yaşlanma eylem planı:mizanpaj 1...2015-2020 ”, “republic of turkey ministry of health,...

ANKARA 2015

TURKEY

HEALTHY AGING ACTION PLAN

AND

IMPLEMENTATION PROGRAM

2015-2020

Turkish Public Health Institution

REPUBLIC OF TURKEY

MINISTRY OF HEALTH

This publication here in has been developed and printed by Turkish Ministry of Health, Turkish Public Health

Institution, Department of Chronic Diseases, Elderly Health and Disabled People.

All rights are reserved and proprietary to Turkish Public Health Institution. No citation or extraction is allowed

without showing reference. The publication cannot be copied, duplicated or republished in part or in whole.

When it is cited, it should be referred as “Turkey Healthy Aging Action Plan and Implementation Program

2015-2020 ”, “Republic of Turkey Ministry of Health, Publication No, Ankara and Date of Publication”.

Not sold against money.

ISBN : 978-975-590-520-4

Publication No : 960

Production : Neyir Matbaacılık

Matbaacılar Sitesi 1341. Cd. İvedik - Ankara / Turkey

Tel : +90 0312 395 53 00

Cover Photo : Nazlı BELENLİ

www.thsk.gov.tr

TECHNICAL STUDY GROUP

MD. Prof. İrfan ŞENCAN President of Turkish Public Health Institution, Ministry ofHealth

MD. Bekir KESKİNKILIÇ Turkish Public Health Institution, Deputy Director of Noncommunicable Diseases, Programs and Cancer, Ministry of Health

MD. Banu EKİNCİ Turkish Public Health Institution, Director of Chronic Diseases,Elderly Health and Disabled People Department, Ministry ofHealth

MD. Assoc. Prof. Nazan YARDIM Turkish Public Health Institution, Director of Obesity, Diabetes and Methabolic Disease Department, Ministry of Health

Dt. Berrin BARUT Turkish Public Health Institution, Department of Chronic Diseases, Elderly Health and Disabled People, Ministry of Health

Nurse Fatma TAMKOÇ Turkish Public Health Institution, Department of Chronic GÜRBÜZTÜRK Diseases, Elderly Health and Disabled People, Ministry

of Health

Social Worker Seyhun ÇAKMAK Turkish Public Health Institution, Department of Chronic(Redaktor) Diseases, Elderly Health and Disabled People, Ministry

of Health

Med. Tech. Nevin ÇOBANOĞLU Turkish Public Health Institution, Department of ChronicDiseases, Elderly Health and Disabled People, Ministry of Health

Sociologist Şerife KAPLAN Turkish Public Health Institution, Department of Chronic Diseases, Elderly Health and Disabled People, Ministryof Health

Rsc. Ertuğrul GÖKTAŞ General Directorate of Administrative Services, Ministry of Health

Sociologist Meltem SEVEN Malatya Provisional Directorate of Public Health, Ministry of Health

Med. Tech. Ayşe GÜNDOĞAN Retired

NOTE: Approved by Publication Commission of Turkish Public Health Institution.

COORDINATION BOARD

MD. Banu EKİNCİ Turkish Public Health Institution, Director of Chronic Diseases, Elderly Health and Disabled People Department, Ministry of Health

Dt. Berrin BARUT Turkish Public Health Institution, Department of ChronicDiseases, Elderly Health and Disabled People, Ministry of Health

Nurse Fatma TAMKOÇ Turkish Public Health Institution, Department of ChronicGÜRBÜZTÜRK Diseases, Elderly Health and Disabled People, Ministry

of Health

Social Worker Seyhun ÇAKMAK Turkish Public Health Institution, Department of Chronic(Redaktor) Diseases, Elderly Health and Disabled People, Ministry

of Health

PREFACE

In this century, improvement in the

environmental conditions and in level and

distribution of incomes, developments in science

and technology, betterment in dwelling conditions,

augmented accessibility to hygiene and healthcare

services, and acquisition of healthy living

conditions have positively contributed to lifespan

and quality of life of individuals, and the process

has further accelerated through globalization in

many countries. This situation leads to increase in

elderly population and aging of the societies in

developed countries.

We need to note that aging is a process that

actually starts with birth. As the people become

older, they gradually become dependent to others in

material or moral point of view due to multiple

factors, such as chronic degenerations, diseases, and

changes in social status.

In order to provide accessible, effective andappropriate health care service for individuals andcommunity and to better respond to the people withspecial needs due to their physical, social oreconomic conditions by rendering this serviceeasily accessible for them, we have prepared an"Turkey Healthy Aging Action Plan and

Implementation Program 2015-2020" aimed toimprove health care of elderly and our efforts willcontinue to increase in this manner.

The bedridden individuals of all ages in need ofhome care and rehabilitation are served at theirhomes by home care service units of our publichospitals and primary health care institutions.Improvement of health tourism services intendedfor the elderly who need rehabilitation service isamong our most important policies.

Elderly are our most important assets that builda bridge between yesterday and today and allow usto move our culture and values into the future. It isour debt of gratitude that the old age is respected atthe same time. I’d like to thank to everyone,especially the Turkish Public Health Institution, forthis study that will make contribution to healthpolicy strategies which will be performed in orderfor elderly to take part in social life and integratewith society and feel the happiness of living.

I wish our elderly to continue better andhealthier mentally and physically quality of life.

Dr. Mehmet MÜEZZİNOĞLU

Minister of Health

CONTENTS

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V

Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IX

Index of Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . XI

Index of Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . XI

Appendixes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . XI

Turkey Healthy Aging Action Plan 2015-2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

General Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Mission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Healthy Aging Action Plan Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Strategy 1 Improvement of Lifelong Health and Healthy Aging . . . . . . . . . . . . . . . . . . . . . 5

Strategy 2 Protection of Society Against Health-Oriented Risks . . . . . . . . . . . . . . . . . . . . . 6

Strategy 3 Improvement of Health Care Services for Elderly and

Provision of Full Access to Health Care Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Strategy 4 Reinforcement of Monitoring and Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Priority Intervention Approaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

First Priority Intervention: Improvement of Exercise, Physical Activity and

Rehabilitation Services for Elderly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Second Priority Intervention: Improvement of Home Health Care Service for Elderly . . . . 8

Third Priority Intervention: Planning and Implementation of Activities about

Neuropsychiatric Diseases, Abuse, Violence and Disability in Old Age . . . . . . . . . . . . . . . 9

Fourth Priority Intervention: Provision of Appropriate and Effective Practice of

Diagnosis, Treatment, Monitoring Services in Old Age . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Fifth Priority Intervention: Arrangement of Training of Health Care Professionals and

Health Care Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Supportive Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

First Supportive Intervention: Provision of Sufficient Nutrition and Access to Food

Product for the Elderly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Second Supportive Intervention: Improvement of Home Care Services . . . . . . . . . . . . . . 12

Third Supportive Intervention: Cooperation with Partner Organizations to

Ensure Full Access to Health Care Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Turkey Healthy Aging Action Plan and Implementation Program 2015-2020

VII

Turkey Healthy Aging Implementation Program 2015-2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

General Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

1. Targets and Strategies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

1.1. Improvement of Lifelong Health and Healthy Aging. . . . . . . . . . . . . . . . . . . . . . . . . . 20

1.2. Improvement of Exercise, Physical Activity and Rehabilitation Services for Elderly. 30

1.3. Development of Home Care Services and Home Health Care Services for Elderly . . 45

1.4. Improvement of Health Care Services for Elderly and Ensuring Full Access to

Health Care Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

1.5. Implementation of Plans and Activities on the Subject of Neuropsychiatric Disorders,

Dementia, Geriatric Psychiatry, Disability, Abuse of Elderly and Violence in Old Age. . . 70

1.6. Ensuring Organization in Acute Care and Emergency in Geriatrics . . . . . . . . . . . . . . 78

1.7. Provision of Appropriate and Effective Practice of Diagnosis, Treatment,

Monitoring Services in old age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

1.8. Arrangement of Training of Health Care Professionals and Health Care Providers . . 97

1.9. Provision of Sufficient Nutrition and Access to Food For the Elderly. . . . . . . . . . . . 106

1.10. Provision of Long-Term Health Care and Full Access to Health Care Services in

Geriatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115

2. Monitoring and Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120

3. Implementation Model of Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

4. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131

5. Appendixes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136

Appendix 1. Contributing Public Institutions and Organizations . . . . . . . . . . . . . . . . . . . 136

Appendix 2. Contributing Universities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137

Appendix 3. Contributing Non-Governmental Organizations. . . . . . . . . . . . . . . . . . . . . . 138

Appendix 4. Contributing Persons. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139


VIII


IX

ABBREVIATIONS

ABPRS Address Based Population Registration System

ADL Activities of Daily Living

APS Adult Protective Services

BHSM Basic Health Statistics Module

CDC Centre for Disease Control and Prevention

CGA Comprehensive Geriatric Assessment

CHA Communiqué of Health Application

COPD Chronic Obstructive Pulmonary Disease

Dep. Department of

DPT State Planning Organization

EAMA European Academy for Medicine of Aging

EKMUD Infectious Diseases and Clinical Microbiology Specialist Association of Turkey

ESPEN European Society for Clinical Nutrition and Metabolism

EUGMS European Union Geriatric Medicine Society

FPIS Family Physicians Information System

GATA Gülhane Military Medical Academy

GDS Geriatric Depression Scale

HALE Healthy Adjusted Life Expectancy

HASUDER Association of Public Health Specialist

ICF International Classification of Functioning, Disability and Health

LE Life Expectancy at Birth

MMT Mini Mental Test

MNA Mini Nutritional Assessment

NGO Non-Governmental Organization

RHTS Remote Health Training System

SGK Social Security Institution

TNHS Turkey Nutrition and Health Survey

TRT Turkish Radio and Television Corporation

TSE Turkish Standards Institute

TUIK Turkish Statistical Institute

UN United Nations

USA United States of America

WHO World Health Organization

WONCA EUROPE World Organization of National Colleges Academies- EUROPE

YOK Higher Education Council


X


XI

INDEX OF TABLES

Table 1. LE Values between 1990 and 2011 in the World Health Organization (WHO) Regions . . . . . 21

Table 2. HALE Value in 2007 in the World Health Organization (WHO) Regions . . . . . . . . . . . . . . . . 21

Table 3. Home Health Care Services by Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Table 4. General Demographic Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

INDEX OF FIGURES

Figure 1. Relation between Age and Independent Living. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Figure 2. Population Pyramid 2013-2075 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Figure 3. Home Care Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Figure 4. Change in Age and Gender Composition of the Population between 1935-2023 in Turkey. . 62

APPENDIXES

Appendix 1. Contributing Public Institutions and Organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136

Appendix 2. Contributing Universities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137

Appendix 3. Contributing Non-Governmental Organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138

Appendix 4. Contributing Persons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139


XII


1

TURKEY HEALTHY AGING ACTION PLAN

2015-2020


2

INTRODUCTION

Among the others, aging population is one of the most prominent demographical phenomenon in

the 21st century. People enjoy a longer lifetime; birth rates decrease and thus the aged population increases

in the world. Being more apparent in developed countries, the fact of aging gets more and more important

for developing countries as well and Turkey is not an exception. Aging of population affects all aspects

of the society ranging from the healthcare to social insurance, education, employment opportunities and

family life. The recent researches indicate transition into a new demographical structure in the country.

Rate of population older than 65 was 7,5 percent in year 2012 and it is estimated that the rate will increase

to 10,2 percent by 2023, 20,8 percent by 2050 and 27,7 percent by 2075 (1). Whereas the population

older than 65 was 5,7 million in 2012, the projections of Turkish Statistical Institute (aka TUIK) estimate that

population older than 65 will be 8,6 million by 2023, 19,5 million by 2050 and 24,7 million by 2075 (2).

Life expectancy at birth gradually increases in Turkey. According to 2013 statistics of the World

Health Organization (WHO), the life expectancy at birth that was 66 years in 1990 increased to 76 years

in 2011. Life expectancy at birth is 73 and 78 years for males and females respectively (3). According

to TUIK statistics, the average life expectancy at birth for both genders was 74,6 years for 2010 and it is

projected that average life expectancy at birth to be 78,5 years by 2050. On the other hand, life expectancy

at birth was estimated 74,7 years for males and 79,2 years for females for 2013 while it is estimated to be

75,8 years for males and 80,2 years for females by 2023 (4).

The WHO defines health as a state of complete physical, mental and social well-being (5). The

quality of the life should be improved in line with the extension in life expectancy at birth. Holistic health

definition requires addressing improvement of both expected lifetime and life quality concepts.

Successful aging does not only refer to a state of physical well-being, but it also refers to a complete

state of wellbeing for physical, psychological, and social aspects as well. Life span, biological and mental

health, cognitive adequacy, social adequacy and productivity, individual control and joy of life are

commonly basic indicators of successful aging in literature (6).

In this context, successful aging refers to maintaining personal social environment and relations

vivid during individual process of preparation for old age, taking protective measure to minimize the

health problems, striving to improve memory and physical functions and having a positive understanding

of life (7).

Aiming to meet healthcare needs and expectations of the individuals with an anthropocentric and

holistic approach, studies for development of healthcare services for people with special needs are

progressing.


3

GENERAL PRINCIPLES

Turkey Healthy Aging Action Plan aims to offer accessible, convenient, effective and active

healthcare services to the individuals and society and to meet the needs of the people with special needs

due to physical, mental, social or economic circumstances by providing them easier access to favourable

healthcare services. Action plan sets priorities of the objectives and strategies and basic framework for the

supportive studies to be conducted with participating authorities and organizations.

VISION

The vision of this action plan is to ensure people maintain their health status and functional

capabilities and enjoy wellbeing by living in dignity through seeing the aging in the society as an

opportunity rather than a threat risk.

MISSION

The mission is to support combat against non-communicable diseases and chronical conditions with

the aim of improving the healthcare services offered to aged individuals within scope of practices of

Ministry of Health; to improve health level of the society and to develop, implement, monitor and assess

the policies on healthy aging.

Improvement in environmental conditions during the process started with industrial revolution,

increase educational level, developments in income level and its distribution, improvements in balanced

and sufficient dietary, betterment in dwelling conditions, availability and accessibility of the healthcare

services, decrease in infant and child deaths, decrease in prevalence of infectious diseases, gaining healthy

habits and developments in science and technology have positive contributions for life span and quality

of life of the individuals. Globalization speeds this process up further in many countries and it contributes

to increase of aged population in developed countries.

Sustainable policies should be developed for the aged people to promote healthier and active aging

individuals; measures should be taken in health and social security systems to take the demographical

changes in the population seriously, and education and employment policies should comply with this

change accordingly.

In parallel and similar to the goals defined in 2012- 2020 Strategy and Action Plan for Healthy

Aging in Europe developed by World Health Organization European Region, this Action Plan herein aims

to realize national goals and strategies to improve responsiveness of the healthcare system in accordance

with the increase in aging population in our country.


4

For the successful implementation of the action plan, it is highlighted that;

- Arrangement and evaluation of successful policies aimed at the elderly by making a good start

or arrangements,

- Implementation of healthy aging strategies at the level of individual and community with the

contribution of volunteers,

- Elimination of inequalities in health will contribute to the lifelong health approach,

- Gender-focused approach will be of great importance for ensuring the proper services to the

needs of elderly women and men,

- Necessity for intersectoral collaborations and for the health approach with the contribution of

public institutions, private institutions and non-governmental organizations,

- Ensuring the financial sustainability by strengthening transformation program in old age and the

public health practices for the elderly.

HEALTHY AGING ACTION PLAN STRATEGIES

Strategy 1-Improvement of Lifelong Health and Healthy Aging

Old Age is one of the periods in which the quality of life decreases. Many priorities can be listed

for the old age. In these evaluations, it should not be forgotten that aging is a process that starts with birth.

When individuals are born, they start to live fully dependent on somebody else in terms of material and

spiritual sense; but after years, they can be fully independent. Adulthood refers to a period in which

individuals manage to survive alone. Over the course of life, with the effects of such multiple factors as

diseases, chronic degeneration, change in social status, individuals start to be dependent on another person

in material and spiritual terms.

Unless the necessary measures are taken, the last period of life can reach a stage at which we are

totally dependent on the others as happened at birth (Figure 1). Therefore, one of the purpose of the studies

conducted in the field of healthy aging is to prolong lifespan which is passed independently, reduce the

dependency in later years of life as far as possible or to postpone this further on.

Figure 1. Relation Between Age and Independent Living


5

Lifestyle and habits of individuals in childhood and adulthood periods are important markers that

determine the health status in later years. Since healthy aging is a process that begins at birth, the studies

of health aging should be oriented towards this goal.

The fundamental issue is to raise awareness of the development of lifelong health both in society

and in health care providers.

This issue was drawn attention at Madrid II. Aging Assembly, and the collaboration necessity in

heathy aging has been emphasized in all relevant activities by the health authorities, academics, non-

governmental organizations and local authorities (8).

Strategy 2- Protection of Society Against Health-Oriented Risks

Ageing is an unavoidable process with biological, chronological, social aspects and issues which is

experienced by every individual.

The importance of aging is multidimensional in terms of health. The reasons for the problems in old

age are the declines and inadequacies in physiological and psychological functions that come along with

old age. Chronic health problems occur in elderly people as a result of these inadequacies. In our country,

90 percent of the people who are 65 and older are estimated to have 1, 35 percent 2, 23 percent 3, 15

percent 4 chronic health problems (9).

Today, the policies and programs related to old age have focused on increasing quality of life and

general health. To remain healthy until later years, the fight against non-communicable diseases should

be conducted in an active way. Improvement of successful health policies and continuity of social services

will only be possible with the conduct of the fight against non-communicable diseases.

It is ensured that elderly can maintain their biological and mental health, perform such basic

elements as cognitive competence, social competence, productivity and enjoyment of life and live an

active and independent life. Active life is a condition indicating a complete of wellbeing in terms of

psychological and social aspects.

Strategy 3- Improvement of Health Care Services for Elderly and Provision of Full Access to Health

Care Services

In general, it has been aimed that elderly health and active aging program is provided in the primary

health care. These centres that directly provide health care services for elderly include such developed

implementations as being easily accessible, positive discrimination and provision of efficient health care

services for elderly.

Studies show that elderly naturally benefit from health care services more than do younger

population. Due to the problems arising from the extension of lifespan, the tendencies in health criteria

should be recognized. Sources are recommended to be used effectively by evaluating these trends.

Especially, it is important to determine the tendencies in causes of death of elderly, disease and functional

impairment criteria, healthy aging factors and disease costs.


6

That provision of health care services for elderly is easily accessible, geriatric services are provided

by trained health care teams, and waiting duration is minimized should be evaluated along with the needs

of the social dimensions. Family physicians should provide coordination with the health care professionals

serving in secondary and tertiary health care services. An efficient geriatric service should be performed

with a multidisciplinary approach by an interdisciplinary team. This issue should be highlighted in the

basic trainings of primary health care physicians.

It is inevitable that developing countries are in a dilemma to struggle to overcome the demographic

changes in their populations on the one hand (while trying to finding a solution to the needs of the young

population, who have relatively the most share, to develop and implement the policies for the elderly

population who have been increasing over the course of time), and to find solutions to the development

of the country and improvement of the prosperity on the other hand. This needs a consistent population

policy and sustainable investment in human capital.

It is planned to revive the policies which have been determined with the divergent needs of the

elderly in the changing society and to provide the development of new projects through the strategies.

Strategy 4- Reinforcement of Monitoring and Evaluation

The evidence-based information should be relied on the implementation of successful of health

reforms and the evaluation of success of the policies. The data should be evaluated in order to determine

the intervention areas aimed at protecting elderly health, increasing the quality of health care provision

for elderly and reinforcing the integration with social services. Statistical evidence should be evaluated

in the guidance of policy and the good practices in our country should be shared internationally.

PRIORITY INTERVENTION APPROACHES

Aging is a normal process in which an increase in the frequency of acute and chronic diseases is

observed to occur and physiological changes are expected to take place with the progression of age.

Priority intervention approaches have been determined with the purpose of maintaining lifelong health and

protecting from risks against health, improving the health care services provided for the elderly people.

• First Priority Intervention: Improvement of Exercise, Physical Activity and Rehabilitation

Services for Elderly

• Second Priority Intervention: Improvement of Home Health Care Service for Elderly

• Third Priority Intervention: Planning and Implementation of Activities about Neuropsychiatric

Diseases, Abuse, Violence and Disability in Old Age

• Fourth Priority Intervention: Provision of Appropriate and Effective Practice of Diagnosis,

Treatment, Monitoring Services in Old Age

• Fifth Priority Intervention: Arrangement of Training of Health Care Professionals and Health

Care Providers


7

First Priority Intervention: Improvement of Exercise, Physical Activity and Rehabilitation Services

for Old Aged People

Active and independent living of individuals should be encouraged with the purpose of maintaining

the lifelong health. Exercise and physical activity are of great importance for active life. Today, physical

activity and exercise are given a great place in the health policies of many countries across the world.

