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0UDC 61.316.7 IRSTI 00.11
MEDICAL AND SOCIAL SERVICES FOR THE ELDERLY IN ALMATY Sydykova G.J.1, *Ashirbekov G.K.2, Baltaeva A.U.3, Omaraliev M.I.4, Shegebaev M.A4.
1KGP on PVC City polyclinic No. 28, Almaty, Kazakhstan;
2Higher School of Public Health, Almaty, Kazakhstan; 3Kazakh National Medical University named after S.D. Asfendiyarov, Almaty, Kazakhstan; international Kazakh-Turkish University named after H.A. Yasawi, Turkestan, Kazakhstan
Summary
Medical and social services and provision of elderly people with cognitive impairment, in Almaty, and in the Republic of Kazakhstan are not at the highest level. Despite government regulations and orders from the ministries of health and social protection, these persons do not receive full assistance and care from the state.
In this article, we conducted a review and research work for possible improvement of elderly people who suffer from cognitive impairment of varying degrees. We also drew a parallel between the work of our foreign colleagues and our capabilities, based on international experience, as with some European countries, the Russian Federation, the United States and Japan on this issue. Have tried to substantiate this issue at the hospital-replacing technologies.
Key words: cognitive impairment; elderly age; outpatient and inpatient conditions; social services; inpatient technologies; systematic review.
Introduction. The main activities of the Government of the Republic of Kazakhstan for the period up to 2020 and the Concept of long-term socio-economic development of the Republic of Kazakhstan until 2030 identified priority socio-economic objectives for the short, medium and long-term prospects, including in the field of social policy.
Social policy as a system consists of relatively independent, interrelated parts, which are its structural elements.
One of such elements is social service which unites activity of social services on social support, rendering social and household, social and medical, social and psychological, social and pedagogical, social and legal services and material assistance in carrying out social adaptation and rehabilitation of the elderly people who are on the verge of a difficult life situation. The
main categories of which include those in need of medical and social security are the disabled and the elderly.
Therefore, one of the natural consequences of aging and disability of the population as a socio-demographic process is the growing need for social services, the need to develop the social service system, the search for resources and sources to ensure the effective operation of this sphere, new technologies and forms of work.
However, the expansion of the network of inpatient facilities may not be the only way to address the problems of the elderly.
The analysis of the state of activity in the direction of persons to stationary social services showed that often practiced in the territories scheme of work, both in the Russian Federation and in the Republic of Kazakhstan had a number of significant drawbacks: there were facts of subjective distortion of the situation when assessing the presence of indications for stationary social services [1-6].
For example, interpersonal psychological conflicts and property contradictions in the family, the inconvenience of the technical condition of the premises, the loss or weakening of social ties, moderate deviations in behavior, creating discomfort for others, often led to the direction of these persons in stationary institutions. While this type of social service, according to the law, can be provided "to citizens, partially or completely lost the ability to self-service and in need of constant outside care." That is, there is a deliberate substitution of grounds for the implementation of social services. Instead of resolving a difficult life situation essentially, it is simply "removed from the service area" along with the patient referred to the hospital.
When determining the need for inpatient social services, it is not always possible to trace the focus on the result as a comprehensive rehabilitation effect of social services, the issues of sufficiency or redundancy of the assistance provided, the effective use of available resources of the social protection system are not sufficiently studied.
In each case, we must be clear - any kind of social service is a tool of social rehabilitation of the client, that is, a means of resolving a difficult life situation. The only purpose of its application is to create a comprehensive positive dynamics in the patient's condition, including the restoration and maintenance of his legal, property, psychological status, compensation for the inability to self-service, the inclusion of opportunities to overcome difficult life situations on their own, by involving it in various forms of non-stationary social services.
The placement of a patient who does not need constant external care, or who has the opportunity to receive the necessary care at the place of residence (from close relatives and social services) in a hospital, often leads to a negative rehabilitation effect - a person quickly loses the desire and ability to self-service, especially to treat people with mild or moderate
dementia, they finally lose useful social skills and connections, not being in demand in society, psychologically and intellectually fades as a person.
