| Abstract|| |
Background: The demographic aging becomes a state problem for the majority countries, Kazakhstan is no exception: sharply increased the number of elderly and senile age people, which led to a number of problems caused by the aging of society, in connection with which the relevant improvement of medical and social assistance of elderly persons based on the study needs in the medical, social and psychological assistance. Methods: In the period from May 2016 for July 2016 was carried out complex research of the needs in the medical, social and psychological assistance to elderly persons in Almaty based on a specially designed questionnaire. The objects of this study are chosen by representatives of various socio-demographic groups (60 years and older), served in the clinics of the city. In total were interviewed 2996 elderly respondents, aged 60 years and older. Results: As an object of research are determined: Respondents' assessment of their health, financial situation, satisfaction with living conditions, some lifestyle factors, questions of life quality, needs in medical and social assistance. Conclusion: The analysis results of the study confirmed the urgency of activating the provision of medical and social assistance of elderly persons as well as low attendance of employees of social service of the elderly population, require regular monitoring of the activities of local governments and institutions, as well as officials for ensuring the rights of older disabled persons in the area of social services.
Keywords: Elderly persons, medical and social assistance, quality of life
|How to cite this article:|
Igissenova AI, Tyrdalieva BS, Nysanova BZ, Shayakhmetova MM, Utepbergenova ZM, Shakiyev SS, Ibadullayeva GS. Some aspects of the providing of medical and social assistance of elderly persons in the Republic of Kazakhstan. Ann Trop Med Public Health 2017;10:1221-7
|How to cite this URL:|
Igissenova AI, Tyrdalieva BS, Nysanova BZ, Shayakhmetova MM, Utepbergenova ZM, Shakiyev SS, Ibadullayeva GS. Some aspects of the providing of medical and social assistance of elderly persons in the Republic of Kazakhstan. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Dec 15];10:1221-7. Available from: http://www.atmph.org/text.asp?2017/10/5/1221/217501
| Introduction|| |
The objectives of extension of active longevity, reducing costs for health care of elderly persons, on increasing their employability, and security in old age are also standing in front of the Kazakhstan society.
Growth in the number of elderly age leads to further demographic aging to increase demographic burden, and this makes it necessary to review the basics organization and financing of existing health and social services.
Providing medical and social care of elderly persons is a major challenge today for all civilized societies, including Kazakhstan.,,,,, The leading public policy areas for elderly persons in Kazakhstan are the development of the pension system; improving health care, expanding the range, volume, and improve the quality of social and rehabilitation services, to create conditions and mechanisms for the effective use of social and employment potential of elderly persons.
Social and political activity of elderly citizens legislatively is not restricted. Elderly persons joining the ranks of the different political parties organize their political movements and associations, participate in social activities of social and cultural orientation, and are actively involved in educational and training programs and patriotic upbringing of the younger generation.
The situation of elderly persons in Kazakhstan is a special sphere of attention of state structures and the head of state. Kazakhstan entered a phase of aging, with the proportion of the population aged ≥60 years in the total population has reached 10.5% in 2015 compared with 9.2% in 1989, while the share of 65 years and older increased from 5.6% (1989) to 6.8% to date (01.01.2015). In the structure of population by sex is still the proportion of women, 54.3% (Almaty) and 51.7% (Republic) remain higher than men (45.7% and 48.3%). “Overweight” proportion of women over men share is largely attributed to differences in age-specific mortality rates and lower life expectancy almost from all-cause mortality of the male population. The proportion of men with age and reduced the age of 80 becomes three times less than similar women's group.
The main mechanism for ensuring revenue guarantees elderly people is the state pension provision. A set of social services include provision of medicines prescribed by doctors, provision sanatoria and health resorts vouchers, and free use of the individual types of transport. Nowadays, gerontological service in the Republic of Kazakhstan is represented by a network of institutions with different functional orientation and specialization, providing medical and social assistance to elderly patients at home, leading, and outpatient care in hospitals. At the same time, uneven territorial distribution of institutions and do not always correspond to the actual needs of the region. Many single pensioners were living in nursing homes. These social homes are designed for permanent residence of citizens of retirement age as well as couples among retain full or partial capacity for self-care at home. Special house is designed to provide favorable living conditions for people of retirement age, to provide living elderly persons' social welfare and medical assistance, the creation of conditions for an active lifestyle, including work feasible.