Physical capacity of persons decreases with age, which limits the functional independence of the

elderly (10). According to the Centre for Disease Control and Prevention (CDC), chronic diseases

significantly limit the activities of daily living for 39 percent of the people who are 65 and older (11). 11,5

percent of the elderly between 65 and 79 need assistance in such activities as moving, bathing, dressing,

toileting and eating. Osteoarthritis and other rheumatic diseases are seen in 50 percent of the age group

65 years and above. In addition, such chronic diseases as sensory loss, heart disease, fractures,

hypertension, diabetes, and cancer are also affecting their daily life (12).

Neuro-cognitive disorders such as auditory-visual and sensory-cognitive disorders, heart diseases,

cancer, hip fractures and dementia are common in the elderly. Joint pain and falls are among the most

common problems. The pain is demonstrated through acute or chronic pain. Control is very difficult and

these are not often shown to correlate with objective findings. Stress and anxiety lead to muscle spasm,

consequently bringing about decreased activity; which reversibly cause a vicious circle.

Fall, is not part of the normal aging process; but it forms the basis of muscle-skeletal and

neurological system disorders associated with aging, and loss of physical function, overuse medication

called polypharmacy and environmental hazards in connection with these. Lack of good health,

inadequacy in exercise and decreased mobility due to lack of activity or chronic disease, imbalance and

earlier falls are important risk factors for the stories of falls.

Regular activity and exercise habits of the elderly are the most important determinants of healthy

aging in the short and long term. Especially, in order to prevent the incidence of the disease seen in the

elderly, exercise is important. In addition to these, physical exercise has a social and psychological aspects

that positively affect the quality of life and well-being of older people.

Second Priority Intervention: Improvement of Home Health Care Service for Elderly

According to the United Nations (UN) report of 2010; Individuals aged 65 and above account for

about 11 percent of the world's population, and this percentage is estimated to rise to 26 percent by 2050.

Given these figures, 400 million elderly people are expected to live in developed countries and more than

1,5 billion are expected to live in less developed countries (13). The WHO statistics of 2013 show that

the rate of the population over 60 years of age surpasses 20 percent of the total population in 21 European

countries (3).

In our country, this situation is parallel to the reality of the world. The demographic transition process

in Turkey will be realized in a much shorter period compared with European countries. With the falling

in fertility rate and the increase in life expectancy, Turkey will no longer be a country with a young

population.


8

Both the number of the people over 65 years of age and their shares in the total population will

increase at an extraordinary rate in the next 20-30 years. Moreover, demographic transition process in

our country will be realized in a much shorter period compared with European countries. With the falling

in fertility rate and the increase in life expectancy, Turkey will no longer be a country with a young

population. While the rate of the elderly people in the total population was 7,5 percent in 2012, it is

estimated to increase to 20,8 percent by 2050, which verifies the defined table (1).

As a result of the increase in the aging population, health expenditure and care requirements have

swiftly increased, and this increase, as well as becoming a noteworthy situation, has posed a serious threat

to all of the countries, including the ones having an extremely powerful social security system, for the

future. In parallel to the increase in the elderly population, the burden of chronic diseases on the total

health expenditures is gradually increasing.

As a result of aging, the increase in population of the people with disabilities and in the degree of

the existing disabilities as well as chronic diseases has been observed. Given all these factors, a significant

increase in the needs of the elderly for health and social care has been seen and this need is known to show

further increase in the future.

In order to meet the long-term care, all of these countries should make future strategies and develop

care models based on the demographic information and numerical predictions. While studies are being

conducted to ensure the effective operation of the system in the developed countries, the models which

are appropriate to realities should be immediately implemented in the countries which do not yet have a

model in this regard. Home care is the most effective model in meeting the health, and social care needs

across the world.

Home care models vary from country to country due to socio-economic structures, differences in

social security systems, health and social service models and cultural changes in the countries. Home care

services that have been created in line with the country needs and opportunities are seen to be integrated

to the health and social services as well as social security system.

While developing a model for our country, it is important to adopt the remarkable parts of the

different models that fit with the conditions of our country and to take the common practices that are

usually observed in different models rather than to take a single model from the examples in the world.

In our country, it is necessary to continue the home care applications with the integration of home care

services and social service provisions.

Third Priority Intervention: Planning and Implementation of Activities about Neuropsychiatric

Diseases, Abuse, Violence and Disability in Old Age

The elderly have been experiencing difficulties due to health problems as well as social and

economic problems. They have difficulty in maintaining their lives in society due to disabilities in

connection with these problems. Neuropsychiatric disorders have an importance place among the health

problems experienced by the elderly. Depression experienced by the elderly in treatment and care

environment is higher than the prevalence in society.


9

15 percent of the patients who consults a doctor for various reasons and 25 percent of the patients

who stays in nursing homes are assessed to have depression (14). In the studies conducted in our country,

the prevalence of major depression of the people over 65 years of age is determined to be 6 percent, the

prevalence of depressive symptoms to be 11 percent (15).

When elderly psychosis, mood disorders, somatization, anxiety disorders are added to this,

psychiatric illnesses can be seen to exist more frequently. Particularly, depression is one of the ten most

common diseases that cause disability and early death (16). As one of the most common psychiatric

illnesses, depression is a major health problem owing to the fact that it reduces the quality of life, increases

health spending, worsens the prognosis of cardiovascular disease, especially chronic internal disease with

increased risk of suicide.

Suicide can be a seen as a reasonable “way out” for physical illnesses in the elderly and for the end-

stage patients, especially the cancer patients. This is frequently associated with depression and this

situation may increase the suicide risk (17).

Dementia is a common problem in the elderly. Its incidence is 5 percent in over 65 years of age and

50 percent in over 80 years of age. Since the disease can start with an insidious forgetfulness, forgetfulness

in old age cannot be seen as normal. Today, with the existing medications, the duration of going to the last

point in the cases diagnosed in early stages can be extended, patient's self-care time can be extended and

caregiver burden can be reduced (18).

As of 2010, when looked at the incidence of dementia; 4,6 percent of the total population in Asia,

6,2 percent in Europe, 6,1 percent in Latin America, 6,9 percent in North America and 4,7 percent of the

population worldwide are stated to have dementia. When the countries having the patients with dementia

are listed, China is ranked in the first place with 5,4 million patients, the USA with 3,9 million, India with

3,7 million, Japan with 2,5 million, Germany with 1,2 million, Russia with 1,1 million, France and Italy

with 1 million each, followed by Brazil with 1 million patients. As of 2010, the cost of dementia for the

whole world is stated to be 604 billion US dollars and 89 percent of this cost is covered by the developed

countries (19). When the problems of the health care providing families, persons and institutions are added

to this table, the importance of the elderly mental health and the development of the relevant service plans

and policies should be taken into account once again.

Fourth Priority Intervention: Provision of Appropriate and Effective Practice of Diagnosis,

Treatment, Monitoring Services in Old Age

With the effect of rapid-evolving technology and the increasing number of scientific studies, the

important advances has been recorded in health care services. Accordingly, the development of diagnosis

and treatment methods, advances in preventive and curative health care services, and support of the studies

aimed at increasing and adopting the quality of life, the average lifespan has been extended and the elderly

population in the total population has increased.

Diagnosing precisely with geriatric assessment, developing medical treatment, ensuring the long-

term care plans, improving the functional status, increasing quality of life, and determining the basic

features, background of patient and results of the treatment should be required.


10

When comprehensive geriatric assessment is periodically performed, the rate of mortality and

placement of patients in nursing homes are identified to reduce and the functional status are identified to

positively develop.

Fifth Priority Intervention: Arrangement of Training of Health Care Professionals and Health

Care Providers

The elderly population is growing in our country as well as in the world, the elderly population in

western countries constitute 15 percent of the total population. However, this section of 15 percent

consumes more than 50 percent of hospital admissions and 40 percent of health sources (20).

In parallel with the growing elderly population, in addition to the need for the institutions and

organizations providing the service to the elderly, qualified staff that provide services to the elderly are

also required. The training of the qualified staff in the subjects of services to be provided and elderly

health are becoming important.

In the world, the training and education of the staff providing healthcare services to the elderly are

given importance and the health problems that may be created by the elderly are tried to be reduced. The

works have been performed for the provision of the geriatric patients approach in Europe and the US by

both preventive medicine services and the specialized physicians as well as for the placement of geriatrics

training in the specialized branches.

Above all, that the subjects of lifelong health and aging should be put in the curricula beginning from

the primary schools will be the first step for making the society conscious of this issue.


11

SUPPORTIVE INTERVENTIONS

The population over 65 years of age accounts for approximately 7,5 percent of the total population

of Turkey. The elderly population in the total population is estimated to be over 20 percent by 2050 (1).

It is seen that the population of Turkey is getting older and services and policies towards the elderly care

should be planned and implemented urgently.

While the improvement and development works of services towards the long-term care needs are

performed in our country, the alternative services that will support the increase of the efficiency and the

quality of the services and reduce the intense demand for care to a certain extent should be carried out

simultaneously. At this point, the understanding of long-term care services, especially in the US, England,

Canada and Germany and review of alternative services will be beneficial.

Supportive interventions that have been identified for the sustainability of healthy aging and health;

First Supportive Intervention: Provision of Sufficient Nutrition and Access to Food Product for the

Elderly

Second Supportive Intervention: Improvement of Home Care Services

Third Supportive Intervention: Cooperation with Partner Organizations to Ensure Full Access to Health

Care Services

First Supportive Intervention: Provision of Sufficient Nutrition and Access to Food Product for the

Elderly

Among the factors that negatively affect nutritional status in the elderly, such factors as physiological

changes, acute and chronic diseases, oral health problems, polypharmacy, economic problems, incapable

of single-handedly shopping and preparing meals and eating take an important place.

Insufficient and unbalanced nutrition plays an important role in the formation and in the course of

such diseases as obesity, cardiovascular diseases, cancer, diabetes and osteoporosis which have high

morbidity and mortality rates in the elderly. Especially malnutrition is a major cause of morbidity and

mortality in the elderly.

Obesity resulting from unhealthy nutrition leads the formation of nutrition-related chronic diseases

(cardiovascular diseases, cancer, diabetes, osteoporosis, etc.). It is recommended that personal nutrition

and physical activity programs should be developed and the lifestyle changes should be provided in obese

elderly.

Second Supportive Intervention: Improvement of Home Care Services

The main objective of home care services is to support the elderly or their families, to increase their

functionality, to help them live independently and retain power as much as possible and to ensure their

full well-being by meeting their needs in the best possible way within the framework of a sense of self-

esteem of the elderly.


12

Home Care covers the services in the direction of;

- Household tasks (such as laundry, shopping, cleaning), preparing meals at home,

- Personal care (dressing, helping with bath and personal hygiene), personal emergency response

(24 hour emergency service)

- Heavy-duty that cannot be performed by individuals alone,

- Transportation,

- Financial consultancy,

- Solutions to the problems within the framework of the speciality fields of professional persons

that form the training and home care service teams.

Home care service is a lower cost service as well as having important benefits, such as covering the

training of the whole family members, maintaining the social activities and hobbies and continuing the

life in an environment to which individuals are accustomed.

Third Supportive Intervention: Cooperation with Partner Organizations to Ensure Full Access to

Health Care Services

When home care service is evaluated, the persons which are very difficult to be regained to the

society and the severely disabled persons needing medical care are the groups with first priority needs.

The increase of quality of care services towards the elderly and the individuals with severe

disabilities and of the quality of life of individuals are of great importance. However, the adults with

severe disability and the elderly are usually of minor importance in terms of care. These individuals, and

especially their needs for care and assistance that increase with aging, is one of the issues that should be

chiefly dealt with on the basis of the principle of the socials state.

With the purpose of the provision of a holistic health care service for the elderly, it is evident that

the works are needed to ensure the collaboration with partner organizations for eliminating the deficiencies

in the matters of institutional care services, developing training programs for the care service, making

prevalent the productions of maintenance and rehabilitative support technologies according to international

standards, determining the system actors and financing methods in the field of maintenance assurance

model and nursing care insurance.


13

REFERENCES

1. TUIK. (2013). Retrieved: 03 February 2014, http://tuik.gov.tr/PreHaberBultenleri.do?id=13466

2. TUIK. (2013). Retrieved: 04 February 2014, http://www.tuik.gov.tr/PreHaberBultenleri.do?id=15844

3. WHO. World Health Statistics 2013. Geneva, World Health Organization.

4. TUIK, İstatistiklerle Yaşlılar [Elderly with Statistics]2012: Publication No: 3909, 2013. Ankara,

Turkish Statistical Institute

5. WHO. Ottawa Charter for Health Promotion. Geneva, 1986, World Health Organization

6. Danış ZM. Yaşlıların Evde Bakım Gereksinimleri ve Evde Bakıma İlişkin Düşünceleri

[Equirements for Home Care and Home Care Considerations Related to the elderly. Güç-Vak

Publishing.] Ankara: Güç-Vak Yayıncılık, 2004:20.

7. Baran AG. Başarılı yaşlanma modellerinin sosyolojik analizi. İçinde: Kalınkara V, Akın G. V.

Ulusal Yaşlılık Kongresi Kitabı. [Sociological analysis of models of successful aging. Inside:

Kalınkara V, Akın G. V. National Ageing Congress Book]. Ankara: Gazi Kitabevi, 2007:236-45.

8. Political Declaration and Madrid International Plan of Action on Ageing. New York:

United Nations; 2002. Retrieved: 06 Mart 2014. (http://undesadspd.org/Ageing/Resources/

MadridInternationalPlanofActiononAgeing.aspx)

9. Aydın ZD. Yaşlanan dünya ve geriatri eğitimi [Aging World and Education of Geriatrics]. Turk

J Geriatrics 1999; 2(4): 179-187.

10. Telatar TG, Özcebe H. Yaşlı nüfus ve yaşam kalitelerinin yükseltilmesi. Türk Geriatri Dergisi

[Increasing Quality of Life of the Elderly Population. Turkish Geriatrics Journal]. 2004; 7: 162-5.

11. Fulmer T, Wallace M, Edelman CL. Older adult, In: Edelman CL, Mandle CL, (Eds). Health

Promotion. Toronto: Mosby, 2002. pp: 709-44.

12. Fadıllıoğlu Ç. İleri Geriatri Hemşireliği. İçinde: Fadıllıoğlu Ç (Editör): Yaşlılığın Önemi [O.

Advanced Geriatric Nursing. Inside: Fadıllıoğlu Ç. (Editor): The Importance of Old Age]. İzmir:

Meta Basım, 2006. Pages:1–17.

13. United Nations (UN). World Population Prospects the 2010 Revision. Retrieved: 22 January

2014.http://www.un.org/en/development/desa/population/publications/pdf/trends/WPP2010/W

PP2010_ Volume-II_Demographic-Profiles.pdf.

14. NIH Consensus Development Panel on Depression in Late Life: Diagnosis and treatment of

depression in late life. JAMA 1992; 268(8):1018-1024

15. Uçku R. Küey L, Yaşlılarda depresyon epidemiyolojisi-yarıkentsel bir bölgede 65 yaş üzeri

yaşlılarda kesitsel bir alan araştırması- Nöropsikiyatri Arşivi [Depression in the Elderly - cross-

sectional area research on the elderly over 65 years of age in a semi-urban region- Archives of

Neuropsychiatry]1992; 29:15-20


14

16. Murray CJL, Lopez AD. The global burden of disease: a comprehensive assessment of mortality

and disability from diseases, injury and risk factors in 1990 projected to 2020. Geneva, World

Bank, Word Health Organization and Harvard School of Public Health, 1996

17. Moscicki, E. K., Epidemiology of Suicide, North American Perspectives, International

Psychogeriatrics, Vol: 7, No: 2, 1995, s. 137-148

18. Ministry of Health (Former) General Directorate of Primary Health Care: Yaşlı Sağlığı

Modülleri: Eğitimciler İçin Eğitim Rehberi [Elderly Health Modules, Guideline for Educators],

2011, Ankara

19. WHO. Dementia a public Health Priority. 2012. Geneva, World Health Organization

20. Bernabei R, Carhonin PU: Medical Education. Lancet 1995; 345:1440.


15


16

TURKEY HEALTHY AGINGIMPLEMENTATION PROGRAM

2015-2020

GENERAL INFORMATION

Aging is a universal and continuous process which causes a reduction in all functions seen in every

living creature without privilege. The recent researches indicate transition into a new demographical

structure in the country. In our country, the rate of population older than 65 was 7,5 percent in year 2012

and it is estimated that the rate will increase to 10,2 percent by 2023, 20,8 percent by 2050 and 27,7

percent by 2075 (1). With the increase in the elderly population, the diseases seen in the elderly are

increasing in parallel. Solving the problems of the elderly people in one centre by allotting enough time

has become a current issue due to such reasons as development of a variety of age-related physiological

changes in the human body, varying of metabolism, effects and side-effects of drugs, different emergence

and course of diseases, and this has also revealed the concept of geriatrics.

The WHO identifies the geriatric age group as the people older than 65 (2). Geriatrics is the science

that deals with the health problems, diseases, social life, life quality, mood, cognitive problems of the

people older than 65, preventive physicians’ practices and aging in society. In comprehensive geriatric

assessment which means the versatile evaluation of the elderly patients, the evaluation of physical, psycho-

social and environmental factors affecting the elderly patient and the functionality and medical evaluation

of the patient are made together.

The increase in the elderly population brings along the special needs for the elderly. In our country

which are getting older, preventive physician’s practices, immunization of patients, revealing the problems,

especially the geriatric syndromes, that might remain confidential, safeguarding environmental-social

support are the issues that should be taken into consideration in order to ensure the implementation of the

elderly health care plan, increase the quality of life and continue their independency. The quality of life

of the elderly can be increased by means of easy and free access of the elderly to health care services, early

diagnosis and treatment of diseases, and health care services to be provided in this manner and the

measures to be taken at the proper time.

Evaluation of the elderly in a comprehensive manner in hospital, outpatient clinic, nursing home,

retirement home, long-term nursing home and at their homes within a home team concept reduces the

hospitalization, mortality, functional dependency, household and non-household accidents, applications

to hospital and nursing home and care costs and ensures health and welfare of patients by improving the

life quality.

Nowadays, due to the decrease in the birth rate and the extension of life expectancy especially in

the developed countries, the increase in aging and the associated problems have become inevitable. The

number and the rate of the people older than 65 in the total population will rapidly increase in the next

20-30 years. Furthermore, the demographic transition process in Turkey will be realized in a much shorter

period compared with European countries. With the falling in fertility rate and the increase in life

expectancy, Turkey will no longer be a country with a young population.

According to the United Nations (UN) report of 2010; Individuals aged 65 and above account for

about 11 percent of the world's population, and this percentage is estimated to rise to 26 percent by 2050.

Given these figures, 400 million elderly people are expected to live in developed countries and more than

1.5 billion people are expected to live in less developed countries (3). The WHO statistics of 2013 show


17

that the rate of the population over 60 years of age surpasses 20 percent of the total population in 21

European countries (4).

As a result of the increase in the aging population, health expenditure and care requirements have

swiftly increased, and this increase has posed a serious threat to all of the countries including the ones

having an extremely powerful social security system for the future as well as becoming a noteworthy

situation. In parallel to the increase in the elderly population, the burden of chronic diseases on the total

health expenditures is gradually increasing.

According to WHO data, the vast majority of world health expenditure is currently being spent on

the treatment of chronic diseases, and 60 percent of deaths arises from chronic diseases (5).

As of 2013, the number of the people with diabetes around the world was 382 million, this number

is expected to reach 471 million by 2035 (6).

According to the study of the Ministry of Health, there are 22 million people with chronic diseases

in our country (7). On the other hand, considering that 12,29 percent of our population is comprised of

the people with disabilities, how immense the care needs that will dramatically increase in the coming

years has already emerged (8).


18


19

1. TARGETS AND STRATEGIES

1.1. IMPROVEMENT OF LIFELONG HEALTH and HEALTHY AGING

Current Situation in Turkey and the World

Prevention of infectious diseases, early diagnosis of disease and effective treatments are contributing

to rapid increase in the average life expectancy. The share of the elderly population in society in parallel

with the changes and transformations in the demographic structure is also increasing. In our country, the

rate of population older than 65 was 7,5 percent in year 2012 and it is estimated that the rate will increase

to 10,2 percent by 2023, 20,8 percent by 2050 and 27,7 percent by 2075. Whereas the population older

than 65 was 5,7 million in 2012, the projections of Turkish Statistical Institute (aka TUIK) estimate that

population older than 65 will be 8,6 million by 2023, 19,5 million by 2050 and 24,7 million by 2075 (9).

In addition to the prolongation of life expectancy, the increase in the quality of life should also be

provided. In order to evaluate the quality of life in a healthy manner, the two key indicators should be

considered together. One of these is Life Expectancy at Birth (LE), the other is Healthy Adjusted Life

Expectancy (HALE).

According to the WHO data in Table 1, it is seen that the Life Expectancy at Birth (LE) increased

in all the regions from 1990 to 2011, with the most increase in South-East Asia and the least increase in

the European region.