Inpatient social services should be considered as the last resort in the process of rehabilitation and social care of the patient. For providing elderly people with the maximum possible Autonomous life expectancy in the usual conditions, it is necessary to actively introduce hospital-replacing technologies with the active introduction of innovative forms of social services [7-12].
One of the key tasks of improving social services at the present stage is to create a more powerful direction for the provision of social services at home to elderly and disabled people.
As part of the introduction of innovative forms of social services in our work the following areas are most relevant:
- introduction of precinct social service in establishments of non-stationary social service of the population;
- application of the brigade method of social service at home;
- implementation of the work of mobile teams in emergency social services;
- organization of social services as a process of social rehabilitation;
- implementation of social rehabilitation cards;
- attracting volunteer help;
- implementation of "social contracts»;
- development of public-private partnerships;
- introduction of modern innovative forms of prevention of family problems;
- creation of a network of "social polyclinics" in social service institutions for families and children;
- development of alternative forms of family education.
As mentioned above, it is the elderly who form a stable demand for social services of a diverse nature. In the future, this demand will increase.
In the structure of their most popular will be resource-intensive services for permanent external care in inpatient facilities and at home, including social and medical services, services of nurses, lifelong social patronage for the elderly, the need to ensure the safety of patients and equipment of social institutions [13-16].
Purpose of work. Development of ways to improve the organization of social and rehabilitation work with the elderly in Almaty.
The objectives of the study is to study the medical and social condition of elderly people with cognitive impairment in the world practice and with the available foreign experience to create an algorithm of stationary technologies with the conditions of the city of Almaty.
Materials and methods of research.
The collected review material on literary data and according to resolutions, orders of the ministries of health and social protection of the Republic of Kazakhstan, as well as regulatory documents of the Russian Federation, as the nearest neighbor and having much in common in the legislation. It was decided to theoretically improve the medical and social situation of elderly people with cognitive impairment of varying degrees in the world experience.
Research result.
For example, for thirty-seven years, since 1982, Sweden has a law "On social security of elderly people". An important part of it is the article entitled "Right to assistance", and it is not only financial benefits [17-19].
According to the law, "the social Affairs Committee is obliged to ensure that persons of advanced age can lead an active existence. Housing, equipped with all amenities, specially adapted means of transport, family assistance - these are just some of the measures."
Every Swedish citizen has the right to an old-age pension, regardless of his or her income and whether he or she has participated in working life. This is the basic national pension. It is supplemented by an additional pension calculated in proportion to professional income.
The Commission on social Affairs ensures that pensioners have good housing conditions: housing should be comfortable, close to social services. Therefore, elderly people are provided with:
- subsidy for housing;
- conventional or specially adapted housing;
- housing with a high level of comfort for the seriously disabled;
- boarding houses for people with particularly serious health conditions.
Elderly people are provided with assistance in housekeeping (cooking, cleaning, washing, etc.). Assistance to pensioners also includes transport services so that older persons can keep in touch with each other. What is not said about the city of Almaty, where a pensioner has to get through their retirement savings obtained in sobuse.
Health care is funded by fees charged by County councils, supplemented by various government grants and universal insurance. Care in public hospitals is free. Some fees apply for consultations outside the hospital.
The responsibility for the formulation of national health policies rests with Parliament and the government.
British governmental policy in relation to senior citizens and persons with disabilities focused on creating a favourable environment for them to live at home. The network of residential institutions is underdeveloped, so the main issues are solved at home.
The organization of social services is entrusted to local governments. Older persons are assisted by both full-time employees and numerous volunteers from various social, religious, charitable, youth and other organizations. The whole system is coordinated nationwide by the state Committee for social services for the elderly.
