TO LIVE LIFE AT AN OLD AGE, THE ITALIAN PERSPECTIVE

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• TO LIVE LIFE AT AN OLD AGE, THE ITALIAN
  PERSPECTIVE
• By DAMIANO MANTOVANI
• A.N.S.D.I.P.P. President

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• One would wonder if what denoted old age was
  this all you wanted to say needed a context. If
  you said the whole idea, people thought you were
  a logorrhoeic imbecile if you were silent,
  people thought you were an obscure weak-minded.
  The venerable old man needs to be interpreted no
  less than the youngest. When the venerable old
  man looses his friends and his mates, he also
  looses his interpreters he looses his true
  affections and also the whole word ability.
• (J.Barnes, Guardando il sole, Milano 1989,
  pag.189)

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• Old people are not only in retirement Residences,
  old people are not only in long-term hospitals.
  These disabled people, in their lives, have
  already suffered from the insult of many
  psychological and physical trauma often
  experiencing loneliness, abandonment and
  indifference.

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• There are also many old people who have not
  renounced to be marginalized by society when
  their health maintains active capabilities and
  abilities and when human relations are good.
• This group of old people live in society and,
  being ever more and more, they desire to maintain
  a high level of decisional power and to be more
  participating in social life.

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• Do our cities help old people to make them
  visible and active ? We could say that the first
  condition for an active citizenship is always
  moving and getting visible. But living means not
  only being in a house or in a building or in a
  city. It also means sharing life with other
  people, other generations, other cultures, other
  traditions and stories. This is the turning point
  of the intergenerational dialogue-conflict, made
  wider by modern communication technologies.

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• Considering the Italian situation, as reported by
  the ISTAT data, the major Central Statistics
  Office, we must notice that the old age index,
  that is the relation between the old population
  over 65 and that under 15, from 1st January 2007,
  is estimated to be 141.5, constantly rising
  compared to the previous years 139.9 in 2006,
  137,8 in 2005 and 135.9 in 2004.

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• Examining the international data from the 1st
  January 2005, the last available year to make a
  comparison, Italy results as the European nation
  with the highest ageing rate, equal to 137.8.

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• Anyway, the other European nations, that exceed
  the threshold 100 (Germany, Bulgaria, Greece,
  Spain, Latvia, Portugal, Slovenia ed Estonia)
  have a lower value rate, that never reaches 130
  elderly for 100 young people up to 14 years.
  This ratio has been exceeded by Italy for five
  years.

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• What can be admitted is that, truly, the average
  life rate is increasing as a consequence of the
  ranger of death reduction at every age (males
  from 77.2 in 2003 to 77.9 in 2004 females from
  82.8 in 2003 to 83.7 in 2004).

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Changes in life expectancy at birth and 60 years
in Italy
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Percentage of subjects gt 65 years of age in Europe
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Elderly Population (65 years and more)
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Education - Age
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Number of households by number of components -
Censuses 1961-2001
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Elderly Type of family in the total population -
Italy
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• What is also true is that, in the light of old
  people clinical conditions, highly improved in
  these years, an inevitable sick rate and
  disability increase has been clearly recorded,
  particularly in the serious forms.

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Elderly and disabled patients by type and age
group
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People suffering from at least one chronic
disease. Gender and age group
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• These data give many hints for reflecting and
  also requires serious intervention in order to
  obtain a true achievement of health and wellness
  of people.
• What must be done ? How moving before the need
  for answers to all those important questions ?

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• Have grandparents
• 98,2 of whom have less than 15 years
• (average 3,1)
• 87,2 of whom have among 15-24 years
• Among grandparents
• 85,6 with grandchildren not living together
  have care of them sometimes Only 14,4 never
• 24,4 often, when parents are working,
• 15,7 in emergency,
• 11,8 when parents go out,
• 9,3 with sick grandchildren,
• 8,9 on holiday
• Grandmothers are more envolved to be 87 to
  83,7

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• The fragile old person

Advanced Growing old
Risk or presence of disabilities
Heavy Comorbility
FRAGILITY
Complex Poli-medicine-therapy
Knowledge damage
Critical social-environment situation
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• Dynamics of disability
• To change the elderly age towards to higher age
• In advanced age there is a prevalence in the
  share of people with disabilities because of
  whole yielding.

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• Among the possible answers there are also
  residential services.
• Users who need retirement residences have
  remarkably changed in these years. Nowadays the
  60-70 among the people who live there is
  suffering from knowledge confusion. Moreover
  dementia is a highly invalidating pathology.

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• Prevalence of dementia, by age group

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• Taking care of elderly, including those demented,
  is subordinated to the evaluation of a number of
  elements age, clinical aspects, concomitant
  pathologies, socio-economic environmental and
  familiar situation, medical care quality and
  National Sanitary Service System efficacy, as
  well as a possible necessity of a correct
  therapeutic intervention.

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• In contrast, we have less family support
• Family Crisis
• There are fewer children
• Increased employment of women
• The children will work longer

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• The Badanti Army (homeworks assistant)
• In Italy they are two milliondo we need more ?
• Foreigner, one to two have a black work, they
  come from
• Ex URSS Nations 29,3 East Europe 31,00 Asia
  15,9 Central and South America 14,5 Africa
  9,4.
• Age 18-30 years, 19 31-40 years, 38,1 41-50
  years, 27,7 over 50 years, 15.
• Irregular 851.000 Requests of regulation
  presented 403.500 Members of INPS 745.500.