20

Population Pyramid, 2013-2050 Population Pyramid, 2013-2075

MALE - 2013

FEMALE - 2013

MALE - 2050

FEMALE - 2050

MALE - 2013

FEMALE - 2013

MALE - 2075

FEMALE - 2075

Figure 2. Population Pyramid 2013-2075

Source: TUIK.(2013). Population Projections, 2013-2075 Retrieved: 03 February 2014,

http://www.tuik.gov.tr/PreHaberBultenleri.do?id=15844)

Table 1. LE Values between 1990 and 2011 in the World Health Organization (WHO) Regions

In Table 2; according to WHO, the value of Healthy Adjusted Life Expectancy (HALE) is seen to

be the lower in the African Region, the highest in Europe, America and the Western Pacific regions; HALE

value is seen to be lower than LE values in all of the regions. That the difference between LE and HALE

values means that the desired level cannot be captured in terms of life quality.

In old age, some decline in the quality of life in parallel to the physiological changes in the elderly

is an expected situation. In order for the elderly to maintain their lives independently and to have a better

quality of life, ensuring the lifelong health and healthy aging can only be possible by providing the

necessary arrangements with the aim of creating a healthy and safe environment, developing the healthy

life behaviours between the elderly people and in the society, arranging the socio-economic conditions that

may negatively affect the elderly health and treating the chronic diseases in old age.


21

Africa 50 56

America 71 76

South-East Asia 59 67

Europe 72 76

Eastern Mediterranean 61 68

Western Pacific 70 76

COUNTRIES1990 2011

LE

(Source: World Health Statistics 2013. Geneva, World Health Organization, 2013. Retrieved: March 10, 2014, http://www.who.int/gho/publications/world_health_statistics/EN_WHS2013_Full.pdf?ua=1

Table 2. HALE Value in 2007 in the World Health Organization (WHO) Regions

Africa 45

America 67

South-East Asia 57

Europe 67

Eastern Mediterranean 56

Western Pacific 67

COUNTRIES HALE (2007)

(Source: World Health Statistics 2010. Geneva, World Health Organization, 2010. Retrieved: March 10, 2014,http://www.who.int/gho/publications/world_health_statistics/EN_WHS10_Full.pdf


22

Targets and Strategies Identified for Improvement of Lifelong Health and Healthy Aging

Target 1- Taking necessary measures to prolong life expectancy at birth

Strategy 1

Reducing the incidence of non-communicable diseases and the deaths arising from these diseases

Strategy 2

Reducing the incidence of communicable diseases and the deaths arising from these diseases

Target 2- Improvement of life quality in old age

Strategy 1

Treatment of chronic diseases in old age

Target 3- Improvement of healthy lifestyle in the elderly and the society

Strategy 1

Raising awareness of healthy lifestyle in the elderly

Strategy 2

Raising awareness about healthy aging in the society

Target 4- Making necessary arrangements for the establishment of a safe and healthy

environment for the elderly

Strategy 1

Ensuring a safe and healthy environment for the elderly inside and outside of home


23

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24

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diov

ascu

lar

Dis

ease

Pre

vent

ion

and

Con

trol

Pro

gram

(20

15-2

020)

2.1.

3. T

.R. M

inis

try

of H

ealt

h T

urke

y C

hron

ic R

espi

rato

ry D

isea

seP

reve

ntio

n an

d C

ontr

ol P

rogr

am(2

014-

2017

)

See

the

Rel

evan

tP

rogr

ams

See

the

Rel

evan

tP

rogr

ams

See

the

Rel

evan

tP

rogr

ams

See

the

Rel

evan

tP

rogr

ams

Act

ivit

ies

Ou

tpu

tIn

dic

ator

sR

esu

ltIn

dic

ator

sP

erio

dR

esp

onsi

ble

In

stit

uti

onan

d O

rgan

izat

ion


25

Tar

get

3- I

mp

rove

men

t of

hea

lth

y li

fest

yle

in t

he

eld

erly

an

d t

he

soci

ety

Str

ateg

yA

ctiv

itie

sO

utp

ut

Ind

icat

ors

Res

ult

In

dic

ator

sR

esp

onsi

ble

In

stit

uti

onan

d O

rgan

izat

ion

Per

iod

Per

iodi

c

3 ye

ars

3.1.

Rai

sin

g aw

aren

ess

of h

ealt

hy

life

styl

e in

th

e el

der

ly3.

1.1.

Arr

ange

men

t of

heal

thy

life

styl

e ed

ucat

ion

in 8

1 pr

ovin

ces

3.1.

2. I

mpl

emen

tati

on o

f ed

ucat

ion

in s

peci

al d

ays

and

wee

ks

3.1.

3.In

crea

sing

the

use

and

acti

viti

es o

f W

ebsi

tes

by M

inis

try

ofH

ealt

h to

pre

vail

the

stud

ies

tow

ards

the

elde

rly

3.1.

4. C

reat

ion

of w

ritt

en a

nd v

isua

lm

ater

ials

as

wel

l as

vide

os

1. R

ate

of th

e el

derl

y th

atre

ceiv

es e

duca

tion

2. P

erio

dica

lly

and

prop

erly

Impl

emen

tati

on o

f ed

ucat

ion

1. I

ncre

ase

in th

e nu

mbe

r of

the

orga

niza

tion

s he

ld in

spec

ial d

ays

and

wee

ks

2. A

llow

ing

for

the

rela

ted

acti

viti

es in

the

web

site

s of

Min

istr

y of

Hea

lth

3.P

erio

dica

lly

and

prop

erly

impl

emen

tati

on o

f ed

ucat

ion

For

mat

ion

of w

ebsi

tes

aim

ed a

t the

eld

erly

hea

lth

Aw

aren

ess-

rais

ing

rate

of th

e el

derl

y tr

aine

es

Incr

ease

rat

e in

awar

enes

s-ra

isin

g of

the

elde

rly

trai

nees

1. S

igni

fica

nt in

crea

sein

the

use

of M

inis

try

of H

ealt

h w

ebsi

te

2.In

crea

se r

ate

inaw

aren

ess-

rais

ing

ofth

e el

derl

y

Min

istr

y of

Hea

lth

1. M

inis

try

of H

ealt

h

2. M

inis

try

of F

amil

yan

d S

ocia

l Pol

icie

s

3. M

inis

try

of I

nter

nal

Aff

airs

4.M

inis

try

of N

atio

nal

Edu

cati

on

5.U

nive

rsit

ies

6.G

over

nora

tes

7.T

urki

sh R

adio

and

Tel

evis

ion

Cor

pora

tion

(TR

T)

8.N

GO

’s

Min

istr

y of

Hea

lth


26

Tar

get

3- I

mp

rove

men

t of

hea

lth

y li

fest

yle

in t

he

eld

erly

an

d t

he

soci

ety

Str

ateg

yA

ctiv

itie

sO

utp

ut

Ind

icat

ors

Res

ult

In

dic

ator

sR

esp

onsi

ble

In

stit

uti

onan

d O

rgan

izat

ion

Per

iod

3 ye

ars

3.1.

Rai

sin

g aw

aren

ess

of h

ealt

hy

life

styl

e in

th

e el

der

ly3.

1.5.

Coo

rdin

atio

n w

ith

the

Min

istr

y of

Hea

lth

of th

e tr

aini

ngac

tivi

ties

con

duct

ed b

y U

nive

rsit

ies

and

NG

O’s

tow

ards

for

the

publ

ic

1. N

umbe

r of

coo

rdin

ated

acti

viti

es, t

rain

ing,

etc

.

2. C

omm

unic

atio

n w

ith

the

inst

itut

ions

and

org

aniz

atio

nby

the

Min

istr

y of

Hea

lth

Incr

ease

rat

e in

soc

ial

awar

enes

s 1.

Min

istr

y of

Hea

lth

2. M

inis

try

of F

amil

yan

d S

ocia

l Pol

icie

s

3. M

inis

try

of I

nter

nal

Aff

airs

4. U

nive

rsit

ies

5.N

GO

2 ye

ars

3.1.

6. H

oldi

ng s

tudy

mee

ting

s fo

rpr

epar

atio

n of

the

trai

ning

mat

eria

lsab

out h

ealt

hy a

ging

for

indi

vidu

als

1. T

rain

ing

mat

eria

ls a

bout

heal

thy

agin

g pr

epar

ed f

orin

divi

dual

s

2. P

rint

ing

and

dist

ribu

tion

of tr

aini

ng m

ater

ials

abo

uthe

alth

y ag

ing

prep

ared

for

indi

vidu

als

Aw

aren

ess

surv

eys

and

life

qua

lity

sur

veys

(eve

ry 5

yea

rs)

1. M

inis

try

of H

ealt

h

2. M

inis

try

of I

nter

nal

Aff

airs

3. M

inis

try

of N

atio

nal

Edu

cati

on

4. U

nive

rsit

ies

5.N

GO


27

Tar

get

3- I

mp

rove

men

t of

hea

lth

y li

fest

yle

in t

he

eld

erly

an

d t

he

soci

ety

Str

ateg

yA

ctiv

itie

sO

utp

ut

Ind

icat

ors

Res

ult

In

dic

ator

sR

esp

onsi

ble

In

stit

uti

onan

d O

rgan

izat

ion

Per

iod

2 ye

ars

3.2.

Rai

sin

g aw

aren

ess

abou

th

ealt

hy

agin

g in

th

e so

ciet

y3.

2.1.

All

owin

g fo

r th

eco

mm

unic

atio

n ca

mpa

igns

rel

ated

to o

ld a

ge a

nd e

lder

ly h

ealt

h th

emes

to b

e co

nduc

ted

by th

e M

inis

try

ofH

ealt

h

1. I

nclu

ding

the

old

age

and

the

elde

rly

heal

th th

emes

inth

e ca

mpa

igns

of

the

Min

istr

y of

Hea

lth

2.A

llow

ing

for

the

old

age

and

the

elde

rly

heal

thth

emes

in th

e re

late

dco

mm

unic

atio

n ca

mpa

ign

ofth

e M

inis

try

of H

ealt

hpe

riod

ical

ly

Aw

aren

ess

surv

eys

and

life

qua

lity

sur

veys

(eve

ry 5

yea

rs)

Min

istr

y of

Hea

lth

3 ye

ars

3.2.

2. A

ddin

g th

ein

form

atio

n/ed

ucat

ion

rela

ted

tohe

alth

y ag

ing

and

com

mun

icat

ion

wit

h th

e el

derl

y in

to th

e cu

rric

ula

ofpr

imar

y sc

hool

s

1. A

llow

ing

for

the

rele

vant

subj

ects

in th

e fu

ndam

enta

ltr

aini

ng p

rogr

ams

of th

eM

inis

try

of N

atio

nal

Edu

cati

on p

rope

rly

and

peri

odic

ally

2. A

rran

gem

ent o

f so

cial

acti

viti

es f

or th

e re

leva

ntsu

bjec

ts r

elat

ed to

old

age

incl

uded

in th

e fu

ndam

enta

ltr

aini

ng p

rogr

ams

1. A

war

enes

s su

rvey

s

2. R

ate

of s

choo

lsar

rang

ing

soci

alac

tivi

ties

for

the

subj

ects

rel

ated

to o

ldag

e

1. M

inis

try

ofN

atio

nal E

duca

tion

2. M

inis

try

of H

ealt

h

3. M

inis

try

of F

amil

yan

d S

ocia

l P

olic

ies

3 ye

ars

3.2.

3. A

llow

ing

for

the

proj

ects

unde

r th

e he

alth

titl

e in

the

proj

ect-

base

d co

mpe

titi

ons

cond

ucte

d by

the

Min

istr

y of

Nat

iona

l Edu

cati

on

Sub

mis

sion

of

the

subj

ect-

rela

ted

proj

ects

Num

ber

of p

roje

cts

inth

e re

late

dco

mpe

titi

ons

1. M

inis

try

ofN

atio

nal E

duca

tion

2. M

inis

try

of H

ealt

h


28

Tar

get

3- I

mp

rove

men

t of

hea

lth

y li

fest

yle

in t

he

eld

erly

an

d t

he

soci

ety

Str

ateg

yA

ctiv

itie

sO

utp

ut

Ind

icat

ors

Res

ult

In

dic

ator

sR

esp

onsi

ble

In

stit

uti

onan

d O

rgan

izat

ion

Per

iod

3 ye

ars

3.2.

Rai

sin

g aw

aren

ess

abou

th

ealt

hy

agin

g in

th

e so

ciet

y3.

2.4.

Pro

mot

ing

and

All

ocat

ing

reso

urce

s to

the

proj

ects

in w

hich

univ

ersi

ty s

tude

nts

and

the

elde

rly

take

par

t tog

ethe

r

1. N

umbe

r of

pro

posa

l mad

eto

the

rele

vant

inst

itut

ions

2. F

orm

atio

n of

sub

-uni

ts in

univ

ersi

ties

for

ens

urin

gin

tegr

atio

n an

dco

mm

unic

atio

n be

twee

nge

nera

tion

s

Impl

emen

tati

on a

nsu

stai

nabi

lity

of

the

proj

ects

in w

hich

univ

ersi

ty s

tude

nts

and

the

elde

rly

take

par

tto

geth

er

1. M

inis

try

of H

ealt

h

2. M

inis

try

of F

amil

yan

d S

ocia

l Pol

icie

s

3. M

inis

try

of N

atio

nal

Edu

cati

on

4. M

inis

try

of I

nter

nal

Aff

airs

5.U

nive

rsit

ies

3 ye

ars

3.2.

5. P

rovi

ding

the

impl

emen

tati

onof

in-s

ervi

ce tr

aini

ng p

rogr

ams

abou

t hea

lthy

and

suc

cess

full

yag

ing

in w

orkp

lace

s

Pre

para

tion

and

impl

emen

tati

on o

f in

-ser

vice

trai

ning

pro

gram

s ab

out

heal

thy

and

succ

essf

ully

agin

g in

wor

kpla

ces

Aw

aren

ess

surv

eys

and

life

qua

lity

sur

veys

(Eve

ry 5

yea

rs)

1. M

inis

try

of H

ealt

h

2. M

inis

try

of L

abou

ran

d S

ocia

l Sec

urit

y

2 ye

ars

3.2.

6. P

repa

rati

on o

f m

ater

ials

abo

uthe

alth

y ag

ing

for

the

heal

th c

are

prov

ider

s

Hol

ding

mee

ting

s fo

rpr

epar

atio

n of

mat

eria

lsab

out h

ealt

hy a

ging

for

the

heal

th c

are

prov

ider

s ı

Pri

ntin

g an

dD

istr

ibut

ion

ofm

ater

ials

1. M

inis

try

of H

ealt

h

2.U

nive

rsit

ies

3. N

GO


29

Tar

get

4- M

akin

g n

eces

sary

arr

ange

men

ts f

or t

he

esta

bli

shm

ent

of a

saf

e an

d h

ealt

hy

envi

ron

men

t fo

r th

e el

der

ly

Str

ateg

yA

ctiv

itie

sO

utp

ut

Ind

icat

ors

Res

ult

In

dic

ator

sR

esp

onsi

ble

In

stit

uti

onan

d O

rgan

izat

ion

Per

iod

Per

iodi

c

4.1.

En

suri

ng

a sa

fe a

nd

hea

lth

yen

viro

nm

ent

for

the

eld

erly

insi

de

and

ou

tsid

e of

hom

e

4.1.

1. P

repa

rati

on o

f m

ater

ial a

ndtr

aini

ngs

that

wil

l rai

se a

war

enes

s in

the

soci

ety

in th

e su

bjec

t of

ensu

ing

the

heal

thy

envi

ronm

ent c

ondi

tion

sin

side

hom

e fo

r th

e el

derl

y

Rel

evan

t mod

ule

in th

eE

lder

ly H

ealt

h D

iagn

osis

and

Tre

atm

ent G

uide

of

the

Min

istr

y of

Hea

lth

Use

of

the

rele

vant

mat

eria

ls a

nddi

stri

buti

on o

f pr

int

mat

eria

l

1. M

inis

try

of H

ealt

h

2.U

nive

rsit

ies

2 ye

ars

4.1.

2. R

evie

w o

f H

ome

Car

eS

ervi

ces

Reg

ulat

ions

and

prep

arat

ion

of p

erso

nnel

trai

ning

sfo

r en

suri

ng a

hea

lthy

and

saf

een

viro

nmen

t in

hom

e ca

re s

ervi

ces

1. R

elev

ant m

odul

e in

the

Eld

erly

Hea

lth

Dia

gnos

isan

d T

reat

men

t Gui

de o

f th

eM

inis

try

of H

ealt

h

2.U

se o

f th

e tr

aini

ngm

ater

ials

com

pris

ed o

f th

ere

leva

nt tr

aini

ng m

odul

es o

fun

iver

siti

es a

nd f

orm

atio

nof

pri

nt m

ater

ials

Use

of

the

rele

vant

mat

eria

ls a

nddi

stri

buti

on o

f pr

int

mat

eria

l

1. M

inis

try

of H

ealt

h

2. U

nive

rsit

ies

Per

iodi

c

4.1.

3. P

rovi

sion

of

trai

ning

s by

Hea

lth

Car

e P

rofe

ssio

nals

abo

uten

suri

ng a

hea

lthy

and

saf

een

viro

nmen

t con

diti

ons

insi

de h

ome

to th

e el

derl

y

Hol

ding

mee

ting

s re

late

d to

the

subj

ect

Num

ber

of th

e el

derl

ytr

aine

es1.

Min

istr

y of

Hea

lth

2. M

inis

try

of F

amil

yan

d S

ocia

l Pol

icie

s

3.U

nive

rsit

ies

4. N

GO

1.2. IMPROVEMENT OF EXERCISE, PHYSICAL ACTIVITY AND REHABILITATION

SERVICES FOR ELDERLY

Current Situation in the World and Turkey

Regular activity and exercise habits of the elderly are the most important determinants of short and

long-term healthy aging. Physical activity is important for the elderly health by preventing the incidence

of the diseases seen in old age.

Stating that physical activity is one of the important factors for health aging, the World Health

Organization (WHO) asserts that regular physical activity improves physical and social well-being of the

people over 65 and prevents them from the risk of injury and catching illnesses. In addition to this, it is

also stated that physical activity made by the elderly reduces the risk of injury, strengthens mental and

cognitive competence and also contributes socialization (10).

Active living improves mental health of older people, reducing the risk of falls, promotes social

interaction and help them to remain as independent as possible. So the elderly people obtain economic

benefits and their medical expenses significantly reduce as long as they continue to be physically active

(11). Regular physical activity reflects the lifestyles as an important factor in maintaining the body's

health. An effective physical activity program; improves strength, speed, endurance, balance, physical

and mental functions and quality of life (12).

When a society profile, who is more dependent and has lost the joy of life and whose physical

capacity and functional status have reduced, appears, morbidity and mortality rates in the elderly increase,

the share allocated to health spending grows, the productivity decreases and more care staff are needed

for the elderly care.

These problems in the elderly population brings a serious burden on the economy and productivity

levels of the country. Today, many countries around the world, especially the ones in Europe, make urgent

action plans for the solution and implement the promotion of the physical activity in the elderly as a

priority health policy.

Examples from the World

As well as preventing obesity, physical activity contribute to the well-being situation in terms of

physically and mentally sense. The researches show that physical activity reduce the risks of heart attack

type 2 diabetes by 50 percent and this reduction may also be applicable for high blood pressure and certain

cancers (13).

Furthermore, physical activity reduce stress, anxiety and depression risks. Sedentary lifestyle and

smoking may cause deaths (14). Many researches have been conducted towards the effect of physical

activity on fall, fear of falling and fractures. The studies related to activity show that physical activity

reduce the falls by at least 30 percent (15).


30

In a research conducted in Europe, sedentary lifestyle is shown to be cause of 5,5 percent of

coronary diseases, 6,8 percent of diabetes, 9,3 percent of breast cancer, 9,3 percent of colon cancer and

8,8 percent of all deaths (16). The World Health Organization states that 1 million deaths in the European

Region arise from insufficient physical activity (13). 30 percent of Americans over 65 years was found

to make regular physical activity and taking this rate to 60 percent is projected as a target (17).

Examples from our Country

Within the scope of “Status of Elderly and National Action Plan for Ageing” plan which was

completed in 2007 and with the projects, study meetings and the reports of these which were carried out

after then, such issues as “Home Care Services”, “Chronic Obstructive Disease Care Services" and

"Obesity Prevention and Activity" were focused on. The subject of exercise in the elderly was included

in the physical activity guideline within the framework of “Turkey Healthy Nutrition and Active Life

Program”.

Gaining the exercise habits to the elderly individuals helps the protection of their functional

performance levels, thus the levels of daily life of activity level. The studies show that the elderly with

physical activity habits have longer, healthier and better health levels than the individuals living a

sedentary life. Small gains in functional levels may lead to significant changes at functional levels.

Therefore, that the elderly are encouraged and motivated to exercise within the framework of home care

positively affects their physical and psychosocial health outcomes and the development of well-being

status.

When elderly patients, rehabilitation when the return home is discharged home and environmental

arrangements for people to cope with the problems of the natural life and to minimize the obstacles

independent restricting the movement should continue with target home rehabilitation programs.

Comprehensive Geriatric Assessment for seniors who are at risk and after the multi-dimensional program

of preventive home visits, mortality rate, with reference to the functional loss or retirement homes and

nursing homes are known to have positive effects.