The difficulties in the management of the household is facilitated by visits of the employees of "home care", they will help in the wash, will deliver meals at home. The district nurses come to help the old man take a bath, give injections, dressings. And the British pensioners visit the so-called day centers. In these centers there are clubs, workshops, tea clubs, gyms. Also in the centers there are medical staff and teachers who help British grandparents to get additional education.
There are in Britain and boarding houses, but they are, as in Russia, designed for old people who have no relatives. They look like this: a group of small houses with a veranda, where pensioners live permanently. There lives the caretaker - he, if necessary, provides assistance to the elderly. In Almaty, there is a dedicated building, with a convenient yard, with all facilities, but there can live a person who can take care of themselves.
In addition, there are about 200 specialized hospitals in the country, which provide preventive, medical and domestic assistance to the elderly.
In Germany, traditionally an important role in social services for the elderly and persons with disabilities play a voluntary Association, in the first place, Church charitable unions and the German Red Cross. However, in modern conditions, part of their functions are forced to take over the state. Day centres and various clubs for the elderly have become widespread in the country. A few decades ago, social departments began to be created to provide social and medical assistance to the elderly at home and include services for assistance in economic Affairs, care for the sick.
In Almaty, specialized buildings have all the amenities for cultural pastime - their libraries, film libraries, games rooms, and on national holidays held small receptions. But visiting theaters and concerts funding is not provided, persons with mild and moderate cognitive impairment do not conduct additional classes due to the lack of additional service personnel -not provided by the States.
In the United States, as in England, there is a clear trend of creating conditions for the elderly to live at home.
In the country there are many different funds that provide payment for medical care, the provision of cheap housing, food, transport services. The social system of family allowances for home care for the elderly is becoming more and more widespread.
Social servants for a lot of seniors. This is home delivery of Lunches, bathing, change of linen, pedicure, haircut, hair styling, washing, cleaning things, providing vehicles, therapeutic exercises. Also it is repair and improvement of apartments, the organization of leisure and entertainment.
In addition to the usual day care centers for the elderly, the United States is rapidly developing a network of special paid centers, Where wealthy elderly people use diet, receive physiotherapy, gymnastics, occupational therapy, their services speech therapist. Excursions, dances, sparing sports games, conversations or disputes on various subjects with involvement of doctors, including psychiatrists and even sexopathologists are organized for them. There is a beauty salon. Note that the stay in such centres is significantly cheaper than residential care [2022].
In Almaty, elderly people with cognitive impairment, at home are left to themselves, as the law does not provide for a separate article their treatment in hospital. Such patients are mainly a burden on their relatives and friends.
In Japan, as one of the highly industrialized countries, life expectancy has increased since the second world war to 74.3 years for men and 79.8 years for women. Older people make up more than 20% of the population.
Various health services for persons over 40 years of age operate at the local level. They include:
- introduction of the medical book;
- health education;
- medical Council;
- health check-up: General and special;
- retraining.
Health care for persons aged 65-70 years and 70 years and older is provided by local government authorities and insurance schemes.
Aging of the population requires changes in the organization of not only medical care, but also in the field of pensions, various social actions, housing, etc. the New policy in the field of social services provides for the rapid development of a network of intermediate (between home and hospital) medical and social institutions for the elderly [23, 24].
Today, in the structure of the social protection system of the population in the city of Almaty are functioning:
- 9 institutions, of which 6 are in-patient institutions, 5 are social service institutions for families and children and 3 are non-stationary social service institutions for the elderly and disabled.
In 2018, the number of services provided to the population by social service institutions increased by 8% - 73 thousand services. State tasks have been developed for each institution, allowing not only to optimize the cost of providing a particular service, but also to improve the quality of its provision, the level of remuneration of employees. The timing of working time of social workers in order to identify the most optimal methods of work and determine the appropriate standards of working time. As a result, changes were made to the standards of service to persons in need, i.e. the restrictive bar on the number of serviced has been removed, which made it possible to virtually eliminate the priority for home social services (29 man, and is in the main current, for the period of the survey of social and living conditions, collection of documents and execution of contracts).