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• The necessity to take care of needing people,
  particularly of old people, suffering from
  dementia, who have behavioural diseases, should
  have a positive answer also for their families
  asking for relief
• For this reason, then, we all feel the need to
  have to and to be able to take care of ourselves
  thinking about one person in all his/her
  totality.

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• Organization Model guarantee for Continued
  Support
• Punto Unico di Accesso (PUA) ai Servizi - Sole
  Point of Admitance to Services)
• Unità di Valutazione Multiprofessionale (UVM)
  -Multiprofessional Evaluation Unit
• Progetto Assistenziale Personalizzato (PAP) -
  Assistence Personalized Plan
• Rete dei Servizi Socio sanitari - Net of Social
  and Care Services
• ( all the possible responses care, and
  provides for flexibility and circularity)

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• The efficacy of the Multidisciplinary
  intervention to the old person

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• The objective, therefore, is on one hand health
  promotion through health education activities in
  order to prevent from those services like house
  assistance on the other hand what must be
  offered is true residential answers more an more
  able to offer solutions to the various needs of
  all those different people (from the temporary
  relief stay to the rehabilitative one from the
  residential stay for non self-sufficient people
  to that for mental disabled from parahospital
  hospice for terminal patients to Alzheimer's
  disease centres ).

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SOCIAL SERVICES
SEGNALAZIONE (Hospital- Territory)
Simple case social/sanitary
Only Point of Access
SANITARY SERVICES
Fragile healt with scompense
CONTINUITY
UVM COMPREHENSION OF
COMPLEX NEED (multi-dimensional instruments of
evaluation ) Personalized Plan of
assistance (Characterization responsable of the
care processes) Management of the assistencial
way
Casustry Hospital Dismissions hard/case
programmed Aggravamento conditions of health of
person at the domicile assistence
Sel-sufficient person with high risk of loss of
the self sufficient status (BRITTLE)
ACTIVE SURVEILLANCE
INTERMEDIATE STRUCTURES
ASSIST DOMIC.
FREE WAY OF INTERVENT
Not self-sufficient person permanent
RSA (Base or Special form).
RIABIL. INTENSIVE
CIRCULANCE
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Not self-sufficient person permanent
Run of Healt services Trust fund for not
self-sufficient
with SPECIALISED COMPETENCE
UVM PROCEDURES VALUTATIVES MULTIDIMENSIONALS
Area SOCIAL and ENVIRONMENTAL
Area KNOWLEGED-EMOT.BEHAVIOUR
Area CLINICAL and FUNCTIONAL
Direct domicyle assistance Domic. Assist.
Indirect/integrative Frequence Day-Centre Temporar
y hospitalize RSA
PROJECT-ASSISTENCE INDIVIDUALIZED (PAI)

• Base Form
• Temp/permanent
• Specialist Form
• (temporary)

DOMICILES
RESIDENCE
MEDICAL ASSISTANCE NURSARY ASSISTANCE
LEA REHABILITATION ASSISTANCE
PERSON ASSISTANCE ISO-RESOURCES PACKET
SETTLEMENT QUALITATIVE (Answer tiplogy) QUANTITATI
VE (quantity resources)
ISEE EVALUATION AND PARTICIPATION DEFINITION
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ELDERLY
Area of bed
Day service
Day Hospital
UVM Medical of District MMG Hospital
attendant Social Worker VMD?PAI
DISTRICT
Structures of rehabilitation
DOMICILE (ADI)
Intermediatesstructures
RSA Base, nucleus specialistics
Social Residence
Day-centre
Out-patients department
REHABILITATIVE TENSION
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• MULTIDISCIPLIARY TEAM MODEL
• because a multidisciplinary team could be
  efficacious all the members must accept that
  nobody have all answers to all questions,
  considering in someway that each one depend from
  the culture and competence from the others all
  that one can deduce from the ensemble is bigger
  than the simply addition of interested parties
• Workshop on the multidisciplinary Assessment
  of the Elderly, Goteborg, 1987

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• Role and function of a Centre of Services
• Residential Home care Institution for the Elderly
  are transforming into Centres of Services to the
  old person.
• From Custody, to residential facilities, until
  the territorial net of services to the old person
  able to manage as well domiciliary services
  referenced to process of attendance in elderly
  favour.

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• To an architecture of domiciliarity
• A good home, a good life...
• Therapy of beauty and of giving sense...
• What is of the town must be enjoy from the
  town...
• ...Does it impossible that an elderly society
  couldnt take care and charge of the Elderly
  ???!!!???

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• Economic question about the fund for elderly
  dependent
• Italy provided recently to appoint a found for
  elderly dependent, but assigning less resources
  as to national demand.
• A special attention come from Italian regions ,
  with an interesting experience as in Alto Adige
  region
• It is necessary to think about some integrative
  assurance or to one tax to the purpose.

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• This is a great engagement, an ethical solidary
  social imperative from which nobody can escape
  and in favour of which everybody has to promote
  adequate economic resources able to give support
  to all those citizens who need residential
  services.