31


32

Target and Strategies towards the Improvement of Exercise, Physical Activity and Rehabilitation

Service for the Elderly

Target 1- Creation of knowledge level and social awareness in increasing physical activity and

preventing sedentary lifestyle for healthy aging

Strategy 1

Ensuring to improve social consciousness and to raise social awareness of all age groups in society

about the importance of physical activity for healthy aging

Strategy 2

Increasing social involvement and improving social responsibility projects about old age and aging

in society

Strategy 3

In the joint works to be conducted through or with universities or other scientific organizations or

professional associations, to increase the knowledge related to healthy aging and physical activity and

the scientific researches thereof and to support universities, institutions and organizations working

on this subject

Target 2- Prevention of chronic diseases arising frequently in old age or aging-associated

diseases, implementation of studies related to cost effectiveness and reduction of health spending

Strategy 1

Development of targets towards the prevention of musculoskeletal and chronic diseases related to

aging and increasing social awareness on this matter

Strategy 2

Prevention of chronic diseases and changes occurred in musculoskeletal and other systems in old age

through exercise, physical activity, recreational activities and sports


33

Strategy 3

Reduction of elderly care costs, number of the elderly requiring constant care due to chronic diseases,

frequency and duration of hospitalization and hospital admissions in chronic diseases

Target 3- Development of preventive and rehabilitative approaches towards determination of

risk factors that may cause loss of balance, fall and fear of falling in the elderly

Strategy 1

Training about balance and fall, and understanding of the importance of physical activity and exercises

in the subject of prevention of falls and fractures and development of service related to these issues

Target 4- Determination of rehabilitation needs and development of all rehabilitation services

including professional and social rehabilitations for the dependent or semi-dependent elderly

people in activities of daily living and social participation

Strategy 1

Determination of needs of the elderly who are dependent or semi-dependent in activities of daily

living or social participation

Strategy 2

Development of special rehabilitation approaches for the elderly with higher mortality and morbidity

risks and arrangement of physical activity programs to increase social participation

Strategy 3

Development or health tourism and rehabilitation services in order for our elderly citizens living

abroad to receive the elderly care services in our country or for the foreign elderly people to benefit

from the health care and rehabilitation services provided in our country with short and long term

periods


34

1.2.

Im

pro

vem

ent

of E

xerc

ise,

Ph

ysic

al A

ctiv

ity

and

Reh

abil

itat

ion

Ser

vice

s fo

r E

lder

ly

Tar

get

1- C

reat

ion

of

kn

owle

dge

leve

l an

d s

ocia

l aw

aren

ess

in in

crea

sin

g p

hys

ical

act

ivit

y an

d p

reve

nti

ng

sed

enta

ry li

fest

yle

for

hea

lth

y ag

ing

Str

ateg

y

1.1.

En

suri

ng

toim

pro

ve s

ocia

lco

nsc

iou

snes

s an

d t

ora

ise

soci

al a

war

enes

sof

all

age

gro

up

s in

soci

ety

abou

t th

eim

por

tan

ce o

f p

hys

ical

acti

vity

for

hea

lth

yag

ing

1.1.

1. D

evel

opm

ent o

f cu

rric

ula

for

norm

alag

ing

proc

ess,

hea

lthy

agi

ng a

nd p

hysi

cal

acti

vity

in p

rim

ary,

sec

onda

ry a

nd h

ighe

red

ucat

ion

inst

itut

ions

; rai

sing

aw

aren

ess

onth

is is

sue

thro

ugh

book

s, b

roch

ures

and

intr

oduc

tory

con

fere

nce

1. C

ours

e, c

ours

eco

nten

t giv

en a

ndnu

mbe

r of

stu

dent

s in

prim

ary,

sec

onda

ry a

ndhi

gher

edu

cati

onin

stit

utio

ns2.

Num

ber

and

cont

ents

of th

e ed

ucat

ion

mee

ting

s he

ld to

info

rmth

e tr

aine

rs a

nd te

ache

rs

3.N

umbe

r of

boo

kspr

inte

d in

sch

ools

for

prom

otio

n an

din

form

atio

n or

num

ber

and

cont

ent o

f th

e vi

sual

mat

eria

ls p

repa

red

(sli

des,

vid

eo, f

ilm

, etc

.)

1. Y

oung

gen

erat

ion

that

know

the

impo

rtan

ce o

fex

erci

se a

nd p

hysi

cal

acti

vity

on

heal

thy

agin

gas

a r

esul

t of

deve

lopi

ngpo

siti

ve a

ppro

ache

s to

the

elde

rly

begi

nnin

g fr

ompr

imar

y sc

hool

s 2.

You

ng p

eopl

e w

ho h

ave

unde

rsto

od th

eim

port

ance

of

acti

veag

ing

and

prep

are

them

selv

es f

or th

e fu

ture

wit

h th

is c

onsc

ious

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Int

erna

lA

ffai

rs3.

Min

istr

y of

Nat

iona

lE

duca

tion

4. M

inis

try

of F

amil

y an

dS

ocia

l Pol

icie

s5.

Min

istr

y of

Dev

elop

men

t6.

Und

erse

cret

aria

t of

Tre

asur

y 7.

SG

K8.

Ins

titu

te o

f P

opul

atio

nS

tudi

es9.

YO

K10

.Uni

vers

itie

s11

. TR

T12

. Pre

ss a

ndB

road

cast

ing

Org

aniz

atio

ns13

. NG

O

3 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


35

Tar

get

1- C

reat

ion

of

kn

owle

dge

leve

l an

d s

ocia

l aw

aren

ess

in in

crea

sin

g p

hys

ical

act

ivit

y an

d p

reve

nti

ng

sed

enta

ry li

fest

yle

for

hea

lth

y ag

ing

Str

ateg

y

1.1.

En

suri

ng

toim

pro

ve s

ocia

lco

nsc

iou

snes

s an

d t

ora

ise

soci

al a

war

enes

sof

all

age

gro

up

s in

soci

ety

abou

t th

eim

por

tan

ce o

f p

hys

ical

acti

vity

for

hea

lth

yag

ing

1.1.

2. R

aisi

ng a

war

enes

s in

som

epr

ofes

sion

al a

nd e

duca

tion

al o

rgan

izat

ions

(mil

itar

y tr

aini

ng, p

olic

e, te

ache

r, e

tc.)

and

othe

r o

rgan

izat

ions

(no

n-go

vern

men

tal

orga

niza

tion

s or

pro

fess

iona

l ass

ocia

tion

s)ab

out o

ld a

ge, h

ealt

hy a

ging

and

phy

sica

lac

tivi

ty

Num

ber

and

cont

ent o

fth

e tr

aini

ng r

elat

ed to

soci

al p

arti

cipa

tion

, car

ean

d aw

aren

ess

tow

ard

the

elde

rly

peop

le w

hich

are

give

n to

sol

dier

sdu

ring

mil

itar

y, s

ervi

ce,

to p

olic

e an

d te

ache

rs

1. E

nhan

ced

know

ledg

eof

pro

fess

iona

ls a

nd N

GO

abou

t the

eld

erly

and

elde

rly

care

2. S

ocie

ty w

ith

the

incr

ease

d nu

mbe

r of

pers

ons

who

can

pla

yro

les

in s

ocia

lre

spon

sibi

lity

pro

ject

sre

late

d to

the

elde

rly

heal

th a

nd c

are

3. S

urve

ys c

ondu

cted

for

cont

roll

ing

the

soci

alaw

aren

ess

and

thei

rre

sult

s

1.1.

3. R

aisi

ng s

ocia

l aw

aren

ess

abou

t nor

mal

agin

g pr

oces

s, a

ctiv

e an

d he

alth

y ag

ing

thro

ugh

pres

s an

d br

oadc

asti

ng o

rgan

izat

ions

,fo

rmat

ion

of m

odel

s w

ith

the

exam

ples

of

acti

ve a

nd h

ealt

hy e

lder

ly p

eopl

e

1. N

umbe

r an

d co

nten

tof

art

icle

s an

din

terv

iew

s fo

und

in th

epr

int m

edia

rel

ated

toth

is s

ubje

ct2.

Num

ber

ofpr

ogra

mm

es, d

ebat

esan

d di

scus

sion

s in

vis

ual

and

audi

tory

med

ia(r

adio

and

tele

visi

on)

rela

ted

to th

is s

ubje

ct,

rati

ngs

of th

ese

prog

ram

mes

or

the

nega

tive

or

posi

tive

crit

ique

s fr

om m

edia

1. E

lder

ly in

divi

dual

sw

ith

an e

nhan

ced

cons

ciou

s of

exe

rcis

e2.

Eld

erly

indi

vidu

als

wit

h su

ffic

ient

and

enha

nced

phy

sica

l act

ivit

yle

vel

3.E

lder

ly in

divi

dual

sw

ith

enha

nced

fun

ctio

nal

acti

vity

, dev

elop

ed q

uali

tyof

life

, bei

ng f

ar f

rom

soci

al is

olat

ion

4.S

ocie

ty w

hose

eld

erly

peop

le a

re m

ore

acti

vean

d pr

oduc

tive

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Int

erna

lA

ffai

rs3.

Min

istr

y of

Nat

iona

lE

duca

tion

4. M

inis

try

of F

amil

y an

dS

ocia

l Pol

icie

s5.

Min

istr

y of

Dev

elop

men

t6.

Und

erse

cret

aria

t of

Tre

asur

y 7.

SG

K8.

Ins

titu

te o

f P

opul

atio

nS

tudi

es9.

YO

K10

. Uni

vers

itie

s11

.TR

T12

. Pre

ss a

ndB

road

cast

ing

Org

aniz

atio

ns13

. NG

O

3 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


36

Tar

get

1- C

reat

ion

of

kn

owle

dge

leve

l an

d s

ocia

l aw

aren

ess

in in

crea

sin

g p

hys

ical

act

ivit

y an

d p

reve

nti

ng

sed

enta

ry li

fest

yle

for

hea

lth

y ag

ing

Str

ateg

y

1.2.

In

crea

sin

gso

cial

invo

lvem

ent

and

imp

rovi

ng

soci

alre

spon

sib

ilit

yp

roje

cts

abou

t ol

dag

e an

d a

gin

g in

soci

ety

1.2.

1. B

egin

ning

fro

mpr

imar

y sc

hool

,en

suri

ng th

at th

e st

uden

tgr

oups

of

vari

ous

ages

spen

d th

eir

tim

es b

yco

ntri

buti

ng to

the

dail

yca

r an

d li

ving

act

ivit

ies

of th

e el

derl

y es

peci

ally

in n

ursi

ng h

ome

and

reti

rem

ent h

omes

, and

incr

easi

ng o

f so

cial

part

icip

atio

n ar

eas

1. N

umbe

r of

pri

mar

y, s

econ

dary

and

high

er e

duca

tion

inst

itut

ions

whe

re th

e y

oung

and

eld

erly

spe

ndti

me

toge

ther

and

mak

e so

cial

part

icip

atio

n, a

nd th

e fe

atur

e an

dfr

eque

ncy

of th

is s

ocia

lpa

rtic

ipat

ion

2.N

umbe

r of

the

stud

ents

pla

ying

role

in s

ocia

l res

pons

ibil

ity

proj

ects

rela

ted

to th

e el

derl

y an

d fe

edba

ckre

ceiv

ed f

rom

thes

e st

uden

ts a

ndfe

edba

cks

and

sati

sfac

tion

sur

veys

rece

ived

fro

m th

e el

derl

y in

the

sam

e w

ay

1. T

he e

lder

ly w

ith

enha

nced

com

mun

icat

ion

wit

h th

e yo

ung

2. T

he y

oung

wit

h en

hanc

edco

mm

unic

atio

n w

ith

the

elde

rly

3. T

he e

lder

ly w

ith

redu

ced

heal

thpr

oble

ms

aris

ing

from

soc

ial i

sola

tion

4. T

he in

divi

dual

s in

the

soci

ety,

youn

g, e

lder

ly a

nd c

hild

ren,

who

hav

ele

arne

d to

hel

p ea

ch o

ther

, lea

rnto

geth

er a

nd s

pend

som

e ti

me

toge

ther

5. T

he e

lder

ly w

ith

enha

nced

rol

e an

dac

tivi

ty in

the

soci

ety

6. S

cale

s ev

alua

ting

psy

cho-

soci

al s

tatu

s

7. S

cale

s ev

alua

ting

qua

lity

of

life

8.S

cale

s ev

alua

ting

life

sat

isfa

ctio

n,w

ell-

bein

g an

d li

fe h

appi

ness

1.2.

2. D

evel

opm

ent o

fm

anda

tory

soc

ial

resp

onsi

bili

ty p

roje

cts

and

the

join

t pro

ject

sw

ith

the

elde

rly

in th

ecu

rric

ula

of s

econ

dary

and

high

er e

duca

tion

inst

itut

ions

1. N

umbe

r of

sch

ools

per

form

ing

soci

al r

espo

nsib

ilit

y pr

ojec

ts a

ndnu

mbe

r of

teac

hers

taki

ng p

art i

nth

ese

proj

ects

2. N

umbe

r, f

eatu

res

and

scop

e of

proj

ects

to b

e pe

rfor

med

in th

issu

bjec

t in

scho

ols,

and

the

resu

lts

ofth

ese

proj

ects

3. S

tati

stic

s, r

ecor

ds a

nd r

epor

ts o

fjo

int p

roje

cts

that

are

per

form

edw

ith,

inst

itut

ions

or

non-

gove

rnm

enta

l or

gani

zati

ons

wor

king

wit

h th

e el

derl

y,m

unic

ipal

itie

s, n

ursi

ng h

omes

1. T

he y

oung

that

kno

w n

orm

al c

ours

eof

old

age

and

the

prob

lem

s th

at m

ayar

ise

in c

onne

ctio

n w

ith

old

age

2. T

he y

oung

wit

h a

deve

lope

d se

nse

ofso

cial

res

pons

ibil

ity,

look

ing

afte

r an

dsu

ppor

ting

the

elde

rly

3. T

he y

oung

who

pla

y ro

le in

the

care

or th

e su

ppor

t of

the

elde

rly

and

in th

eco

mm

unit

y he

alth

, and

hav

e cr

eate

d an

acti

ve h

uman

pow

er w

hich

has

bec

ome

a pr

oble

m in

the

care

of

the

elde

rly

4. S

urve

ys r

elat

ed to

the

effi

cien

cy o

fso

cial

par

tici

pati

on

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Int

erna

lA

ffai

rs3.

Min

istr

y of

Nat

iona

lE

duca

tion

4. M

inis

try

of F

amil

y an

dS

ocia

l Pol

icie

s5.

Min

istr

y of

Dev

elop

men

t6.

Und

erse

cret

aria

t of

Tre

asur

y 7.

SG

K8.

Inst

itut

e of

Pop

ulat

ion

Stu

dies

9. Y

OK

10. U

nive

rsit

ies

11. T

RT

12. P

ress

and

Bro

adca

stin

gO

rgan

izat

ions

13

. NG

O

3 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


37

Tar

get

1- C

reat

ion

of

kn

owle

dge

leve

l an

d s

ocia

l aw

aren

ess

in in

crea

sin

g p

hys

ical

act

ivit

y an

d p

reve

nti

ng

sed

enta

ry li

fest

yle

for

hea

lth

y ag

ing

Str

ateg

y

1.3.

In

th

e jo

int

wor

ks

to b

eco

nd

uct

edth

rou

gh o

r w

ith

un

iver

siti

es o

rot

her

sci

enti

fic

orga

niz

atio

ns

orp

rofe

ssio

nal

asso

ciat

ion

s, t

oin

crea

se t

he

kn

owle

dge

rel

ated

to h

ealt

hy

agin

gan

d p

hys

ical

acti

vity

an

d t

he

scie

nti

fic

rese

arch

es t

her

eof

and

to

sup

por

tu

niv

ersi

ties

,in

stit

uti

ons

and

orga

niz

atio

ns

wor

kin

g on

th

issu

bje

ct

1.3.

3. C

reat

ion

ofsc

ient

ific

dat

abas

e of

the

elde

rly

and

soci

ety

wit

hth

e st

udie

s to

be

cond

ucte

d w

ith

univ

ersi

ties

, the

rel

evan

tin

stit

utio

ns a

ndor

gani

zati

ons

and

prof

essi

onal

asso

ciat

ions

Sur

veys

con

duct

ed b

y un

iver

siti

esw

ith

the

othe

r re

leva

nt in

stit

utio

nsan

d or

gani

zati

ons

and

prof

essi

onal

asso

ciat

ion

or s

urve

ys o

r sc

reen

ing

stud

ies

cond

ucte

d by

eac

hin

stit

utio

n in

depe

nden

tly,

or

com

para

tive

stu

dies

per

form

ed b

yag

e, g

ende

r an

d re

gion

s, a

ndst

atis

tica

l res

ults

of

thes

e st

udie

s

1.E

nhan

ced

scie

ntif

ic d

atab

ase

on th

eel

derl

y

2.S

ocie

ty th

at h

as a

mor

e lo

cal a

ndhe

alth

ier

agin

g gu

idel

ine

arra

nged

acco

rdin

g to

Tur

key

prof

ile

1.3.

4. P

rovi

sion

of

impl

emen

tati

on o

fpo

stgr

adua

te r

esea

rch

and

thes

is r

elat

ed to

this

issu

e in

uni

vers

itie

s an

dsh

arin

g th

e re

sult

s of

mul

tidi

scip

lina

ry s

tudi

es

1.R

esul

t of

mor

e re

sear

ches

rel

ated

toel

derl

y an

d he

alth

y ag

ing

2. C

lini

cal p

ract

ices

tow

ards

incr

easi

ngol

d ag

e an

d el

derl

y he

alth

or

mor

esc

ient

ific

bas

is f

or s

ocie

ty-b

ased

stu

dies

3. N

umbe

r of

the

elde

rly

who

se q

uali

tyof

life

is m

easu

red

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Int

erna

lA

ffai

rs3.

Min

istr

y of

Nat

iona

lE

duca

tion

4. M

inis

try

of F

amil

y an

dS

ocia

l Pol

icie

s5.

Min

istr

y of

Dev

elop

men

t6.

Und

erse

cret

aria

t of

Tre

asur

y 7.

SG

K8.

Inst

itut

e of

Pop

ulat

ion

Stu

dies

9. Y

OK

10. U

nive

rsit

ies

11. T

RT

12. P

ress

and

Bro

adca

stin

gO

rgan

izat

ions

13

. NG

O

3 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n

1.R

epor

ts o

f th

eses

con

duct

ed a

tth

e gr

adua

te o

r p

ostg

radu

ate

leve

lsor

the

prin

t mat

eria

ls d

eriv

ed f

rom

thes

e (a

rtic

les,

boo

ks, o

ral o

r po

ster

pres

enta

tion

s or

sum

mar

ies

of th

ese

pres

enta

tion

s)

2. O

utpu

ts o

r su

rvey

res

ults

dem

onst

rati

ng th

e ef

fect

s of

res

ults

aris

ing

from

the

rese

arch

es a

ndth

eses

on

elde

rly

nurs

ing

hom

e an

dpu

blic

hea

lth

3. N

umbe

r of

stu

dies

, res

earc

hes,

proj

ects

and

thes

es c

ondu

cted

on

this

sub

ject

, fee

dbac

ks o

f st

uden

tsan

d ot

her

rese

arch

ers,

res

ults

of

thes

is a

nd s

tudi

es

4. N

umbe

r an

d ra

tes

of s

ocie

ty-

base

d or

ent

erpr

ise-

base

d pr

ojec

ts


38

Tar

get

2-

Pre

ven

tion

of

chro

nic

dis

ease

s ar

isin

g fr

equ

entl

y in

old

age

or

agin

g-as

soci

ated

dis

ease

s, i

mp

lem

enta

tion

of

stu

die

s re

late

d t

o co

stef

fect

iven

ess

and

red

uct

ion

of

hea

lth

sp

end

ing

Str

ateg

y

2.1.

Dev

elop

men

t of

targ

ets

tow

ard

s th

ep

reve

nti

on o

fm

usc

ulo

skel

etal

an

dch

ron

ic d

isea

ses

rela

ted

to

agin

g an

din

crea

sin

g so

cial

awar

enes

s on

th

ism

atte

r

2.1.

1. I

nfor

min

g th

e so

ciet

y of

the

dise

ases

aris

ing

freq

uent

ly in

old

age

or

agin

g-as

soci

ated

dis

ease

2.1.

2. U

sing

pre

ss a

nd m

edia

in in

form

ing

abou

t the

har

mfu

l eff

ects

of

inac

tivi

ty a

ndse

dent

ary

life

on

deve

lopm

ent o

f ch

roni

cdi

seas

es

2.1.