At the same time, unproductive expenses were reduced and the quality of public services increased by optimizing the existing network of social service institutions - in 2018, in order to improve the efficiency of public administration, as well as the quality and expansion of the range of services provided to the population, 2 institutions were reorganized through consolidation.
It is also established that when choosing the type of hospital-replacing technology, district doctors took into account the reduced mobility of patients, and under the same medical conditions, their choice was influenced by the remoteness of the patient's place of residence from the medical institution. Thus, in remote areas among all hospitalized patients such technology prevailed as a hospital at home (64.8%), and in the nearby - day hospital (35.2%).
With the increase in the age of patients, the difference in the choice of treatment became more significant (81.1% and 18.9%, respectively), which was associated with a violation of patient mobility and a decrease in the ability to visit the clinic during the deterioration of the condition. In assessing the value of the independent activity index in patients from the day hospital, the low level was observed in 2.1% of men and 1.1% of women, the average - in 89.1% of men and 88.5% of women, high - in 8.8% of men and 10.4% of women. In the group of patients from the hospital at home, the low level of independent activity index was observed in 51.1% of men and 59.1% of women, the average - in 47.8% of men and 39.7% of women, high -in 1.1% of men and 1.2% of women.
The social effect of medical care implies patient satisfaction with the care provided. It was found that 85.7% of elderly patients previously referred to the day hospital preferred to be treated in it in the future.
Hospital-replacing technologies have been actively developing in Almaty in recent years, due to the need of patients for new forms of medical services, on the other - the need to effectively spend financial and other resources of health care institutions.
At the opening of day hospitals, the age structure of the population attached to the medical institution, the structure of diseases and the availability of different types of stationary medical care for residents of the territory were studied in detail. An important factor was the material and technical base of the institution, on the basis of which day hospitals were created [25].
The main purpose of the establishment of day hospitals was to carry out therapeutic and diagnostic measures, as well as preventive and rehabilitation measures for the elderly with mild and moderate cognitive impairment, which are not shown round the clock medical care.
Day hospital is in demand for the elderly with mild and moderate cognitive impairment:
- which, after treatment and diagnostic measures, short-term observation by health workers is shown;
- who need to be monitored after infusions of drugs;
- who are assigned certain procedures followed by a short rest;
- if the patient needs complex medical procedures and if it requires prior preparation;
- if emergency care was needed during the stay in the clinic;
- if the patient needs to be treated after hospitalization;
- if to address questions to ITU the patient requires additional testing;
- if the patient is in need of special rehabilitation procedures;
- if the patient has to stay in the day hospital for social reasons.
Also, such hospital-replacing technologies as various day hospitals had a number of contraindications for elderly people with cognitive impairment:
- round-the-clock supervision in medical institution of persons in a serious somatic condition;
- persons limited to self-care and movement;
- persons who need round-the-clock administration of drugs;
- if the patient must follow a special diet, possible only at home.
Existing types of stationary substituting technologies:
In Almaty, there are several options for the organization of day hospitals, for example, on the basis of a hospital or clinic. Thus, this form is an intermediate between the assistance provided in outpatient and inpatient settings, and has its undeniable advantages. The main of them - the elderly are observed regularly, receives the necessary treatment, but are most of the time in a familiar place.
In this regard, we note the positive aspects of stationary replacement technologies:
- carrying out in medical institution of treatment and rehabilitation actions which are directed on improvement of a state of health of these patients;
- active treatment of somatic diseases in hospitals, if there is no possibility for hospitalization;
- adaptation and treatment of patients after hospital according to indications;
- carrying out complex diagnostic studies that require special training and supervision by health workers;
- reduction of the period of temporary disability of patients;
- preventive measures with persons with cognitive impairment who are registered at the dispensary and often suffer from long-term illness;
- temporary placement in a day hospital, which became ill during his stay in the clinic.