Although according to the Order of the Ministry of Health of the Republic of Kazakhstan dated March 16, 2009 no 134, social worker must have higher professional education in social work, medical, psychological, or pedagogical profile, and minimum staffing standards for personnel in organizations of home-based care, one social worker should provide special social services 8 elderly and disabled at least for 2 times a week, which also includes services to assist in housekeeping, the elderly deprived of other social assistance., For successful solution, a variety of practical problems to meet the specific physical and spiritual needs of people of old age require significant strengthening of special training for health and social workers, to ensure these needs. Significant place in the medical and social services for this population should take patronage work, the creation of groups of charity, and raising the qualification level of the personnel.
Marked reduction of the functional state of the elderly person body makes their position more dependent from society. At the same time, it becomes essential medical and social work as a kind of social work, aimed at protecting and supporting physical and mental health, and especially of elderly persons, and on the other, it is an activity aimed at achieving “social welfare” and a significant improvement in their quality of life.,,,,,,,,,,,,,,,
At the same time, medical and social services for elderly persons, especially long-term care services provided to elderly people at home, require further development; the use of new social models includes proven experience of other countries. Are relevant issues of introduction of technologies of social and sociomedical services, implementation issues in the world and Kazakhstan International Madrid Plan of Action on Ageing.
| Methods|| |
To achieve the goal and solutions, modern methods of studies related with these tasks were used:
- Sociologically conducting questionnaires of elderly persons seeking medical care in ambulatory polyclinic organizations in the city
- Information and analytical analysis of the legislative and normative documents, reporting and ongoing documents of modern scientific bibliographic sources
The material of the study was policy and regulatory instruments in the field of public health, statistical compilations Ministry of Health, the National Agency of the Republic of Kazakhstan materials on statistics, and questionnaires (2996) survey of elderly persons. To study the various aspects of needs of elderly people in health and social care in the period from May 2016 to July 2016, we carried out a comprehensive study of the needs in the medical, social, and psychological assistance to elderly persons in Almaty on the basis of a specially designed questionnaire.
| Results|| |
In a study exploring the need for medical, social, and psychological care of elderly and older age of Almaty, 2996 people were participated in the study. Distribution of respondents by gender revealed a predominance of three-fifths (58.9%) of the female over two-fifths (41.1%) of the male. The obtained data of the survey show the predominance of the age group 60–74 years - two-thirds of respondents (75%), 75–89 years - one in four (24%), 90 and older - only 1% of respondents. Investigation of the question of obtaining assistance in housekeeping by other persons is shown in [Figure 1].
|Figure 1: Distribution of respondents by answering the question “Who helps you in charge of the household?”|
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According to the survey, large number of respondents received assistance in housekeeping from relatives (81%), friends help (6%), and about 1% of the neighbors. At the same time, 1 in 9 (11.2%) is engaged in self-housekeeping, and social services provide assistance only in 0.7% of cases. A high percentage of respondents receiving support from family show a significant influence generations of mutual assistance traditions we have in Kazakhstan. At the same time, there is the almost complete lack of assistance from the social services of the city on both objects of research.
Lonely about 30% in the age group 60–74 years old, 75–89 years old, and about 23% at age 90 or more, thus, though insignificant, the proportion of living alone decreases with increasing age [Table 1]. Most live in the family, which supports a large family tradition in Kazakhstan. At the same time, one-third of elderly persons living alone represent a considerable proportion of persons in need of attention from the medical and social services.
|Table 1: Study of a lonely residence, depending on the age of the respondents|
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A study of elderly respondents' willingness to receive fee-based services showed that only every sixth respondent has a financial opportunity to receive paid medical services and every fourth may pay social domestic [Table 2]. Thus, 85% of respondents could not afford paid medicine and 73% even social and domestic, which confirms the relevance of providing different type of assistance, including medical and free of charge by the state.