3.E

stab

lish

men

t of

awar

enes

s ab

out

phys

ical

act

ivit

y an

d de

sire

1.R

esul

ts o

f su

rvey

sm

easu

ring

the

know

ledg

e le

vel o

nch

roni

c di

seas

es

2. T

UIK

rec

ords

3. A

rtic

les,

pro

gram

mes

and

intr

oduc

tory

fil

ms

publ

ishe

d in

pre

ss a

ndm

edia

1. S

ocie

ty h

avin

g m

ore

and

accu

rate

info

rmat

ion

on c

hron

ic d

isea

ses

2. S

ocie

ty k

now

ing

the

harm

ful e

ffec

ts o

fse

dent

ary

life

and

phys

ical

act

ivit

y on

chro

nic

dise

ases

3. I

ndiv

idua

ls w

ho k

now

and

havi

ng e

nhan

ced

awar

enes

s ab

out t

hepo

siti

ve e

ffec

ts o

fph

ysic

al a

ctiv

ity

onch

roni

c di

seas

es

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Int

erna

lA

ffai

rs3.

Min

istr

y of

Nat

iona

lE

duca

tion

4. M

inis

try

of F

amil

y an

dS

ocia

l Pol

icie

s5.

Min

istr

y of

Dev

elop

men

t6.

Und

erse

cret

aria

t of

Tre

asur

y 7.

SG

K8.

Ins

titu

te o

f P

opul

atio

nS

tudi

es9.

YO

K10

.Uni

vers

itie

s11

. TR

T12

. Pre

ss a

ndB

road

cast

ing

Org

aniz

atio

ns13

. NG

O

3 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


39

Tar

get

2-

Pre

ven

tion

of

chro

nic

dis

ease

s ar

isin

g fr

equ

entl

y in

old

age

or

agin

g-as

soci

ated

dis

ease

s, i

mp

lem

enta

tion

of

stu

die

s re

late

d t

o co

stef

fect

iven

ess

and

red

uct

ion

of

hea

lth

sp

end

ing

Str

ateg

y

2.2.

Pre

ven

tion

of

chro

nic

dis

ease

s an

dch

ange

s oc

curr

ed in

mu

scu

losk

elet

al a

nd

oth

er s

yste

ms

in o

ldag

e th

rou

gh e

xerc

ise,

ph

ysic

al a

ctiv

ity,

recr

eati

onal

act

ivit

ies

and

sp

orts

2.2.

1. C

reat

ion

of m

odel

pro

gram

sre

late

d to

the

bene

fits

of

exer

cise

2.2.

2. D

evel

opm

ent o

f el

derl

yex

erci

se p

rogr

ams

on lo

cal a

ndco

mm

unit

y ba

sis

2.2.

3. E

ncou

rage

men

t of

phys

ical

acti

vity

by

orga

nizi

ng e

lder

ly jo

urna

ls

2.2.

4. E

stab

lish

men

t of

prog

ram

sen

suri

ng e

lder

ly p

eer

trai

ning

s

2.2.

5. E

stab

lish

men

t of

prog

ram

spr

omot

ing

recr

eati

onal

act

ivit

ies

and

spor

ts

2.2.

6. R

ecei

ving

sup

port

of

and

bein

gco

llab

orat

ion

wit

h th

e pe

ople

who

have

the

lead

er p

osit

ions

in th

eco

mm

unit

y on

the

subj

ect o

f sp

orts

,an

d es

tabl

ishm

ent p

rogr

ams

tow

ards

thes

e

2.2.

7. I

f po

ssib

le, e

stab

lish

men

t of

recr

eati

onal

act

ivit

y pr

ogra

ms

that

wil

l con

trib

ute

to p

rodu

ctio

n

1.N

umbe

r, m

onit

orin

gra

tes

and

rati

ngs

ofbo

okle

t, vi

deo

or m

ovie

ste

llin

g th

e po

siti

ve e

ffec

tsof

phy

sica

l act

ivit

y an

dex

erci

se o

n ch

roni

cdi

seas

es

2. N

umbe

r of

gui

debo

oks,

book

lets

and

leaf

lets

cont

aini

ng e

lder

ly e

xerc

ise

prog

ram

s on

loca

l and

com

mun

ity

basi

s

3. T

otal

num

ber

ofex

erci

se p

rogr

ams

prov

ided

in a

ll h

ealt

hin

stit

utio

ns, r

etir

emen

tho

mes

and

spo

rts

hall

s fo

rel

derl

y an

d to

pre

vent

chro

nic

dise

ases

and

num

ber

of p

eopl

ere

ceiv

ing

serv

ice

ther

ein

1. N

umbe

r of

eld

erly

taki

ngex

erci

se a

nd d

oing

phy

sica

lac

tivi

ty

2. E

lder

ly p

opul

atio

n do

ing

phys

ical

exe

rcis

e an

d ha

ving

enha

nced

soc

ial p

arti

cipa

tion

3. E

lder

ly in

divi

dual

s do

ing

regu

larl

y ph

ysic

al a

ctiv

ity

and

havi

ng e

nhan

ced

perf

orm

ance

4. N

umbe

r of

eld

erly

fee

ling

enha

nced

app

reci

atio

n fo

rso

cial

par

tici

pati

on

5. M

ore

inde

pend

ent a

ndha

ppie

r el

derl

y in

rec

reat

ion,

spor

ts a

nd a

ctiv

itie

s of

dai

lyli

ving

6. E

lder

ly h

avin

g en

hanc

edm

otiv

atio

n fo

r ph

ysic

al a

ctiv

ity

and

acti

ve li

ving

7. E

lder

ly in

divi

dual

s w

ith

mor

e pr

oduc

tive

abi

lity

inso

ciet

y an

d w

ith

less

depr

essi

on a

nd f

eeli

ngs

oflo

neli

ness

and

soc

ial i

sola

tion

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Int

erna

lA

ffai

rs3.

Min

istr

y of

Nat

iona

lE

duca

tion

4. M

inis

try

of F

amil

y an

dS

ocia

l Pol

icie

s5.

Min

istr

y of

Dev

elop

men

t6.

Und

erse

cret

aria

t of

Tre

asur

y 7.

SG

K8.

Ins

titu

te o

f P

opul

atio

nS

tudi

es9.

YO

K10

.Uni

vers

itie

s11

. TR

T12

. Pre

ss a

ndB

road

cast

ing

Org

aniz

atio

ns13

. NG

O

3 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


40

Tar

get 2

- Pre

ven

tion

of c

hro

nic

dis

ease

s ar

isin

g fr

equ

entl

y in

old

age

or

agin

g-as

soci

ated

dis

ease

s, im

ple

men

tati

on o

f stu

die

s re

late

d to

cos

t eff

ecti

ven

ess

and

red

uct

ion

of

hea

lth

sp

end

ing

Str

ateg

y

2.3.

Red

uct

ion

of

eld

erly

car

e co

sts,

nu

mb

er o

f th

e el

der

lyre

qu

irin

g co

nst

ant

care

du

e to

ch

ron

icd

isea

ses,

fre

qu

ency

and

du

rati

on o

fh

osp

ital

izat

ion

an

dh

osp

ital

ad

mis

sion

s in

chro

nic

dis

ease

s

2.3.

1.D

evel

opm

ent o

f ch

roni

cdi

seas

es p

reve

ntio

n pr

ogra

ms

tore

duce

hos

pita

l adm

issi

ons

2.3.

2.E

stab

lish

men

t of

unit

s th

atin

form

of

the

impo

rtan

ce o

f ex

erci

sein

trea

tmen

t of

chro

nic

dise

ases

2.3.

3.D

evel

opm

ent o

f ex

erci

sepr

ogra

ms

for

any

kind

of

chro

nic

dise

ases

2.3.

4.U

se o

f fi

nanc

ial b

enef

its

aris

ing

from

the

redu

ctio

n of

hea

lth

spen

ding

for

prep

arat

ion

of b

ookl

ets,

leaf

lets

and

othe

r st

atis

tica

l rep

orts

, and

subm

issi

on o

f th

ese

to th

e ne

cess

ary

inst

itut

ions

and

org

aniz

atio

ns a

nd f

orth

e in

form

atio

n of

com

mun

ity

1. F

amil

y pr

acti

ce a

ndpr

imar

y s

ervi

ce r

ecor

ds

2.R

ecor

ds o

f th

e pe

rson

sre

spon

sibl

e fo

r ho

me

care

serv

ices

3.R

ecor

ds o

f el

derl

ynu

rsin

g ho

mes

, day

car

ece

ntre

s, r

etir

emen

t hom

es

4. H

ospi

tal r

ecor

ds

5.S

pend

ing

reco

rds

ofM

inis

try

of H

ealt

h an

dS

GK

1. R

educ

tion

in th

e nu

mbe

r of

peop

le c

onsu

ltin

g fa

mil

yph

ysic

ian

2.R

educ

tion

of

requ

irem

ent f

oran

d se

rvic

e sp

endi

ng in

prim

ary

heal

th c

are

3. R

educ

tion

in th

e nu

mbe

r of

elde

rly

requ

irin

g ho

me

care

serv

ice

and

of h

ome

care

prov

ider

s

4. R

educ

tion

of

the

num

ber

ofpa

tien

ts r

equi

ring

con

stan

t car

eor

inst

itut

iona

l car

e (e

lder

lynu

rsin

g ho

me,

etc

.) a

ndre

duct

ion

of h

ealt

h sp

endi

ngth

erei

n

5. R

educ

tion

of

hosp

ital

izat

ion

and

hosp

ital

adm

issi

ons

6. R

educ

tion

of

hosp

ital

izat

ion

dura

tion

and

hea

lth

spen

ding

and

the

need

for

less

num

ber

ofhe

alth

car

e pe

rson

nel

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Int

erna

lA

ffai

rs3.

Min

istr

y of

Nat

iona

lE

duca

tion

4.M

inis

try

of F

amil

y an

dS

ocia

l Pol

icie

s5.

Min

istr

y of

Dev

elop

men

t6.

Und

erse

cret

aria

t of

Tre

asur

y 7.

SG

K8.

YO

K9.

Uni

vers

itie

s10

.Pre

ss a

ndB

road

cast

ing

Org

aniz

atio

ns

11. N

GO

3 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


41

Tar

get 3

- Dev

elop

men

t of p

reve

nti

ve a

nd

reh

abil

itat

ive

app

roac

hes

tow

ard

s d

eter

min

atio

n o

f ris

k fa

ctor

s th

at m

ay c

ause

loss

of

bal

ance

, fal

l an

d fe

arof

fal

lin

g in

th

e el

der

ly

Str

ateg

y

3.1.

Tra

inin

g ab

out

bal

ance

an

d f

all,

and

un

der

stan

din

g of

th

eim

por

tan

ce o

f p

hys

ical

acti

vity

an

d e

xerc

ises

in t

he

sub

ject

of

pre

ven

tion

of

fall

s an

dfr

actu

res

and

dev

elop

men

t of

ser

vice

rela

ted

to

thes

e is

sues

3.1.

1. C

reat

ion

of m

ater

ials

and

prog

ram

s to

info

rm e

lder

ly o

f in

tern

alan

d ex

tern

al f

acto

rs le

adin

g to

fal

lsan

d lo

ss o

f ba

lanc

e an

d to

rai

seaw

aren

ess

on th

is is

sue

3.1.

2.E

stab

lish

men

t of

cour

ses

and

prep

arat

ion

of p

hysi

cal e

nvir

onm

ent

aim

ed a

t inf

orm

ing

elde

rly

rela

tive

san

d ca

regi

vers

in o

rder

to in

crea

se th

epo

siti

ve e

ffec

ts o

f ph

ysic

al a

ctiv

ity

onfa

ll a

nd b

alan

ce

3.1.

3.A

rran

gem

ent o

f ho

uses

and

exte

rnal

env

iron

men

t of

elde

rly

insu

ch a

way

to p

reve

nt f

alls

and

fea

r of

fall

ing

3.1.

4. E

stab

lish

men

t of

the

unit

s in

whi

ch th

e re

leva

nt s

peci

aliz

ed h

ealt

hpr

ofes

sion

als

that

det

erm

ine

the

risk

fact

ors

tow

ards

fal

ls w

ork.

1. S

tati

stic

s on

fal

lin

cide

nce

in c

erta

in a

gegr

oups

2.S

tati

stic

s an

d da

ta o

nfa

ll in

cide

nce

of e

lder

ly in

hosp

ital

, ins

titu

tion

and

hom

e

3. R

epor

ts d

emon

stra

ting

mor

tali

ty a

nd m

orbi

dity

leve

ls a

risi

ng f

rom

the

fall

-ass

ocia

ted

com

plic

atio

ns

4. S

tati

stic

al d

ata

on f

all

and

com

plic

atio

n-as

soci

ated

hea

lth

spen

ding

and

serv

ices

5. D

ata

(sta

tist

ical

dat

a,ho

spit

al d

ata,

etc

.) o

n th

ech

ange

s in

fal

l inc

iden

ceob

serv

ed a

fter

phy

sica

lac

tivi

ty a

nd tr

aini

ng

1.E

lder

ly w

itho

ut f

ear

offa

llin

g

2. E

lder

ly w

ith

decr

ease

din

cide

nce

of f

all a

nd f

ract

ure

deve

lopm

ent

3.D

ecre

ased

num

ber

of e

lder

lyha

ving

loss

of

bala

nce

and

fall

-re

late

d ac

tivi

ty li

mit

atio

n

4. E

lder

ly w

ho f

eel s

afe

and

com

pete

nce

them

selv

es li

ve in

a pl

ace

arou

nd w

hich

arra

ngem

ents

aim

ed a

t ris

kfa

ctor

s ha

ve b

een

mad

e at

hom

e an

d in

thei

r in

stit

utio

nsor

hos

pita

ls

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Int

erna

lA

ffai

rs3.

Min

istr

y of

Env

iron

men

t and

Urb

anis

atio

n4.

Uni

vers

itie

s5.

NG

O

3 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


42

Tar

get 4

- Det

erm

inat

ion

of r

ehab

ilit

atio

n n

eed

s an

d d

evel

opm

ent o

f all

reh

abil

itat

ion

ser

vice

s in

clu

din

g p

rofe

ssio

nal

an

d s

ocia

l reh

abil

itat

ion

s fo

r th

ed

epen

den

t or

sem

i-d

epen

den

t el

der

ly p

eop

le in

act

ivit

ies

of d

aily

livi

ng

and

soc

ial p

arti

cip

atio

n

Str

ateg

y

4.1.

Det

erm

inat

ion

of

nee

ds

of t

he

eld

erly

wh

o ar

e d

epen

den

t or

sem

i-d

epen

den

t in

acti

viti

es o

f d

aily

livi

ng

or s

ocia

l par

tici

pat

ion

4.1.

1.D

eter

min

atio

n of

fun

ctio

nal

stat

us, f

unct

iona

lity

, dis

abil

ity

and

heal

th o

f el

derl

y ac

cord

ing

toin

tern

atio

nal s

tand

ards

4.1.

2. D

eter

min

atio

n of

the

prof

ile

ofde

pend

ent a

nd s

emi-

depe

nden

tel

derl

y w

ith

tem

pora

ry o

r pe

rman

ent

disa

bili

ty, a

ctiv

ity

lim

itat

ion

and

soci

al p

arti

cipa

tion

4.1.

3.A

ccor

ding

to th

e W

HO

and

inte

rnat

iona

l dat

abas

e, d

eter

min

atio

nof

pri

orit

y of

eld

erly

wit

h im

port

ant

dise

ases

4.1.

4.D

eter

min

atio

n of

sta

ndar

dsde

fini

ng th

e le

vels

of

func

tion

allo

sses

ari

sing

fro

m p

hysi

cal a

ctiv

ity

leve

l, ch

roni

c di

seas

es a

nd in

acti

vity

;de

term

inat

ion

of c

lini

cal a

nd f

ield

stud

ies

rela

ted

to th

ese

issu

es

1. R

esul

ts o

f ph

ysic

alfu

ncti

ons

2. E

valu

atio

n of

act

ivit

yli

mit

atio

n

3. R

esul

ts o

f ev

alua

tion

of

soci

al p

arti

cipa

tion

1. F

orm

atio

n of

hea

lth

poli

cies

know

ing

the

func

tion

al le

vels

of e

lder

ly a

ccor

ding

tofu

ncti

onal

sta

tus

eval

uati

on a

ndde

fini

ng t

he ta

rget

sac

cord

ingl

y

2. M

inis

try

of H

ealt

h an

dre

leva

nt h

ealt

h in

stit

utio

ns th

atca

n de

velo

p st

rate

gic

and

targ

et-s

peci

fic

heal

th p

olic

ies

on r

ehab

ilit

atio

n an

d ca

rese

rvic

es b

y de

term

inin

g th

ene

eds

of e

lder

ly p

opul

atio

n

1. M

inis

try

of F

amil

y an

d S

ocia

l Pol

icie

s2.

Min

istr

y of

Hea

lth

3. M

inis

try

of

Inte

rnal

Aff

airs

4.U

nive

rsit

ies

5.N

GO

3 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


43

Tar

get 4

- Det

erm

inat

ion

of r

ehab

ilit

atio

n n

eed

s an

d d

evel

opm

ent o

f all

reh

abil

itat

ion

ser

vice

s in

clu

din

g p

rofe

ssio

nal

an

d s

ocia

l reh

abil

itat

ion

s fo

r th

ed

epen

den

t or

sem

i-d

epen

den

t el

der

ly p

eop

le in

act

ivit

ies

of d

aily

livi

ng

and

soc

ial p

arti

cip

atio

n

Str

ateg

y

4.2.

Dev

elop

men

tof

sp

ecia

lre

hab

ilit

atio

nap

pro

ach

es f

orth

e el

der

ly w

ith

hig

her

mor

tali

tyan

d m

orb

idit

yri

sks

and

arra

nge

men

t of

ph

ysic

al a

ctiv

ity

pro

gram

s to

incr

ease

soc

ial

par

tici

pat

ion

4.2.

1. P

rovi

sion

of

prio

riti

zed

reha

bili

tati

on s

ervi

ces

for

the

elde

rly

wit

h hi

gher

mor

tali

ty a

nd m

orbi

dity

ris

ks

4.2.

2. E

stab

lish

men

t of

mul

tidi

scip

lina

ry r

ehab

ilit

atio

n te

ams,

and

Pro

visi

on o

f se

rvic

e by

thes

e te

ams

for

such

inst

itut

ions

as

reti

rem

ent h

omes

, nur

sing

hom

es, d

ay c

are

cent

res

4.2.

3. E

stab

lish

men

t and

Dis

sem

inat

ion

of c

entr

es in

pub

lic

and

priv

ate

inst

itut

ions

that

wil

l pro

vide

ser

vice

for

eld

erly

4.2.

4. D

eter

min

atio

n by

mul

tidi

scip

lina

ry r

ehab

ilit

atio

n te

am w

here

the

disa

bled

eld

erly

wil

l be

care

d an

d re

habi

lita

ted

afte

rho

spit

aliz

atio

n

4.2.

5. E

stab

lish

men

t of

nati

onal

pol

icie

s to

soc

iety

-bas

edre

habi

lita

tion

ser

vice

s (r

ural

are

as, c

orre

ctio

n fa

cili

ties

and

hom

eles

s, e

tc.)

4.2.

6.R

egul

atio

n of

ser

vice

veh

icle

s an

d m

obil

e re

habi

lita

tion

team

s in

ord

er to

pro

vide

hea

lth

care

ser

vice

s fo

r th

e el

derl

y w

hoca

nnot

rea

ch in

stit

utio

nal r

ehab

ilit

atio

n se

rvic

es

4.2.

7. D

eter

min

atio

n an

d G

uida

nce

by P

rovi

ncia

l Aut

hori

ties

of

the

elde

rly

who

are

in n

eed

of r

ehab

ilit

atio

n an

d ca

nnot

rea

ch th

ese

rvic

es

4.2.

8. R

aisi

ng a

war

enes

s of

the

com

mun

ity,

pla

nnin

g of

the

com

mun

ity-

base

d re

habi

lita

tion

team

ser

vice

s an

d vo

lunt

ary

orga

niza

tion

s fo

r th

e el

derl

y w

ho c

anno

t rea

ch th

e re

habi

lita

tion

serv

ices

4.2.

9. P

lann

ing

of te

le-r

ehab

ilit

atio

n se

rvic

es f

or th

e el

derl

y w

hoar

e in

nee

d of

reh

abil

itat

ion

and

cann

ot r

each

the

serv

ice

4.2.

10. H

andl

ing

of th

e su

bjec

ts o

f di

sabi

lity

and

inca

paci

ty in

elde

rly

and

disa

bled

eld

erly

in n

atio

nal p

rogr

ams

and

poli

cies

4.2.

11. S

uppo

rtin

g an

d fa

cili

tati

on o

f th

e es

tabl

ishm

ent o

f no

n-go

vern

men

tal o

rgan

izat

ions

by

the

elde

rly

wit

h di

sabi

liti

es a

nd th

eon

es p

rovi

ding

car

e se

rvic

es. S

uppo

rtin

g an

d en

cour

agem

ent o

f th

eN

GO

’s w

orks

on

this

issu

e

4.2.