In all countries, the elderly have devoted their lives to the service of the state and society. They have the right to expect that the society will pay them with gratitude [26].
Discussion of results.
Theoretically developed model in improving the organization of outpatient care for the elderly suffering from cognitive impairment on the basis of foreign standards - "on social assistance to the needy". You can apply in our Republic of Kazakhstan, in particular in Almaty. Of course, every elderly person has a pension contribution, but the organization of social assistance and treatment is increasing every year, the price of service is growing. And here it is necessary to help in the form of an initial contribution from the city akimat, public and religious organizations and self-sacrifice of citizens. Given the fact that sooner or later in this situation may be any of us, your family or friends. Given positive foreign experience as not by the way is necessary today.
The materials of the study will be used in the activities of health authorities, medical organizations, as well as for the training of health professionals, including in the field of public health and health, improving their skills.
The main trends and factors influencing the development of market relations in medical services in Almaty are studied.
The solution to these problems will give the opportunity of the need for the formation of the organizational-methodical approaches ensuring the quality of socio-medical services to elderly persons suffering from cognitive disorders.
The study of the issues of medical and economic standards as a tool for assessing the volume and quality of social and medical care provided under the program of guaranteed compulsory free medical care will help to solve the problems in the rehabilitation of elderly people with cognitive impairment. With justification of application of concrete economic methods of management of resource ensuring quality of social and medical services in the conditions of realization in the city of Almaty.
These theoretical and methodological basis of the study were the works of domestic and foreign scientists in the field of stationary substituting technologies, regulating mainly the branches of the social sphere.
Data of the national state statistics service, as well as statistical data of the health system of the Republic of Kazakhstan were used as an information base.
Conclusions:
1. In the world practice, the medical and social attitude to the elderly suffering from cognitive impairment in comparison to domestic patients in Almaty was studied;
2. The algorithm of stationary substituting technologies in examination and treatment in the conditions of day hospital of persons suffering from cognitive impairment in the city of Almaty is Made.
МЕДИЦИНСКИЕ И СОЦИАЛЬНЫЕ СЛУЖБЫ ДЛЯ ПОЖИЛЫХ ЛЮДЕЙ В
АЛМАТЫ
Сыдыкова Г.Ж.1, *Аширбеков Г.К.2, Балтаева А.У.3, Омаралиев М.И.4, Шегебаев М.А4.
1КГП на ПХВ Городская поликлиника № 28, Алматы, Казахстан;
2Высшая школа общественного здравоохранения, Алматы, Казахстан;
3Казахский национальный медицинский университет имени С.Д. Асфендиярова,
Алматы, Казахстан;
^Международный казахско-турецкий университет имени Х.А. Ясави, Туркестан,
Казахстан
Аннотация
Медико-социальное обслуживание и обеспечение пожилых людей с когнитивными нарушениями, в городе Алматы, да и в Республике Казахстан находятся не на высшем уровне. Несмотря на правительственные постановления и приказы министерств здравоохранения и социальной защиты, данные лица не находят в полной мере помощи и заботу со стороны государства.
В данной статье мы провели обзорно-исследовательскую работу для возможного улучшения лицам пожилого возраста, которые страдают когнитивными нарушениями различной степени. Также провели параллель работы зарубежных коллег с нашими возможностями, основываясь на мировой опыт, как с некоторыми Европейскими
странами, Российской Федерацией, США и Японией по этому вопросу. Постарались научно обосновать эту проблему по стационарозамещающим технологиям.
Ключевые слова: когнитивные нарушения; пожилой возраст; амбулаторно-стационарные условия; социальное обслуживание; стационарнозамещающие технологии; систематический обзор.
