care, home care, day care homes)
(n = 9; 56.3%), health services organizations (n = 7,
43.8%), complexity (n = 2; 12.5%), counseling services
(n = 13; 81.3%), ethical and cultural problems (n =
5; 31.3%), and social problems (n = 5; 31.3%).
The research priorities, that
should be included in the elderly health field were
mentioned as elderly health problems in family health
centers (n = 10; 62.5%), elderly care monitoring in
family health centers (n = 13; 81.3%), family health
centers and hospital relations (n = 8, 50%), management
of frailty (n = 12; 75%), %), the establishment of elderly
health outpatient clinics in hospitals (n = 5; 31.3%),
the first point of care issues (n=6; %37.5), inter-professional
collaboration (n=6; %37.5), electronic records (n =
7, 43.8%), longitudinal care (n = 2; 12.5%), patient
compliance (n = 2, 12.5%), communication skills (n =
3, 18.8%), chronic disease management (n = 11;68.8%),
care of acute problems (n = 2; 12.5%), diagnostic approaches
(n = 8; 50%), treatment approaches (n = 6; 37.8%), decision
making (n = 3, 18.8%), multi-morbidity (n = 5;31.3%),
health promotion (n = 9; 56.3%), palliation (n = 3;
18.8%), prevention (n = 6, 37.5%), integration (n =
1, 6.3%), biopsychosocial approach (n = 6, 37.5%), and
cultural sensitivity (n = 1, 6.3%).
The
participants reported the following opinions on the
effect of capacity building and network formation on
elderly health care and professional environment: reaching
out to patients and their families at home health care,
collaborating with universities and primary care, ensuring
networking of family physicians and other branch specialists,
participating in educational activities, and communicating
via social media.
The
strengths of the elderly health special interest group
was as follows: the opportunity for participants to
be able to work in different regions of Turkey and in
strong multi-center studies, their willingness and enthusiasm,
their participation from different health care institutions
at different health care levels, the opportunity to
develop different perspectives and different solutions,
their competency, the support of academicians.
Weaknesses
have been reported as follows: the roadmap for the studies,
that can be done has not been established yet; the distances
of cities, where they leave; obstacles to meet; existence
of different groups, and problems of sustainability.
Opportunities were defined as
the possibility of taking part in more extensive studies;
the possibility of multi-centered studies that can determine
geriatric patients’ problems and their distribution;
the competence of the team; the lack of work in this
area, and the opportunity to develop an elderly health
care approach, that can be developed in our country.
Threats have been argued as
communication problems, institutional barriers, interdisciplinary
competition, difficulties in finding resources for projects,
and the risk of disintegration due to poor coordination.
Discussion
It is striking that participants have a balanced distribution
of institutions. As Family Physicians, they report predominantly
primary prevention and primordial protection and secondary
protection. At the same time, this refers to the limits
of the working area in family medicine. Accordingly,
in the elderly it is necessary to develop health (sports,
proper nutrition), vaccination, chemoprophylaxis and
secondary protection in chronic diseases.(3,4)
It is also a fact that family
doctors spend a lot of time in home health care due
to the need in Turkey. Especially those working in education
and research hospitals undertake this task. In this
framework, it is possible to add health and palliative
care services at home to the above preventive health
services. The problems that arise in this area also
need to be investigated and managed.
Family doctors who work in the
university are contributing to the elderly health and
care education, because of their educational duties
as well as limited service to the elderly in a clinical
sense.
The study group has proposed
mainly the development of health monitoring concept,
a preventative approach, a counseling service, a program
for the management of chronic diseases, polypharmacy,
standards, nutrition program, elderly evaluation, and
aging- friendly practices. It is possible to collect
these works under one heading. The “Age-friendly
PHC Instrument Set”, which is an initiative initiated
by the World Health Organization(5). Expanding this
concept, would help to meet the anticipation of inclusion
of the key areas proposed above. However, the development
of the instrument alone will not suffice. Older “follow-up”
(monitoring) or periodic health check-ups or the institutionalization
of assessment needs should be continued. It would be
unrealistic to expect these services to be provided
by a single physician and family health worker. Some
support schemes, such as aging-friendly coordination
centers, should support this process.(6,7) Major conditions
such as cognitive impairment, depression, urinary incontinence,
instability, and immobility; which are called geriatric
giants that impair life quality, are quite common among
the elderly.(8) Aging-friendly coordination centers
counseling may also be possible.
Information should be produced
in order to better understand the duties related to
elderly care, which are attributed to family physicians
and the emerging health problems. Special interest groups
have reported, that in the direction of their experience,
the issues such as elderly follow-up, frailty management,
management of chronic diseases, elderly health problems
and health promotion should be examined. As understood
from these statements, health monitoring of the elderly
has high priority. There are some proposals on the periodic
health examinations by the Public Health Institution
of Turkey, which needs to be elaborated on and transformed
into a monitoring program. Based on the best evidence
available in this framework, it is important to form
a guide and assess the quality of this guide, and then
take the views of the different stakeholders. The linguistic
adaptation of the screening instruments to be recommended
in the handbook also constitute an important field of
study. In addition, the development of new diagnostic
and management instruments specific to our country and
culture should be targeted. Frailty is a new concept,
that attracts the attention of the health care environment.
The management of the frail individuals and more importantly
its prevention has priority. Undoubtedly, family physicians
will be the contributors to this issue. (9) The development
of diagnostic tools for this and the planning of early
interventions should be included in research topics.
Another growing group of problems is dementia. This
issue should be addressed, although it has not been
addressed in this study.(10,11)
The Elderly Care Special Interest
Group expresses the strengths of its members to be made
up of diligent, interested, motivated, experienced,
competent members, and with easy accessibility to faculty
members. They say; that the lack of a roadmap, the lack
of standards, and the fact that the members reside in
different places are weaknesses. As an opportunity,
it is stated that the group is very multi-centered and
that the studies in this area are few in number. As
a threat, it is stated that individuals participate
at different levels of care, that they could face communication
problems, support for projects is difficult, and the
project may have the risk of poor coordination .
Conclusion
Special interest groups, which are needed in our family
medicine society, will undoubtedly contribute to important
studies in this area. Participating researchers of this
group are enthusiastic and competent, which will take
the group further. The fact that the group members live
in different cities seems like a handicap, but the presence
of social media and the openness of communication channels
will be helpful in overcoming this problem.
Acknowledgement:
I would like to thank Didem Kafadar and Ramazan Vural
for their support.
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