The risk is that Italy, in the next 40 years, could become a large “disorganized hospice”. According to forecasts made by demographic experts in 2050 in Italy 2.5 million Italians could be over 65 years of age. If today the elderly are a quarter of the total population, by 2050 they will be more than a third. We talked about this issue with Dr. Elena Maria Abati, geriatrician and physiatrist of the Rehabilitation Operating Unit and head of the Shockwave Service of Humanitas Gavazzeni Bergamo.
In 2050, in fact, there will be two and a half million fewer Italians and the over 65s, now a quarter of the population, will become more than a third: 20 million people, of whom over 4 million will be over 85 years old. These are some of the data that emerged from socio-demographic and health-assistance projections to 2030 and 2050 drawn up by ISTAT for Italia Longeva, the national network on ageing and active longevity, and recently presented to the Ministry of Health during the third edition of the General States of long-term care.
For the President of Istat, Giorgio Alleva, we are faced with “a question of structural sustainability for the whole country”. If Italia Longeva speaks in a note of a “demographic bomb ready to explode”, its president Roberto Bernabei comments: “We must prevent Italy from becoming a huge disorganized hospice in which few young people will remain forced to work more than they can to support millions of elderly people who are alone and disabled”.
The problem of chronic diseases
In the next ten years 8 million elderly people will have at least one serious chronic illness such as hypertension, diabetes, dementia, cardiovascular and respiratory diseases. This is what the projections drawn up by ISTAT for Italia Longeva – the national network on ageing and active longevity – say Roberto Bernabei, president of Italia Longeva: “Treating them all in hospital would be tantamount to transforming Rome, Milan, Naples, Turin, Palermo, Genoa, Bologna and Florence into large open-air wards. It is clear, therefore, that care in the area is no longer an option, but an obligation to give an effective response to the fragility and non-self-sufficiency of our elders, which will also accompany a growing loneliness. Istat estimates for long-lived Italy also say that in 2030 the over-65s who will live alone could reach 4.5 million and out of these 1.2 million will be over 85 years old. According to the study, in the North an over 65 year-old has three times more possibilities to be hosted in a health care residence than a citizen of the South, and has about five times more home care, in terms of hours and services.
Disabled people will also be on the increase
“Then there is disability – continues Bernabei – which in 2030 will affect 5 million elderly people, and will become the real emergency of the future and the main problem of economic sustainability” for Italy. “Being disabled – concludes Bernabei – means needing long-term care that, in 2016 alone, have absorbed 15 billion euros, of which three and a half billion paid out of their own pockets by families.
“These numbers are not new to those who work in geriatric clinics and gerontology, but they are a confirmation of future prospects that were already known in the nineties,” said Abati.
In an article published in 1990 in a number of Archives of Internal Medicine it was already written: “The challenges that the explosive growth of the elderly population poses in the years to come to the medical profession, researchers and the entire social and health system is enormous. It is necessary to prepare oneself to manage a new category of patients, that of the elderly characterized by a particular vulnerability for the simultaneous presence of more chronic diseases, frailty and disability such as to require high and specific professional skills and a specific and different welfare organization”.
According to the authors, the consequences of an incorrect approach to these subjects are incomplete and incorrect diagnoses, excessive pharmacological prescription, inappropriate institutionalization, inadequate use of territorial services and failure to resort to rehabilitation strategies. Already in those years it was hypothesized about the inadequacy in the geriatric field of a hospital-centric model, appropriate for an acute young adult patient, but inadequate for an eighty year old person, with high comorbidity and at risk of non-self-sufficiency.
Urgency: giving more space to chronicity
“Until now little has changed, the same schools of medical and nursing education devote only a small part of the training course to geriatric-gerontological preparation, preferring training in the field of acute than in that of chronicity, although, as we have seen, the demographic trend is exactly the opposite – continued the specialist. In the Lombardy Region a first, I would call it, initial attempt to ‘open the lid’ of the aging problem of the population is represented by the Chronic Project. This project, which began this year, is based on taking charge of people with chronic diseases. The path involves hospitals, social welfare and territorial realities. The first objective is to create a support and coordination to specialized health care with the construction of diagnostic and therapeutic customized paths, to facilitate but also regulate access.
The key element is the clinical manager, who, on the basis of what is foreseen by the project, follows the figure of the competent doctor in the geriatric field. The clinical manager, using other support figures, mostly nurses, “care” subjects often complex for high comorbidity, polypharmacotherapy, the high risk of disability and institutionalization. “The Cronici Lombardo Project – concluded Abati -, with all the limitations that characterize it at the time and the misunderstandings that has unfortunately generated, is an opportunity to bring to the center the problem of taking care of elderly patients who are fragile, poly-pathological and multi-treated to an advanced health system that is focused on acute, as already highlighted by us geriatricians since the late nineties.