12. O

peni

ng o

f el

derl

y ho

bby

hous

es, d

ay c

are

and

reha

bili

tati

on c

entr

es

1. D

ata

indi

cati

ng th

ede

crea

sed

freq

uenc

y in

hosp

ital

izat

ion

2. N

umbe

r of

the

elde

rly

rece

ivin

gse

rvic

e fr

om h

obby

hous

es a

nd d

ay c

are

and

reha

bili

tati

once

ntre

s

3. S

atis

fact

ion

leve

ls o

fth

e el

derl

y th

emse

lves

and

thei

r fa

mil

ies

1. I

ncre

ase

inph

ysic

al f

unct

ions

and

soci

alpa

rtic

ipat

ion

of th

eel

derl

y

2. R

educ

tion

in th

ebu

rden

of

the

fam

ilie

s as

sum

ing

elde

rly

care

3.D

ecre

ase

in th

efr

eque

ncy

ofho

spit

aliz

atio

n

4. R

educ

tion

inhe

alth

spe

ndin

gre

late

d to

eld

erly

reha

bili

tati

on

5.In

tegr

ated

reha

bili

tati

on a

ndre

crea

tion

ser

vice

s

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Fam

ily

and

Soc

ial P

olic

ies

3. M

inis

try

of I

nter

nal

Aff

airs

4. S

GK

5. U

nive

rsit

ies

6.N

GO

3 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


44

Tar

get 4

- Det

erm

inat

ion

of r

ehab

ilit

atio

n n

eed

s an

d d

evel

opm

ent o

f all

reh

abil

itat

ion

ser

vice

s in

clu

din

g p

rofe

ssio

nal

an

d s

ocia

l reh

abil

itat

ion

s fo

r th

ed

epen

den

t or

sem

i-d

epen

den

t el

der

ly p

eop

le in

act

ivit

ies

of d

aily

livi

ng

and

soc

ial p

arti

cip

atio

n

Str

ateg

y

4.3.

Dev

elop

men

t or

hea

lth

tou

rism

an

dre

hab

ilit

atio

n s

ervi

ces

inor

der

for

ou

r el

der

lyci

tize

ns

livi

ng

abro

ad t

ore

ceiv

e th

e el

der

ly c

are

serv

ices

in o

ur

cou

ntr

y or

for

the

fore

ign

eld

erly

peo

ple

to

ben

efit

fro

mth

e h

ealt

h c

are

and

reh

abil

itat

ion

ser

vice

sp

rovi

ded

in o

ur

cou

ntr

yw

ith

sh

ort

and

lon

g te

rmp

erio

ds

4.3.

1. P

rom

otio

n of

init

iati

ves

ofut

iliz

atio

n fr

om tr

ansp

ort a

ndac

com

mod

atio

n se

rvic

es p

rovi

ded

bypu

blic

and

pri

vate

sec

tors

fre

e of

char

ge

4.3.

2. I

mpl

emen

tati

on o

f ne

wre

gula

tion

s fo

r sp

a to

uris

m in

ord

er to

ensu

re e

qual

ity

of o

ppor

tuni

ty th

e fo

rut

iliz

atio

n of

eld

erly

hea

lth

and

reha

bili

tati

on s

ervi

ces

incl

udin

g th

eel

derl

y li

ving

in r

ural

are

as, a

ndpr

omot

ion

of q

uota

all

ocat

ion

for

elde

rly

who

are

in n

eed

ofre

habi

lita

tion

1. N

umbe

r of

the

elde

rly

bene

fitt

ing

from

fre

etr

ansp

ort a

ndac

com

mod

atio

n se

rvic

es

2. N

umbe

r of

the

elde

rly

bene

fitt

ing

from

spa

tour

ism

1.E

lder

ly w

ith

enha

nced

wel

l-be

ing

and

qual

ity

of li

fe

2. I

ncre

ase

in th

e nu

mbe

r of

the

reha

bili

tati

on s

ervi

ces

for

the

elde

rly

who

are

livi

ng in

rur

alar

eas

and

are

not l

ikel

y to

reac

h th

ese

serv

ices

3. E

lder

ly w

ho h

ave

bene

fitt

edfr

om r

ehab

ilit

atio

n se

rvic

es in

spa

4.E

lder

ly w

ith

decr

ease

dso

cial

isol

atio

n an

d in

crea

sed

soci

al p

arti

cipa

tion

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Int

erna

lA

ffai

rs3.

SG

K

3 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


45

1.3. DEVELOPMENT OF HOME CARE SERVICES AND HOME HEALTH CARE SERVICES

FOR ELDERLY


Considering the fact that preventive, curative and rehabilitative care should be provided continuously

and in an effective way, the concept of home care refers to a care system aiming to strengthen and support

common health care services.

The concept of home care is expressed in different ways in different countries, and the “Home Care,

Home Health Care, Home Health and Social Care” definitions are often used interchangeably. The

conceptual confusion related to the definition and scope of home care has not yet resolved in our country.

Generally, home social support and assistance services are defined as home care.

Home care is a complete wide range of short or long-term health and social services provided for

the people with health problems, chronic or terminal diseases or disabilities at home.

According to the WHO, home care is the service provided by formal and informal caregivers in the

home environment. With a more general definition, home care can also be stated as all services presented

at home in order to develops, improve and protect physical, mental and psychological health of individuals

(18).

“Home Care” which is found in the literature as a general concept covering both health and social

services are divided into two main categories as “Home Health Care” and “Home Social Care And Support

Services.”

Different definition have been used in various meanings in our country. For improvement of home

care services, it is of vital importance to use a common definition for the studies to be conducted by the

relevant institutions and organizations. To create a common language in the studies of Turkey Healthy

Aging Action Plan and Implementation Program 2015-2020, the following definitions established in the

world examples have been accepted.

Figure 3. Home Care Services

In target, strategy and actions related to both fields covering social and support services in the studies

of Turkey Healthy Aging Action Plan and Implementation Program 2015-2020, “Home Care” has been

used as a definition covering both fields. When it is required to define one of the service fields, “home

health care” and “home social care and support services” have been used as separate concepts.

Home Health Care Home Social Care And Support Services

Home Care

Today, home care has become a health care service model which is preferred and regarded as an

effective service delivery model in many countries. Although the models implemented differ from one

country to another due to the differences in socio-economic structures, health and social service models

and social security systems and cultural dissimilarities, the intense works are seen in all of the country

models which have established home care system and are about to establish this for the sake of

dissemination and development of these services. Some application examples seen in the world examples

and solution approaches are listed below:

1. Service Providers: Non-profit organizations, home care units established in hospitals, home care

institutions, non-governmental organizations and voluntary organizations play roles in the provision of

home care services. Service providers undergo a licensing process by the relevant institutions according

to their activity fields (health care services or social care and support services). Families play important

roles both in health care services and in home social care and support services, thus many programs have

been developed in order to support the families.

2. Regulation and Supervision of Services: In some examples which are suitable for the existing systems

of the countries, while home care and social care services are arranged by a single public institution, in

other examples, home care services are regulated by Ministry of Health and home social care and support

services are under the responsibility and control of local authorities. Supervision are supported by public

institutions and local authorities as well as accreditation systems.

3. Integration of Services: Even if home care and home social care and support services are provided

by different institutions, they should be conducted in full coordination and collaboration with each other.

When both health and social care needs come into question at the same home, the institution providing

health care services mostly provides social services as well. In some examples, home care institutions

provide for both fields and host the multidisciplinary structure entailing this.

4. Imbursement of Services and Financing: Both health care service and social care services provided

at home which are seen in the examples of developed countries are covered by public social security

systems. Imbursement of services are generally carried out through two channels. While home care

services are covered by social security system, social care services are covered by care insurances. Care

insurance particularly covers personal care and social rehabilitation services, and financing of some

support services (repair, arrangements, transportation, delivery services, etc.) apart from this are covered

by local authorities. Care insurance not only cover social care services but it can also be maintained if

health care services provided at homes surpass the determined period (60 days, 90 days, etc.).

Care insurance is funded by premiums collected during the working period as in health insurance.

Also it is supported by tax-based public sources. With the increasing elderly population and chronic

diseases creation of an additional source for care insurance is of great importance. As seen in the past

examples, the deductions made from lottery and other betting games or other implementations to create

additional funds with other sources for care insurances are becoming prevalent. On the other hand, private

care insurance has been promoted by governments in many countries in order to alleviate the burden on

public social security system.


46

In sum, public health insurance system, private care insurances, public and private care insurances,

budgets of local governments, tax-based public funds, and the payments of individuals and families are

used as a source to finance home health care and home social care and support services.

5. Specialization and Branching in Services: In treatment and care methods, the rapid advances in

medical technology have made it possible to take more services to home, and the scope of services and

the service providing teams have also been expanded. This development has introduced the need for

specialization and branching. Beginning with the applications of community health nursing practices in

the 1800s, home care, which was carried out as a nursing service for a long time, has developed into an

interdisciplinary service field since 1950s. In this regard, specialization has become extremely important

with wide-ranging service fields with respect to the increasing need for more effective and efficient service

provision. Today, in the examples of developed countries, many specialization areas, such applications as

nutrition at home, wound care, chemotherapy at home, home medical equipment and equipment services,

physical therapy at home, home psychotherapy, disease management, telemedicine at home (remote

management of the individual's health by using the latest technology devices and systems) were formed

and have been formed many specialist areas such as applications It formed and are formed.

6. Role of Family: Despite the improvement in the provision of professional services, it should be

remembered that family members have assumed one of the most important roles in home care services in

the past and present. That the family members undertaking roles in home care are supported in terms of

social, psychological and financially and that the supervision support is provided through professional

organizations has been included in the home care models of many countries.

Current Situation in Turkey in Terms of Home Care Services

Unfortunately, provision of home care in Turkey as a professional service has begun quite late in

comparison with the examples in the word. The first professional service provision examples were started

by private enterprises 15 years ago, and these services have been followed by the services provided by

local authorities since 2001. The first legal regulation on this field was the “Regulation on Home Care

Service Provision,” which was issued by the Ministry of Health and came into force be being published

on the Official Gazette No: 25751 of 10 March 2005 many years after the start of service provision.

Apart from the Ministry of Health, a number of regulations on this field, beginning from 1 July

2005 (Repealed), have been carried out by the Prime Ministry, Social Services and Child Protection

Agency. With these regulations, provision of care at home or at institutions for the “Disabled that Need

for Care” by public or private care centres was made to be possible. Moreover, for the first time, care

benefit payment has been put into practice for the family members suffering economic and social

deprivation who assume to provide home caring for the disabled in need of care. With an addition made

in the following dates, the elderly in need of care were enabled to benefit from these opportunities.

The first examples of home health care services provided by public hospitals began in 2004. In the

following period of 5-6 years, home health care services have begun to be offered by public hospitals in

10 provinces. The “Regulation on Principles and Procedures of Home Health care service Provisions”,

issued by the Ministry of Health and put into practice in February 2010, was an important step for the

dissemination of these services throughout the country. The aim of the directive was expressed as


47

"Provision of examination, diagnosis, treatment, medical care and rehabilitation for the individuals who

are in need of home health care service and Establishment of home health care service units within the

health institutions under the Ministry of Health in order to provide social and psychological support

services as a whole to these individuals and their family members.”

In addition, with the expression in the Directive, "to provide home health care services in an effective

and accessible way with the perception of social state,” the Ministry of Health reveals its approach to the

provision of these services by means of public hospitals. Since the last months of 2010, public hospitals

the Ministry of Health has included public hospitals, family physicians and community health centres in

the provision of service to disseminate home health care services across the country. As well as home

care units established public hospitals, coordination centres within the public health directorates have

been established as per the legislations.

With the amendments and additions, in February 2011, the “Regulation on Principles and Procedures

of Home Health care service Provisions” issued by the Ministry of Health was updated. The education and

research hospitals and general or branch hospitals operating under the Ministry of Health, home health care

service units established within oral and dental health centres and community health centres, family health

centres and family physicians have been restructured. By establishing home care units, University hospitals

have been made to be possible to provide these services.

While neurological bedridden patients were targeted initially, over the course of the process, the

target group and services were extended with such health care services as chronic pulmonary diseases,

cardiovascular diseases, palliative care, oral and dental health, new-born care and psychotherapy at home.

One of the key developments in 2011 was that home health services was included in the coverage of

General Health Insurance over the payments on the “daily treatment” table found in the Communiqué of

Health Applications.

Table 3. Home Health Care Services by Year


48

Home Health Care Services by Year

Total Patient Access

Active Registered Patient

Number of Units

Number of Vehicles

Number of Employees

2010 2011 2012 2013 2014 (December)

16.651 124.085 244.961 380.814 510.352

16.651 80.388 139.214 186.666 218.353

407 642 715 817 915

78 793 956 1.128 1114

478 3.512 4.143 4.248 4.605

Source: Basic Health Statistics Module (BHSM)


49

Target and Strategies for Home Health Care Services towards Elderly and Improvement of

Home Care Services

Target 1- Development of State Home Care Model

Strategy 1

Clarification of definition and scope of home care services (for both health and social services) anduse of common language by the relevant institutions

Strategy 2

Clarification of roles of the institutions providing home care services (health and social services)

Strategy 3

Ensuring coordination between service providing institutions and unit

Target 2- Improvement of Home Care Services

Strategy 1

Establishment of standards for home care (for health and social services)

Strategy 2

Development of implementation of primary health care

Strategy 3

Prevention of the problems and errors associated with drug use at home

Target 3- Dissemination of Home Care Service

Strategy 1

Introduction of home care service, and informing the elderly and their families about home careservice and to which services they can access

Strategy 2

Effective contribution of university hospitals to the provision of home care service

Strategy 3

Supporting NGO’s in the contribution to home care, service provision and studies


50

Target 4- Improvement of the Legislations related to Home Care

Strategy 1

In the current situation, harmonization of the relevant legislations issued by the Ministry of Healthand the Ministry of Family and Social Policies with each other and the needs

Strategy 2

Updating the Regulation on Home Care Service Provision issued by the Ministry of Health in 2005in accordance with the current needs and conditions

Strategy 3

Harmonization of all of the legislations related to home care and health care services of the Ministryof Health and the Ministry of Family, Social Policies and the relevant public institutions with therelevant professional legislations

Strategy 4

Defining the legislations related to duties and responsibilities of care support personnel

Target 5- Improvement of Home Care Reimbursement (Funding)

Strategy 1

Facilitating prescription practices especially for bedridden patients

Strategy 2

Facilitating committee report applications for the individuals receiving home health care service andwith chronic diseases

Strategy 3

Arrangement of the use of medical equipment and devices at home as a professional service area asin the international examples

Strategy 4

Development of public and private care insurance models to meet the long-term care requirementsthat will increase in the coming years

Strategy 5

Introduction of cost-effectiveness studies in home care service

Strategy 6

Including private home care centre and units in Communiqué of Health Applications (CHA) withthe establishment of the necessary supervision infrastructure by SGK


51

Target 6- Meeting Educational Needs of Home Care Personnel and Developing EmploymentPolicies

Strategy 1

Developing education levels of health care and social service personnel involved in home careservices in cooperation with the Ministry of Family and Social Policies

Strategy 2

More involvement of health care professionals specialized in the field of geriatrics (physicians, nurses,physiotherapists, etc.) in home health care services

Strategy 3

Making improvements in the contribution of professional groups involved in home health careservices to performance systems and working capitals

Strategy 4

Ensuring the education of the elderly receiving home health care services and their families


52

1.3.

Hom

e H

ealt

h C

are

Ser

vice

s to

war

ds

Eld

erly

an

d I

mp

rove

men

t of

Hom

e C

are

Ser

vice

s

Tar

get

1-D

evel

opm

ent

of S

tate

Hom

e C

are

Mod

el

Str

ateg

y

1.1.

Cla

rifi

cati

on o

fd

efin

itio

n a

nd

sco

pe

ofh

ome

care

ser

vice

s (f

orb

oth

hea

lth

an

d s

ocia

lse

rvic

es)

and

use

of

com

mon

lan

guag

e b

yth

e re

leva

nt

inst

itu

tion

s

1.1.

1. H

oldi

ng m

eeti

ngs

to d

efin

e se

rvic

ear

eas

and

Est

abli

sh a

com

mon

lang

uage

Pub

lish

ing

a co

mm

ongu

idel

ine

that

def

ines

the

scop

e of

ser

vice

area

s an

d to

wil

l be

used

by a

ll in

stit

utio

ns

Pro

visi

on o

f se

rvic

es b

yal

l ser

vice

pro

vide

rs in

acco

rdan

ce w

ith

the

guid

elin

e to

be

publ

ishe

d

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Fam

ily

and

Soc

ial P

olic

ies

3. M

inis

try

ofD

evel

opm

ent

4.S

GK

5.U

nive

rsit

ies

6. N

GO

1 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


53

Tar

get

1-D

evel

opm

ent

of S

tate

Hom

e C

are

Mod

el

Str

ateg

y

1.2.

Cla

rifi

cati

on o

fro

les

of t

he

inst

itu

tion

sp

rovi

din

g h

ome

care

serv

ices

(h

ealt

h a

nd

soci

al s

ervi

ces)

1.2.

1. A

rran

gem

ent o

f le

gisl

atio

ns f

orpr

ovis

ion

of h

ome

heal

th c

are

serv

ices

by

Min

istr

y of

Hea

lth,

uni

vers

itie

s an

d pr

ivat

eho

me

care

cen

tres

and

uni

ts, a

nd p

rovi

sion

of h

ome

soci

al c

are

and

supp

ort s

ervi

ces

by m

unic

ipal

itie

s, w

here

ver

mun

icip

alit

ies

are

unab

le to

pro

vide

suf

fici

entl

y, b

yM

inis

try

of F

amil

y an

d S

ocia

l Pol

icie

s

Cle

arly

def

inin

g w

hich

inst

itut

ion

wil

l pro

vide

whi

ch s

ervi

ce, a

ndin

volv

ing

this

in th

ere

leva

nt le

gisl

atio

ns

Eli

min

atio

n of

the

repe

titi

ons

in s

ervi

cepr

ovis

ions

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Fam

ily

and

S

ocia

l Pol

icie

s3.

Min

istr

y of

Dev

elop

men

t4.

SG

K5.

Uni

vers

itie

s6.

NG

O

1.3.

En

suri

ng

coor

din

atio

n b

etw

een

serv

ice

pro

vid

ing

inst

itu

tion

s an

d u

nit

1.3.

1. E

stab

lish

men

t of

a co

ordi

nati

once

ntre

wit

hin

gove

rnor

ship

s in

eac

hpr

ovin

ce in

for

the

inte

grat

ion

of h

ome

heal

th c

are

and

soci

al s

ervi

ces

and

in o

rder

for

the

peop

le in

nee

d to

acc

ess

to th

ese

rvic

es f

rom

a s

ingl

e po

int.

Pro

visi

on o

fre

pres

enta

tion

of

Pro

vinc

ial D

irec

tora

te o

fF

amil

y an

d S

ocia

l Pol

icie

s, lo

cal a

utho

riti

esan

d, if

app

lica

ble,

NG

O’s

pro

vidi

ng s

ervi

cein

that

are

a in

this

coo

rdin

atio

n ce

ntre

s.

Ope

ning

and

ope

rati

ngof

coo

rdin

atio

n ce

ntre

sw

hich

coo

rdin

atin

ghe

alth

and

soc

ial

serv

ices

in a

ll p

rovi

nces

Fac

ilit

atio

n of

ser

vice

prov

isio

n, in

crea

se in

the

effi

cien

cy o

f se

rvic

epr

ovis

ion

and

prev

enti

onof

ser

vice

rep

etit

ion

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Fam

ily

and

Soc

ial P

olic

ies

3. M

inis

try

of I

nter

nal

Aff

airs

4. N

GO

1 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


54

Tar

get

2-Im

pro

vem

ent

of H

ome

Car

e S

ervi

ces

Str

ateg

y

2.1.

Est

abli

shm

ent

ofst

and

ard

s fo

r h

ome

care

(fo

r h

ealt

h a

nd

soci

al s

ervi

ces)

2.1.

1. C

ondu

ctin

g st

udie

s fo

r es

tabl

ishm

ent

of c

omm

on s

tand

ards

int

ende

d fo

r se

rvic

ear

eas;

est

abli

shm

ent o

f co

ordi

nati

on a

ndN

atio

nal A

ccre

dita

tion

Sta

ndar

ds a

mon

gth

e re

leva

nt a

utho

riti

es

Intr

oduc

tion

of

agu

idel

ine

inte

nded

for

the

stan

dard

s of

ser

vice

area

s

Num

ber

of a

ccre

dite

din

stit

utio

ns w

hich

hav

est

arte

d to

pro

vide

ser

vice

of th

e se

rvic

e pr

ovid

ers

inac

cord

ance

wit

h th

eco

mm

on s

tand

ards

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Fam

ily

and

S

ocia

l Pol

icie

s3.

Soc

ial S

ecur

ity

Inst

itut

ion

4.U

nive

rsit

ies

5. T

SE

6. N

GO

2.2.

Dev

elop

men

t of

imp

lem

enta

tion

of

pri

mar

y h

ealt

h c

are

2.2.

1. E

stab

lish

men

t of

guid

elin

es, p

erio

dic

foll

ow-u

p an

d sc

reen

ing

prog

ram

s fo

r ho

me

prev

enti

ve h

ealt

h ap

plic

atio

ns

1. G

uide

line

s an

dpr

ogra

ms

to b

ees

tabl

ishe

d

2. N

umbe

r of

pat

ient

sun

derg

oing

ger

iatr

icsc

reen

ing

and

foll

ow-u

p

Sup

port

of

prim

ary

heal

thca

re a

t hom

e w

ith

the

guid

elin

es a

nd p

rogr

ams

to b

e es

tabl

ishe

d

1. M

inis

try

of H

ealt

h2.