|Table 2: Distribution of respondents by answering the question: “Do you agree to the additional paid services?” (in absolute numbers and as a percentage)|
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The study of elderly persons' need in various forms of health and social care revealed that two-thirds of respondents would like to receive assistance at home (67%), favorably consider living in an apartment in a residential building with health and social service as well 67% on a geriatric boarding house agree only every sixth respondent (17%), almost all respondents are categorically against the home for senior or disabled citizens (99%), also did not want to go to the hospital 94% of older respondents [Table 3]. Thus, in spite of the lack of access to paid medical services for the majority of elderly people, they do not want to go to a medical hospital, prefer to receive care at home, and to live in proximity to the medical organization.
|Table 3: Distribution of respondents by answering the question: “What form of health and social care you think for yourself the most desirable?” (in absolute numbers and as a percentage)|
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According to the survey to leave their place of residence for various medical and social assistance are willing practically all respondents: 99% - agree to stay in the geriatric boarding house, live in a home for senior or disabled citizens - 97%, and in a medical hospital - 93% [Table 4]. However, at the same time, stay in a boarding house and a home for senior or disabled citizens in the opinion of a large majority should not exceed 6 months, according to the respondents, and in the hospital <1 month, which indirectly indicates, not so much about the needs in assistance from the side much of the need for communication.
|Table 4: Distribution of respondents by answering the question: “What form of health and social care you think for yourself the most desirable, depending on the length of stay?” (in absolute numbers and as a percentage)|
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The study readiness to work and a desire to participate in public life is shown in [Table 5].
|Table 5: Distribution of respondents by answering the question: “You do not want to work and take part in social activities”|
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According to the data, the lack of desire to work and participate in social activities noted 44.7% of respondents with the majority (55.3%) are ready to actively participate in social activities and various events. The share of not wanting an active social life with growing age group from 43.7% to 58.1%, respectively. A commitment to social activity decreases with increasing age of the respondents, respectively.
The answers of the respondents about older person's preference for a closed way of life were presented in [Table 6].
|Table 6: Distribution of respondents by answering the question: “Do you have no desire to go anywhere from the apartment?”|
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The study answers of respondents about the desire to go out of his house found that only a third of the elderly do not want to leave your home, the remaining 67.3% are ready to enter into the social life. Moreover, among of elderly persons is the same tendency with respect to the proportion of persons aged 60–74 years and 75–89 years, and an increase in the indicator, not wanting to leave his house, from 32.8% to 41.9% under the age of 90 years and more. At the same time, more than half in all age groups do not want to stay at home. The study demands to communicate with others is presented in [Table 7].
|Table 7: Distribution of respondents by answering the question: “Do you have no desire to meet with anyone?”|
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A survey of elderly persons showed that only a third of respondents (28%) are not willing to meet with others. This age group says practically equal distribution of preferences in the matter of communication with anyone. Thus, the majority (72%) feel the need to communicate with other people.
The study answers of respondents, the perception of their place in life, found that one in four respondents, elderly persons (27%), considers useless existence. Among elderly persons, a sense of uselessness of their existence increases somewhat with increasing age [Table 8]. However, three quarters (73%) know that they need and can be helpful.
|Table 8: Distribution of respondents answering the question: “Do you feel the uselessness of your existence?”|
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In spite of the high percentage (over 80%) of the respondents receiving support from his family, a third of respondents live alone, it is thus noticed the almost complete lack of assistance from the social services of the city (<1%).