АЛМАТЫДА ЦАРТ АДАМДАРГА АРНАЛГАН МЕДИЦИНАЛЬЩ ЖЭНЕ ЭЛЕУМЕТТ1К
ЦЫЗМЕТТЕР
CMAMKOBa Г.Ж.1, *Аширбеков Г.К.2, Балтаева А.У.3, Омаралиев М.И.4, Шегебаев М.А4.
1ШЖ^ КМК № 28 калалык емхана, Алматы, ^азакстан; ^огамдык денсаулык сактау жогары мектебi, Алматы, ^азакстан;
3С. Д. Асфендияров атындагы ^азак улттык медицина университет^ Алматы, ^азакстан;
4Х. А. Ясауи атындагы Хальщаральщ казак-тYрiк университет^ ТYркiстан, ^азакстан
Туй1ндеме
Алматы каласында жэне ^азакстан Республикасында когнитивтi кемютш бар карттарга медициналык-элеуметпк кызмет керсету жэне оларды камтамасыз ету жогары децгейде емес. Денсаулык сактау жэне элеуметпк коргау министрлштершщ Yкiметтiк каулылары мен буйрыктарына карамастан, бул адамдар мемлекет тарапынан толык кемек пен камкорлык таба алмайды.
Бул макалада бiз эртYрлi дэрежедегi когнитивт бузылулардан зардап шегетiн егде жастагы адамдарды жаксарту Yшiн шолу жэне зерттеу жумыстарын жYргiздiк. Сондай-ак, кейбiр Еуропа елдерi, Ресей Федерациясы, А^Ш жэне Жапония сиякты элемдiк тэж1рибеге CYЙене отырып, шетелдiк эрiптестерiмiздiц бiздiц мYмкiндiктерiмiзбен параллель жумыс жасады. Бiз бул мэселенi стационарды алмастыратын технологиялар бойынша гылыми негiздеуге тырыстык.
TyrnHdi свздер: когнитивт1 бузылулар; егде жас; амбулаториялык-стационарлык жагдайлар; элеуметтiк кызмет керсету; стационарды алмастыратын технологиялар; жYЙелi шолу.
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Conflict of interest. The author declares that there is no potential conflict of interest requiring disclosure in this article.
The contribution of the authors. The author contributed to the development of the concept, the execution and processing of the results, and the writing of the article. We declare that this material has not been previously published and is not under consideration by other publishers.
Financing. Absent.
Information about the authors
Corresponding author. Sydykova Gulnara Zharylkasynovna — KGP on PVC City polyclinic No. 28, Almaty, Kazakhstan, E-mail: ergali- 1970@mail.ru. ORCID https://orcid.org/0000-0001-2345-6789
Ashirbekov Gamal Karimovich - Doctor of Medical Sciences LPP Kazakhstan's Medical University «KSPH», Almaty, Kazakhstan, E-mail: ashirbekovgamal@gmail.com, ORCID https://orcid.org/0000-0002-5202-2311
Baltayeva Alma Urangalievna - candidate of Medical Sciences, Associate Professor of the Department of Clinical Pharmacology Kazakh National Medical University named after S.D. Asfendiyarov, Almaty, Kazakhstan, E-mail: baltaeva.alma@yanex.ru, ORCID https://orcid.org/0000-0003-1424-878X
Omaraliev Mustafa Israilovich — Candidate of Medical Sciences, Associate Professor of the Department of Human Morphology and Physiology, H.A. Yassawi International Kazakh-Turkish University, Turkistan, Kazakhstan, E-mail: mustaha.omaraliev@,ayu.edu.kz. ORCID https://orcid.org/0000-0002-2693-013X
Shegebaev Murat Asylbekovich — Master of Natural Sciences, Senior Lecturer at the Department of Human Morphology and Physiology, H.A. Yassawi International Kazakh-Turkish University, Turkistan, Kazakhstan, E-mail: murat.she gebaev@ayu.edu.kz, ORCID https://orcid.org/0009-0003-3654-7438
Article submitted: 01.04.2024
Accepted for publication: 20.04.2024