Uni

vers

itie

s3.

NG

O

1 ye

ar

1 ye

ar

2.3.

Pre

ven

tion

of

the

pro

ble

ms

and

err

ors

asso

ciat

ed w

ith

dru

gu

se

2.3.

1. E

stab

lish

men

t of

Tra

inin

gs a

ndpr

ogra

ms

abou

t pro

per

med

icat

ion

inte

nded

for

the

fam

ilie

s an

d ca

regi

vers

Tra

inin

g pr

ogra

ms,

book

lets

and

oth

erdo

cum

ents

to b

ees

tabl

ishe

d fo

r pr

oper

med

icat

ion

Incr

ease

in th

e nu

mbe

rs o

ftr

aini

ngs

to b

e ar

rang

edan

d of

the

info

rmat

ive

docu

men

ts d

istr

ibut

ed

1. M

inis

try

of H

ealt

h2.

Uni

vers

itie

s3.

NG

OP

erio

dic

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


55

Tar

get

3-D

isse

min

atio

n o

f H

ome

Car

e S

ervi

ces

Str

ateg

y

3.1.

In

trod

uct

ion

of

hom

e ca

re s

ervi

ce, a

nd

info

rmin

g th

e el

der

lyan

d t

hei

r fa

mil

ies

abou

t h

ome

care

serv

ice

and

to

wh

ich

serv

ices

th

ey c

anac

cess

3.1.

1. U

se o

f pr

omot

iona

l mat

eria

lac

tivi

ties

, pri

nted

and

vis

ual m

edia

inte

nded

for

com

mun

ity;

pre

para

tion

and

dist

ribu

tion

of

info

rmat

ive

pam

phle

ts a

ndbo

okle

ts3.

1.2.

Inf

orm

ing

neig

hbou

rhoo

d he

adm

enof

how

they

can

acc

ess

to s

ervi

ces

and

prov

ide

the

nece

ssar

y in

form

atio

n th

eth

ose

in n

eed

Impr

ovin

g of

the

info

rmat

ion

of th

ose

inin

nee

d an

d th

eir

fam

ilie

s as

to h

ow th

eyca

n re

ceiv

e ho

me

care

serv

ices

Incr

ease

in th

e nu

mbe

r of

the

elde

rly

rece

ivin

gse

rvic

e; f

acil

itat

ion

ofac

cess

to s

ervi

ces

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Fam

ily

and

Soc

ial P

olic

ies

3. M

inis

try

of I

nter

nal

Aff

airs

4. U

nive

rsit

ies

5.N

GO

6.P

ress

and

Bro

adca

stin

gO

rgan

izat

ions

Per

iodi

c

3.2.

Eff

ecti

veco

ntr

ibu

tion

of

un

iver

sity

hos

pit

als

toth

e p

rovi

sion

of

hom

eca

re s

ervi

ce

3.2.

1. E

stab

lish

men

t of

hom

e ca

re u

nits

inun

iver

sity

hos

pita

ls a

nd c

omm

ence

men

t of

prov

isio

n of

thes

e se

rvic

es b

y th

ese

inst

itut

ions

1. N

umbe

r of

univ

ersi

ties

whi

ch h

ave

esta

blis

hed

hom

e ca

reun

its

2. N

umbe

r of

the

elde

rly

rece

ivin

g ho

me

care

serv

ices

in u

nive

rsit

ies

Dis

sem

inat

ion

of h

ome

heal

th c

are

serv

ices

for

thos

e ne

edin

g te

rtia

ryhe

alth

car

e se

rvic

e by

mea

ns o

f ho

me

heal

thca

re u

nits

in u

nive

rsit

ies

1. M

inis

try

of H

ealt

h2.

Uni

vers

itie

s

1 ye

ar

3.3.

Su

pp

orti

ng

NG

O’s

in t

he

con

trib

uti

on t

oh

ome

care

, ser

vice

pro

visi

on a

nd

stu

die

s

3.3.

1. E

ncou

ragi

ng N

GO

’s w

hich

wor

king

for

hom

e ca

re s

ervi

ces

(ser

vice

pro

visi

onan

d tr

aini

ng, e

tc.)

; pro

vidi

ng c

onve

nien

ceth

at th

ese

asso

ciat

ions

can

be

gran

ted

the

stat

us o

f as

soci

atio

ns w

orki

ng f

or p

ubli

cbe

nefi

t

1. T

hat N

GO

’s p

lay

anac

tive

rol

e in

the

prov

isio

n of

hom

e ca

rese

rvic

es a

nd tr

aini

ngac

tivi

ties

2.

Inc

reas

e in

the

num

ber

of N

GO

’sop

erat

ing

in th

e fi

eld

ofho

me

care

ser

vice

s

Num

ber

of th

e el

derl

yre

ceiv

ing

serv

ice

from

NG

O’s

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Fam

ily

and

Soc

ial P

olic

ies

3. M

inis

try

of I

nter

nal

Aff

airs

3 ye

ar

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


56

Tar

get

4-Im

pro

vem

ent

of t

he

legi

slat

ion

s re

late

d t

o h

ome

care

Str

ateg

y

4.1.

In

th

e cu

rren

tsi

tuat

ion

,h

arm

oniz

atio

n o

f t

he

rele

van

t le

gisl

atio

ns

issu

ed b

y th

e M

inis

try

of H

ealt

h a

nd

th

eM

inis

try

of F

amil

y an

dS

ocia

l Pol

icie

s w

ith

each

oth

er a

nd

th

en

eed

s

4.1.

1. H

arm

oniz

atio

n of

the

legi

slat

ions

issu

ed b

y M

inis

try

of H

ealt

h an

d M

inis

try

of F

amil

y an

d S

ocia

l Pol

icie

s w

ith

each

othe

r by

con

duct

ing

a co

mm

on s

tudy

4.1.

2. H

oldi

ng r

egul

ar m

eeti

ngs

in o

rder

toob

tain

the

cont

ribu

tion

s of

all

rel

evan

tin

stit

utio

ns4.

1.3.

Def

inin

g ho

me

heal

th c

are

and

soci

alse

rvic

es w

ith

a ho

list

ic a

nd c

ompl

emen

tary

appr

oach

in th

e le

gisl

atio

ns

Impl

emen

tati

on o

f th

ele

gisl

atio

ns o

n ho

me

care

ser

vice

s by

Min

istr

y of

Hea

lth

and

Min

istr

y of

Fam

ily

and

Soc

ial P

olic

ies

in a

hol

isti

c an

dco

mpa

tibl

e w

ay

Rea

liza

tion

of

the

refl

ecti

ons

of th

est

udie

s co

nduc

ted

in th

eti

tle

of ta

rget

(dev

elop

men

t of

coun

try

mod

el)

on th

ele

gisl

atio

ns

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Fam

ily

and

Soc

ial P

olic

ies

3. M

inis

try

of

Dev

elop

men

t4.

SG

K5.

Uni

vers

itie

s6.

NG

O

3 ye

ars

4.2.

Up

dat

ing

the

Reg

ula

tion

on

Hom

eC

are

Ser

vice

Pro

visi

onis

sued

by

the

Min

istr

y of

Hea

lth

in 2

005

inac

cord

ance

wit

h t

he

curr

ent

nee

ds

and

con

dit

ion

s

4.2.

1. U

pdat

ing

the

Reg

ulat

ion

on H

ome

Car

e S

ervi

ce P

rovi

sion

E

nact

men

t of

the

legi

slat

ions

inac

cord

ance

wit

h th

ecu

rren

t req

uire

men

tsan

d co

ndit

ions

Con

tinu

atio

n of

ser

vice

prov

isio

n by

pri

vate

hom

ehe

alth

car

e un

its

and

cent

res

acco

rdin

g to

the

appl

icab

le r

egul

atio

ns

1. M

inis

try

of H

ealt

h2.

Uni

vers

itie

s3.

NG

O4.

Pri

vate

Hom

e C

are

U

nits

and

Cen

tre

3 ye

ars

4.3.

Har

mon

izat

ion

of

all

of t

he

legi

slat

ion

s re

late

dto

hom

e ca

re a

nd

hea

lth

care

ser

vice

s of

th

eM

inis

try

of H

ealt

h a

nd

the

Min

istr

y of

Fam

ily,

Soc

ial P

olic

ies

and

th

ere

leva

nt

pu

bli

cin

stit

uti

ons

wit

h t

he

rele

van

t p

rofe

ssio

nal

legi

slat

ion

s

4.3.

1. C

ondu

ctin

g st

udie

s fo

rha

rmon

izat

ion

of a

ll o

f th

e le

gisl

atio

nsre

late

d to

hom

e ca

re a

nd h

ealt

h se

rvic

es b

yM

inis

try

of H

ealt

h, M

inis

try

of F

amil

y an

dS

ocia

l Pol

icie

s an

d ot

her

rele

vant

pub

lic

inst

itut

ions

wit

h th

e re

leva

nt p

rofe

ssio

nal

regu

lati

ons

(nur

sing

ser

vice

s re

gula

tion

s)on

this

sub

ject

Invo

lvem

ent o

f th

edu

ties

and

resp

onsi

bili

ties

def

ined

in th

e re

leva

ntle

gisl

atio

ns in

all

of

the

legi

slat

ions

rel

ated

toho

me

care

and

hea

lth

serv

ices

in a

har

mon

ious

way

Upd

atin

g of

the

legi

slat

ions

rel

ated

to b

oth

prof

essi

onal

and

hea

lth

serv

ices

of

the

rele

vant

Min

istr

y, in

stit

utio

n an

dor

gani

zati

ons

in a

harm

onio

us w

ay w

ith

the

new

reg

ulat

ions

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Fam

ily

and

Soc

ial P

olic

ies

3.U

nive

rsit

ies

4. N

GO

3 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


57

Tar

get

4-Im

pro

vem

ent

of t

he

legi

slat

ion

s re

late

d t

o h

ome

care

Str

ateg

y

4.4.

Def

inin

g th

ele

gisl

atio

ns

rela

ted

to

du

ties

an

dre

spon

sib

ilit

ies

of c

are

sup

por

t p

erso

nn

el

4.4.

1.Im

plem

enta

tion

of

job

desc

ript

ion

ofca

re s

uppo

rt p

erso

nnel

, det

erm

inat

ion

of th

eir

wor

k ar

eas;

con

duct

ing

stud

ies

to d

efin

eth

ese

in th

e re

leva

nt le

gisl

atio

ns

4.4.

2. I

n ad

diti

on, e

nsur

ing

that

thes

e su

ppor

tpe

rson

nel a

re e

mpl

oyed

by

serv

ice

prov

idin

gin

stit

utio

ns in

the

sam

e st

anda

rds

1. C

lari

fica

tion

of

job

desc

ript

ion

and

wor

kar

eas

and

incl

udin

gth

ese

in th

e re

leva

ntle

gisl

atio

ns

2. P

repa

rati

on o

f a

guid

elin

e in

volv

ing

serv

ice

stan

dard

s an

djo

b de

scri

ptio

ns to

be

used

in s

ervi

cepr

ovid

ing

inst

itut

ions

1.S

ervi

ce p

rovi

sion

by

care

sup

port

per

sonn

el in

a w

ay s

peci

fied

in th

ele

gisl

atio

ns

2. S

ervi

ce p

rovi

sion

by

serv

ice

prov

idin

gin

stit

utio

ns in

the

sam

est

anda

rds

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Lab

our

and

Soc

ial S

ecur

ity

3.M

inis

try

of F

amil

y an

d S

ocia

l Pol

icie

s4.

Uni

vers

itie

s5.

NG

O3

year

s

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


58

Tar

get

5- I

mp

rove

men

t of

Hom

e C

are

Rei

mb

urs

emen

t (F

un

din

g)

Str

ateg

y

5.1.

Fac

ilit

atin

gp

resc

rip

tion

pra

ctic

eses

pec

iall

y fo

rb

edri

dd

en p

atie

nts

5.1.

1. M

akin

g ne

w r

egul

atio

nsai

med

at f

acil

itat

ing

pres

crip

tion

prac

tice

s es

peci

ally

for

bed

ridd

enpa

tien

ts

Aut

hori

zati

on f

or th

e fa

mil

yph

ysic

ians

or

the

phys

icia

nspr

ovid

ing

hom

e ca

rese

rvic

es to

wri

te o

utpr

escr

ipti

ons

for

the

bedr

idde

n pa

tien

ts in

nee

d of

hom

e ca

re w

ho c

anno

t go

toho

spit

al f

or e

xam

inat

ion

bysp

ecia

list

phy

sici

ans

Ens

urin

g th

e fa

cili

tati

on f

orbe

drid

den

pati

ents

to a

cces

s to

the

requ

ired

med

icat

ion,

med

ical

supp

lies

and

oth

er m

edic

alpr

oduc

ts, a

nd p

reve

ntio

n of

ill-

trea

tmen

t ari

sing

fro

m h

ospi

tal

adm

issi

on im

poss

ibil

itie

s

1.M

inis

try

of H

ealt

h2.

SG

K3.

Uni

vers

itie

s

1 ye

ars

5.2.

Fac

ilit

atin

gco

mm

itte

e re

por

tap

pli

cati

ons

for

the

ind

ivid

ual

s re

ceiv

ing

hom

e h

ealt

h c

are

serv

ice

and

wit

hch

ron

ic d

isea

ses

5.2.

1. M

akin

g ne

cess

ary

arra

ngem

ents

to e

xten

d th

e re

port

peri

od f

or th

e be

drid

den

pati

ents

who

hav

e ch

roni

c di

seas

es a

nd to

elim

inat

e th

e re

quir

emen

t of

obta

inin

g c

omm

itte

e re

port

s af

ter

the

firs

t rep

ort i

n ch

roni

c di

seas

es

Ens

urin

g th

at th

e be

drid

den

pati

ents

rec

eivi

ng h

ome

care

serv

ice

can

rece

ive

serv

ices

and

use

med

ical

equ

ipm

ent

and

prod

ucts

wit

hout

nee

ding

to o

btai

n co

mm

itte

e re

port

sag

ain

afte

r th

e fi

rst r

epor

t

Tha

t the

pat

ient

wit

h ch

roni

cdi

seas

es d

o no

t hav

e to

be

hosp

ital

ized

for

obt

aini

ng a

new

com

mit

tee

repo

rt f

or th

eir

repo

rts

have

exp

ired

1. M

inis

try

of H

ealt

h2.

SG

K3.

Uni

vers

itie

s1

year

s

5.3.

Arr

ange

men

t of

the

use

of

med

ical

equ

ipm

ent

and

dev

ices

at h

ome

as a

pro

fess

ion

al s

ervi

cear

ea a

s in

th

ein

tern

atio

nal

exa

mp

les

5.3.

1. M

akin

g ne

cess

ary

regu

lati

ons

to d

efin

e an

dim

plem

ent t

he u

se o

f m

edic

aleq

uipm

ent a

nd d

evic

es a

t hom

e as

apr

ofes

sion

al s

ervi

ce a

rea

5.

3.2.

Ens

urin

g th

at tr

aini

ng o

fse

rvic

e eq

uipm

ent o

pera

tion

sho

uld

be p

rovi

ded

in a

ssoc

iati

on w

ith

the

nece

ssar

y pe

riod

ic c

are

and

cont

rol,

7/24

tech

nica

l sup

port

, cal

ibra

tion

and

disi

nfec

tion

sho

uld

be p

rovi

ded

5.3.

3. D

evel

opm

ent o

f le

asin

g an

dse

rvic

e pr

ocur

emen

t mod

els

for

cost

-eff

ecti

vene

ss

1. E

nsur

ing

that

the

proc

urem

ent o

f th

e m

edic

aleq

uipm

ent a

nd d

evic

es u

sed

at h

ome

shou

ld b

e pr

ovid

edw

ith

the

com

plem

enta

ryse

rvic

es

2.Im

plem

enta

tion

of

serv

ice

proc

urem

ent m

odel

in th

ede

fine

d st

anda

rds

inst

ead

ofpu

rcha

se o

f de

vice

s

1. I

ncre

ase

in th

e aw

aren

ess

ofpa

tien

ts a

nd th

eir

fam

ilie

s in

the

use

of m

edic

al d

evic

es

2.In

crea

se in

the

perf

orm

ance

of

med

ical

equ

ipm

ent a

nd d

evic

es in

the

com

plem

enta

ry s

ervi

ces

3. I

mpr

ovem

ents

in tr

eatm

ent a

ndca

re o

utco

mes

than

ks to

infe

ctio

nco

ntro

l; p

reve

ntio

n of

ill-

trea

tmen

ts u

nder

gone

by

fam

ilie

sw

ith

supp

ort s

ervi

ces

and

prev

enti

on o

f m

ater

ial i

njur

y in

term

s of

SG

K

4. I

mpr

ovem

ents

and

Dis

sem

inat

ion

in tr

eatm

ent a

ndca

re a

ppli

cati

ons

perf

orm

ed a

tho

me

wit

h th

e su

ppor

t of

med

ical

devi

ces

1. M

inis

try

of H

ealt

h2.

SG

K3.

NG

O

3 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


59

Tar

get

5- I

mp

rove

men

t of

Hom

e C

are

Rei

mb

urs

emen

t (F

un

din

g)

Str

ateg

y

5.4.

Dev

elop

men

t of

pu

bli

c an

d p

riva

teca

re in

sura

nce

mod

els

to m

eet

the

lon

g-te

rm c

are

req

uir

emen

ts t

hat

wil

l in

crea

se in

th

eco

min

g ye

ars

5.4.

1.C

omm

ence

men

t of

ate

chni

cal s

tudy

by

the

rele

vant

inst

itut

ions

to e

stab

lish

Car

eIn

sura

nce

Mod

el5.

4.2.

Exa

min

atio

n of

for

eign

mod

els

and

impl

emen

tati

on o

f a

mod

el th

at c

an b

e co

vere

d by

the

coun

try

sour

ces

as s

oon

as p

ossi

ble

5.4.

3. F

orm

atio

n of

the

legi

slat

ion

stru

ctur

e re

quir

ed f

or c

are

insu

ranc

e

For

mat

ion

of c

are

insu

ranc

esy

stem

s in

our

cou

ntry

ro

mee

t the

long

-ter

mre

quir

emen

ts

Num

ber

of p

erso

ns w

ith

publ

ic o

rpr

ivat

e ca

re in

sura

nce

1. M

inis

try

of F

amil

y an

d S

ocia

l Pol

icie

s2.

Min

istr

y of

Hea

lth

3. M

inis

try

of F

inan

ce4.

Min

istr

y of

D

evel

opm

ent

5. S

GK

6. U

nder

secr

etar

iat o

fT

reas

ury

7. N

GO

1 ye

ars

5.5.

In

trod

uct

ion

of

cost

-eff

ecti

ven

ess

stu

die

s in

hom

e ca

rese

rvic

e

5.5.

1.D

evel

opm

ent o

f re

gist

rati

onsy

stem

s re

quir

ed f

or th

e fo

llow

-up

of c

osts

of

serv

ice

prov

idin

gin

stit

utio

ns (

publ

ic, l

ocal

auth

orit

ies,

pri

vate

ent

erpr

ises

)

5.5.

2.C

alcu

lati

on o

f un

it c

osts

inse

rvic

es

Dev

elop

men

t of

serv

ice

cost

data

in o

rder

to f

or a

bas

isfo

r fu

rthe

r co

st-e

ffec

tive

ness

stud

ies

to b

e pe

rfor

med

Dev

elop

men

t of

data

set

for

serv

ice

prov

isio

n un

it c

osts

1.

Min

istr

y of

Hea

lth

2. M

inis

try

of F

amil

yan

d S

ocia

l Pol

icie

s3.

Uni

vers

itie

s4.

SG

K5.

NG

O

1 ye

ars

5.6.

In

clu

din

g p

riva

teh

ome

care

cen

tre

and

un

its

in C

omm

un

iqu

éof

Hea

lth

Ap

pli

cati

ons

(CH

A)

wit

h t

he

esta

bli

shm

ent

of t

he

nec

essa

ry s

up

ervi

sion

infr

astr

uct

ure

by

SG

K

5.6.

1.D

evel

opm

ent o

f ne

cess

ary

supe

rvis

ion

infr

astr

uctu

re b

y S

ocia

lS

ecur

ity

Inst

itut

ion

in o

rder

to p

ayth

e se

rvic

es o

f ho

me

heal

th c

are

serv

ice

cent

res

and

unit

s w

ithi

n th

esc

ope

of C

HA

Incl

udin

g th

e pa

ymen

t ter

ms

and

scop

es o

f pr

ivat

e ho

me

heal

th c

are

unit

s an

d ce

ntre

sin

the

scop

e of

Com

mun

iqué

of H

ealt

h A

ppli

cati

ons

(CH

A)

1. D

isse

min

atio

n of

ser

vice

prov

isio

n by

pri

vate

hom

e ca

reun

its

and

cent

res

acro

ss th

eco

untr

y, n

ot o

nly

for

the

peop

lew

ho p

ay th

emse

lves

2. N

umbe

r of

ser

vice

s in

clud

ed in

CH

A

3. N

umbe

r of

the

peop

le r

ecei

ving

serv

ice

from

pri

vate

hea

lth

care

unit

s an

d ce

ntre

s

1. M

inis

try

of F

inan

ce2.