The survey showed that a large majority (85%) of the respondents cannot afford to themselves paid medicine, and 73% even social and domestic, which confirms the relevance of providing different type of assistance, including medical and free of charge by the state. Two-thirds of respondents would like to receive medical and social assistance in the home (67%), favorably consider living in an apartment in a residential building with health and social service as well 67%, on a geriatric boarding house agree only every sixth respondent (17%), practically all respondents are categorically against home for senior or disabled citizens (99%), 94% of older respondents also did not want to go toto the hospital. At the same time, majority (55.3%) are ready to actively participate in social activities and various events, 67.3% are willing to take an active part in public life, the majority (72%) feel the need to communicate with other people. Every fourth respondent of elderly persons (27%) considers their existence useless, the sense of futility of their existence increases somewhat with increasing age.
| Discussion|| |
The results of a sociological survey, 2996 of elderly persons revealed a predominance of female (about 60%) over male (about 40%), prevails among persons of respondents aged 60–74 years (75%). At the same time, most of the respondents are aged 60–74 years (two-thirds), every fourth in the age of 75–89 years, and a small part about 1% of those aged 90 and older. Thus, a significant portion of elderly persons, both men and women, is quite active period in the life of an old man, which confirms the relevance of the research of needs of elderly persons, both in the medical, social, and psychological assistance.
Despite the fact that living alone among the respondents about 30%, which represents a considerable proportion of persons in need of attention from the medical and social services, according to a survey, there is practically a complete lack of assistance from the social services of the city (0.7%). The study shows that 85% of the elderly cannot afford to themselves a paid medicine, and 73% even social and personal services, which confirms the relevance of providing various types of assistance, including medical and free by the state.
The study needs of the elderly in various forms of health and social care that despite the lack of access to paid medical services for the majority of elderly persons, nearly all respondents (more 90%) do not want to go to a medical hospital, prefer (about 70%) receive help at home, and live in proximity to the medical organization.
At the same time to leave their residence for various medical and social assistance are willing practically all respondents: 99% - agree to stay in the geriatric boarding house, live in a home for senior or disabled citizens - 97%, in a medical hospital - 93%, but stay in a boarding house and a home for senior or disabled citizens in the opinion of a large majority should not exceed 6 months, according to the respondents, and in the hospital <1 month, which indirectly indicates, not so much about the needs in assistance from much of the need for communication.
According to the study, majority (55%) are willing to actively participate in social activities and various activities, about 70% of all seniors are willing to enter into the social life, the majority (70%) feel the need to communicate with other people. At the same time, every fourth respondent of an elderly people (27%) considers useless of their existence, the sense of futility of their existence increases somewhat with increasing age. In spite of the high percentage (over 80%) of the respondents receiving support from his family, a third of respondents live alone. It is thus noticed the almost complete lack of assistance from the social services of the city (<1%).
Thus, the above survey shows the importance to improve the quality of life of elderly persons by improving health and social care, which should solve many problems of this category of persons associated with loneliness and loss of interest in life, to promote the development of contacts with others, the improvement of living conditions. Actual problems of the expansion of geriatric services in the country, training of doctors of all clinical specialties on Gerontology and Geriatrics, improving the regulatory documents in the field of medical and social assistance to elderly persons.
| Conclusion|| |
Kazakhstan crossed the threshold of an aging population, due to which relevant ways to improve the solutions of elderly persons issues in Kazakhstan. the further development regulatory documents on mechanisms of health and social assistance to elderly persons of the republic, expanding the network of institutions of geriatric services, increase in the issues of public awareness obtaining medical and social assistance and qualification level of health workers in the gerontology and geriatrics.
Carrying out a comprehensive analysis of the aging process of the Republic of Kazakhstan, the definition of the possible consequences for the social and economic development of the country; development of actions aimed at improving the lives of the elderly persons are required to study the key aging problem of population of the Republic of Kazakhstan.
The analysis results of the study confirmed the urgency of activating the provision of medical and social assistance of elderly persons as well as low attendance of employees of social service of the elderly population, require regular monitoring of the activities of local governments and institutions, as well as officials for ensuring the rights of older disabled persons in the area of social services.
Rather high need for communication elderly persons outside the walls of your own home requires the expansion of the various organizations and events specifically for this category of persons to improve the quality of life and feelings of the elderly demand.
Available gerontological service in the Republic of Kazakhstan represented by a network of institutions with different functional orientation and specialization providing medical and social assistance to elderly patients at home, leading outpatient and inpatient care, should be evenly distributed geographically, and conform to the actual needs of the region.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Alfiya I Igissenova
Tole Bi, 94, 050012 Almaty
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]