Min

istr

y of

Hea

lth

3.S

GK

3 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


60

Tar

get

6- M

eeti

ng

Ed

uca

tion

al N

eed

s of

Hom

e C

are

Per

son

nel

an

d D

evel

opin

g E

mp

loym

ent

Pol

icie

s

Str

ateg

y

6.1.

Dev

elop

ing

edu

cati

on le

vels

of

hea

lth

car

e an

d s

ocia

lse

rvic

e p

erso

nn

elin

volv

ed in

hom

eca

re s

ervi

ces

inco

oper

atio

n w

ith

th

eM

inis

try

of F

amil

yan

d S

ocia

l Pol

icie

s

6.1.

1. D

eter

min

atio

n of

sta

ndar

dsfo

r th

e tr

aini

ngs

of h

ealt

h an

d so

cial

serv

ice

pers

onne

l pla

ying

rol

e in

hom

e ca

re, a

nd f

orm

atio

n of

aco

mm

on c

urri

culu

m

6.1.

2. A

rran

gem

ent o

f pr

ogra

ms

for

in-s

ervi

ce tr

aini

ng

6.1.

3.P

lann

ing

of r

efre

shm

ent

trai

ning

s fo

r tr

aine

es

A c

omm

on c

urri

culu

m a

ndgu

idel

ine

on s

tand

ards

to b

ees

tabl

ishe

d fo

r tr

aini

ngpr

ogra

ms

1. I

ncre

ase

in th

e nu

mbe

r an

d in

know

ledg

e le

vel o

f qu

alif

ied

hom

eca

re p

erso

nnel

2. N

umbe

r of

trai

ning

s ar

rang

ed

3. N

umbe

r of

per

sonn

el w

ho h

ave

rece

ived

trai

ning

1. M

inis

try

of F

amil

y

and

Soc

ial P

olic

ies

2.M

inis

try

of H

ealt

h3.

Uni

vers

itie

s4.

NG

O3

year

s

6.2.

Mor

ein

volv

emen

t of

hea

lth

care

pro

fess

ion

als

spec

iali

zed

in t

he

fiel

d o

f ge

riat

rics

(ph

ysic

ian

s, n

urs

es,

ph

ysio

ther

apis

ts, e

tc.)

in h

ome

hea

lth

car

ese

rvic

es

6.2.

1. I

ncre

asin

g th

e nu

mbe

r of

heal

th c

are

prof

essi

onal

s sp

ecia

lize

din

the

fiel

d of

ger

iatr

ics

and

arra

ngin

g qu

otas

and

per

man

ent

staf

f po

siti

ons

acco

rdin

gly

Incr

ease

in th

e nu

mbe

r of

heal

th c

are

prof

essi

onal

spec

iali

zed

in th

e fi

eld

ofge

riat

rics

who

ser

ve in

hom

eca

re u

nits

/ser

vice

1.In

crea

se in

the

num

ber

of h

ealt

hca

re p

rofe

ssio

nal s

peci

aliz

ed in

the

fiel

d of

ger

iatr

ics

play

rol

es in

hom

e ca

re s

ervi

ces

2. I

ncre

ase

in th

e qu

otas

and

perm

anen

t sta

ff p

osit

ions

in th

efi

eld

of g

eria

tric

s in

uni

vers

itie

s

3. N

umbe

r of

ger

iatr

ics

prof

essi

onal

gro

ups

play

ing

role

sin

hom

e ca

re s

ervi

ces

1. M

inis

try

of H

ealt

h2.

YO

K3.

Uni

vers

itie

s

3 ye

ars

6.3.

Mak

ing

imp

rove

men

ts in

th

eco

ntr

ibu

tion

of

pro

fess

ion

al g

rou

ps

invo

lved

in h

ome

hea

lth

car

e se

rvic

esto

per

form

ance

syst

ems

and

wor

kin

gca

pit

als

6.3.

1. D

efin

ing

Hom

e H

ealt

h C

are

Ser

vice

s as

Spe

cial

ized

Hea

lth

Car

eS

ervi

ce

Impr

ovin

g w

orki

ngco

ndit

ions

of

prof

essi

onal

grou

ps s

ervi

ng in

hom

ehe

alth

car

e se

rvic

es, t

akin

gto

the

leve

l of

the

othe

rsp

ecia

lize

d te

ams

wor

king

in th

e in

stit

utio

ns

Enc

oura

ging

per

sonn

el to

be

invo

lved

in th

is te

am b

yim

prov

ing

the

wor

king

con

diti

ons

of th

e pe

rson

nel i

n ho

me

heal

thca

re te

ams

Min

istr

y of

Hea

lth

3 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


61

Tar

get

6- M

eeti

ng

Ed

uca

tion

al N

eed

s of

Hom

e C

are

Per

son

nel

an

d D

evel

opin

g E

mp

loym

ent

Pol

icie

s

Str

ateg

y

6.4.

En

suri

ng

the

edu

cati

on o

f th

eel

der

ly r

ecei

vin

g h

ome

hea

lth

car

e se

rvic

esan

d t

hei

r fa

mil

ies

6.4.

1. F

orm

atio

n an

d im

plem

enta

tion

of

trai

ning

pro

gram

s in

tend

ed f

or th

e di

ffer

ent

need

s of

the

elde

rly

rece

ivin

g se

rvic

es a

ndth

eir

fam

ilie

s (c

hief

ly h

ealt

h an

d so

cial

serv

ices

) in

kee

ping

wit

h th

e st

anda

rds

Sup

port

ing

the

elde

rly

inne

ed o

f ca

re a

nd th

eir

fam

ilie

s by

mea

ns o

ftr

aini

ng p

rogr

ams

1.In

crea

se in

the

num

ber

of th

e tr

aine

e el

derl

y

2. F

ollo

w-u

p an

dev

alua

tion

of

the

impl

emen

tati

on o

ftr

aini

ngs

give

n to

the

fam

ily

mem

bers

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Fam

ily

and

Soc

ial P

olic

ies

3. M

inis

try

of I

nter

nal

Aff

airs

4. U

nive

rsit

ies

5. N

GO

3 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


62

1.4. IMPROVEMENT OF HEALTH CARE SERVICES FOR ELDERLY AND ENSURING FULL

ACCESS TO HEALTH CARE SERVICES


In the changing structure of society, developing policies, ensuring full access to health and care

services and meeting the requirements of elderly are essential to improve the quality of life of elderly,

prevent the illnesses in old age and ensure their participation in the process.

According to the reports of Turkish Statistical Institute (TUIK) of 2007, 2008, 2009, 2010, 2011

and 2012 years, the population of the elderly in the total population is determined to be 7,1 percent, 6,8

percent, 7 percent, 7,2 percent, 7,4 percent and 7,5 percent respectively (19).

Figure 4. Change in Age and Gender Composition of the Population between 1935-2023 in Turkey

Source: TUIK, 1937, 1949, 1961, 1969, 1982, 1989, 2003, 2010b, 2010c

Table 4. General Demographic Information


63

Source: TUIK, 1990 and 2000 Censuses and ABPRS Results of the years 2007, 2008, 2009 and 2010

1990 2000 2010 2011 2012

Total Population 56.473.035 67.803.927 73.722.988 74.724.269 75.627.384

Rural Population Ratio (%) 48,7 40,8 29,0 28,2 27,7

Urban Population Ratio (%) 51,3 59,2 71,0 71,8 72,3

Population Ratio aged between 0-14 (%) 35,0 29,8 25,6 25,3 24,9

Population Ratio 65 years and above (%) 4,3 5,7 7,2 7,3 7,5

Youth Dependency Ratio (0-14 ages) 57,6 46,3 38,1 37,5 36,9

Old Age Dependency Ratio (65 + Above) 7,0 8,8 10,8 10,9 11,1

Total Dependency Ratio (%) 64,7 55,1 48,9 48,4 48,0

Annual Population Growth Rate ( ‰) 17,0 13,8 13,0 12,8 12,5

Approximate Birth Rate ( ‰) 24,1 20,3 17,5 17,3 17,0

Approximate Death Rate ( ‰) 7,1 6,6 6,3 6,3 6,3

Total fertility Rate (children per woman) 2,9 2,4 2,1 2,1 2,1

When we look at the change in the age structure of the population of Turkey, due to the downward

trend in fertility levels and improvement in the adverse conditions affecting the causes of death, it is

evident that there will be a real transformation from young to old in the structure of population of Turkey.

However, the aging of the population in Turkey is not a phenomenon that can be observed immediately.

Depending on the increase in the population of 15-64 years which constitutes the population of working

age over the course of time due to high fertility seen until recently, old age dependency ratio will not be

negatively affected for a long period. Nevertheless, it is also essential to take the necessary measures and

make the necessary adjustments in health and social assistance systems by considering the demographic

transformation in advance.

The increase in the elderly population brings on physiological, psychological, social and economic

problems. Aging of the population is a situation that has very different effects on socio-economic aspects

of human life. In economic terms, an aging population affects economic growth, savings, investment and

consumption, labour markets, pension funds, taxes and intergenerational transfers; health and health care

services, family composition, lifestyle, housing and immigration status in social terms . All of these

generate the risks of a reduction in labour supply (reduction in population of producers), increase in public

spending (increase in health expenditure and social security payments) increased care needs (corporate and

home care services).

Health and social services are required to be developed for improving the quality of life of elderly

people in the changing structure of society, responding to their problems requirements and ensuring their

social and family integration. Elderly health and active aging program is intended to be applied directly

in primary health care.


64

It is important that this should include such advanced implementations as that the centres providing

direct health service for elderly is easily accessible, implementation of positive discrimination for elderly,

planning of healthy aging and active care services.

Developed by WHO, “Age-Friendly Primary Care Centre” is one of the projects involving advanced

applications prepared for this purpose. Family Medicine that forms the basis for the provision of primary

health care in our country was laid down to be compatible with the active aging approach in the best way

with the definition of the WONCA (World Organization of National Colleges Academies) in Europe in

2002. According to this definition, family physicians are the physicians who are responsible for providing

periodic and comprehensive care for every individual seeking medical care, not considering their age,

gender and illness (20). They provide assistance for the individuals in the context of their families, cultures

and societies, whilst performing this, they always respect the individual personality of the patient and

have a professional responsibility to society.

Permanence principle in the geriatric population is important in family medicine. It is known that

the elderly pay tribute to the long-term relationship with family physicians and do not change their family

physicians until they die or move. However, protective, diagnostic, therapeutic and monitoring services

should be promoted in performance-based payments. As generally recognized, chronic diseases may lead

to results in irreversible outcomes in terms of health and finance when they become acute.


65

Target and Strategies towards the Improvement of Health Care for Elderly and Ensuring Full

Access to Health Care

Target 1- Improvement of Health Care for Elderly

Strategy 1

Provision, maintenance and development of preventive health care services for elderly

Strategy 2

Increasing the quality diagnostic and treatment services for elderly

Strategy 3

Provision, maintenance and development of rehabilitation services

Strategy 4

Implementation of health, social and rehabilitation services for elderly by providing cooperation

Strategy 5

Improvement of the standards in the geriatrics departments and units of hospitals, geriatrics hospitals,rehabilitation centres and geriatrics care centres and elderly day care services providing health careservices for elderly and opening of centres in accordance with these standards

Target 2- Ensuring Full Access to Health Care Service

Strategy 1

Ensuring that elderly can have equal access to health and care services in the universal standards,eliminating inequalities in access to care services and giving priority to the elderly individuals whohave mental, social or economic difficulties in accessing to health, care and rehabilitation services

Strategy 2

Providing positive discrimination for elderly in health institutions

Target 3- Improvement of Welfare Strategy 1

Increasing satisfaction for health care providers and those receiving service with the quality of healthcare


66

1.4.

Im

pro

vem

ent

of H

ealt

h C

are

for

Eld

erly

an

d E

nsu

rin

g F

ull

Acc

ess

to H

ealt

h C

are

and

Im

pro

vem

ent

of W

elfa

re

Tar

get

1-I

mp

rove

men

t of

Hea

lth

Car

e fo

r E

lder

ly

Str

ateg

y

1.1.

Pro

visi

on, m

ain

ten

ance

and

dev

elop

men

t of

pre

ven

tive

hea

lth

car

ese

rvic

es f

or e

lder

ly

1.1.

1. E

stab

lish

men

t of

foll

ow-u

p pr

ogra

ms

for

elde

rly

(at h

ome,

nur

sing

hom

es, h

ealt

h ca

rein

stit

utio

ns)

1.1.

2. A

s pr

egna

nt w

omen

and

chi

ldre

n fo

llow

-up

for

ms,

invo

lvem

ent o

f el

derl

y he

alth

fol

low

-up

for

ms

in F

amil

y P

hysi

cian

s In

form

atio

nS

yste

m (

FP

IS)

1.1.

3.P

rovi

sion

of

addi

tion

al p

aym

ent f

or th

epe

rson

nel i

nvol

ved

in th

e pr

ovis

ion

of e

lder

lypa

tien

t fol

low

-up

and

prev

enti

ve h

ealt

h ca

rese

rvic

es

1.1.

4. I

nfor

min

g th

e co

mm

unit

y w

ith

prin

ted

and

visu

al m

edia

aga

inst

pos

sibl

e ac

cide

nts

1.1.

5.F

orm

atio

n of

vac

cina

tion

pro

gram

for

the

peop

le a

bove

65

year

s of

age

1. A

s pr

egna

nt w

omen

and

chil

dren

fol

low

-up

form

s, in

volv

emen

t of

elde

rly

heal

th f

ollo

w-u

pfo

rms

in F

PIS

2. D

eter

min

atio

n of

the

perc

enta

ge o

f pr

iori

tygr

oups

3. V

acci

nati

on r

atio

in th

eel

derl

y po

pula

tion

4. N

umbe

r of

the

adm

itte

dpa

tien

ts a

bove

65

year

s of

age

and

geri

atri

csev

alua

tion

rat

io

1. D

ecre

ase

inm

orbi

dity

and

mor

tali

ty

2. I

ncre

ase

in th

enu

mbe

r of

imm

uniz

edel

derl

y

3.A

naly

sis

of F

PIS

regi

stra

tion

(av

erag

efo

llow

-up,

fol

low

-up

by p

rovi

nces

)

1. M

inis

try

of H

ealt

h2.

SG

K

1 ye

ar

1.2.

In

crea

sin

g th

e q

ual

ity

of d

iagn

osti

c an

d t

reat

men

tse

rvic

es f

or e

lder

ly

1.2.

1. T

rain

ing

of p

erso

nnel

invo

lved

in e

lder

lyhe

alth

ser

vice

1.2.

2.In

crea

sing

the

num

ber

of h

ealt

hpr

ofes

sion

als

spec

iali

zed

in th

eir

fiel

ds

1.In

crea

se in

the

num

ber

of th

e el

derl

y w

ho a

reea

rly

diag

nose

d an

dre

ceiv

ing

prop

ertr

eatm

ent

2. D

ecre

ase

inho

spit

aliz

atio

n ra

tes

and

stay

ing

peri

ods

3. N

umbe

r of

the

com

pete

nt h

ealt

h ca

repr

ofes

sion

als

1. R

educ

tion

inm

orbi

dity

and

mor

tali

ty

2.R

educ

tion

in th

elo

ng-t

erm

dia

gnos

isan

d tr

eatm

ent c

osts

Min

istr

y of

Hea

lth

1 ye

ar

1.3.

Pro

visi

on, m

ain

ten

ance

and

dev

elop

men

t of

reh

abil

itat

ion

ser

vice

s

1.3.

1.In

clud

ing

geri

atri

c re

habi

lita

tion

inun

derg

radu

ate

and

grad

uate

edu

cati

onpr

ogra

ms

in th

e fi

eld

of h

ealt

h

1.N

umbe

r of

hea

lth

care

prof

essi

onal

trai

ned

in th

efi

eld

of g

eria

tric

reha

bili

tati

on

2. S

atis

fact

ion

surv

eys

Incr

ease

in th

enu

mbe

r of

the

elde

rly

rece

ivin

g ge

riat

ric

reha

bili

tati

on

Min

istr

y of

Hea

lth

Per

iodi

c

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


67

Tar

get

1-Im

pro

vem

ent

of H

ealt

h C

are

for

Eld

erly

Str

ateg

y

1.4.

Im

ple

men

tati

on o

fh

ealt

h, s

ocia

l an

dre

hab

ilit

atio

n s

ervi

ces

for

eld

erly

by

pro

vid

ing

coop

erat

ion

1.4.

1.P

lann

ing

of m

eeti

ngs

and

cong

ress

es to

be

join

tly

held

inor

der

to e

nsur

e co

mm

unic

atio

n,co

llab

orat

ion

and

coop

erat

ion

amon

g in

stit

utio

ns

1.4.

2. S

tren

gthe

ning

and

trai

ning

the

elde

rly

and

thei

r re

lati

ves

inth

e us

e an

d ch

oice

of

heal

th,

soci

al a

nd r

ehab

ilit

atio

n se

rvic

es

1. I

ncre

ase

in th

e qu

alit

y of

ser

vice

2.In

crea

se in

the

num

ber

of p

atie

nts

and

pati

ent r

elat

ives

who

hav

ere

ceiv

ed tr

aini

ng o

n th

is s

ubje

ct

3.In

crea

se in

the

num

ber

ofpe

rson

nel w

ho w

ill p

rovi

de th

ese

serv

ices

4.D

eter

min

atio

n of

ser

vice

stan

dard

s an

d co

oper

atio

n be

twee

nth

e se

rvic

es

1. D

ecre

ase

in c

osts

2. E

lder

ly w

ith

enha

nced

qua

lity

of

life

3. E

lder

ly a

nd th

eir

fam

ilie

s w

ith

decr

ease

dca

re p

robl

ems

4. I

ncre

ase

in th

esa

tisf

acti

on o

f he

alth

care

pro

fess

iona

ls a

nd in

job

plea

sure

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Fam

ily

and

Soc

ial P

olic

ies

3. M

inis

try

of I

nter

nal

Aff

airs

4.S

GK

1 ye

ar

1.5.

Im

pro

vem

ent

of t

he

stan

dar

ds

in t

he

geri

atri

csd

epar

tmen

ts a

nd

un

its

ofh

osp

ital

s, g

eria

tric

sh

osp

ital

s, r

ehab

ilit

atio

nce

ntr

es a

nd

ger

iatr

ics

care

cen

tres

an

d e

lder

ly d

ayca

re s

ervi

ces

pro

vid

ing

hea

lth

car

e se

rvic

es f

orel

der

ly a

nd

op

enin

g of

cen

tres

in a

ccor

dan

ce w

ith

thes

e st

and

ard

s

1.5.

1. P

lann

ing

of d

isse

min

atio

nan

d im

prov

emen

t of

publ

ic a

ndpr

ivat

e ce

ntre

s pr

ovid

ing

serv

ice

for

the

need

s of

eld

erly

1.5.

2.D

eter

min

atio

n of

sta

ndar

dof

pub

lic

and

priv

ate

cent

res

prov

idin

g se

rvic

e fo

r el

derl

y

1.5.

3.E

stab

lish

men

t of

the

perc

epti

on A

ge-F

rien

dly

Cen

tre

in p

rim

ary,

sec

onda

ry a

ndte

rtia

ry h

ealt

h ca

re

1.5.

4. E

nsur

ing

regu

lar

supe

rvis

ions

in p

ubli

c an

dpr

ivat

e in

stit

utio

ns s

ervi

ng in

the

fiel

d of

ger

iatr

ic

1. I

ncre

ase

in th

e nu

mbe

r of

eld

erly

bene

fitt

ing

from

pri

mar

y he

alth

car

e

2. I

ncre

ase

in th

e nu

mbe

r an

dac

tivi

ties

of

publ

ic a

nd p

riva

tece

ntre

s pr

ovid

ing

serv

ice

for

elde

rly

wit

h th

e de

term

ined

sta

ndar

ds

3.In

crea

se in

the

qual

ity

of s

ervi

ce

1. T

he n

umbe

r of

elde

rly

wit

h en

hanc

edqu

alit

y of

life

2.In

crea

se in

the

num

ber

of e

lder

lyha

ving

acc

ess

to h

ealt

hca

re s

ervi

ces

3. I

ncre

ase

in th

epa

tien

ts r

ecei

ving

trea

tmen

t

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Fam

ily

and

Soc

ial

Pol

icie

s3.

Min

istr

y of

Dev

elop

men

t4.

Uni

vers

itie

s

4 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


68

Tar

get

2- E

nsu

rin

g F

ull

Acc

ess

to H

ealt

h C

are

Ser

vice

Str

ateg

y

2.1.

En

suri

ng

that

eld

erly

can

hav

eeq

ual

acc

ess

toh

ealt

h a

nd

car

ese

rvic

es in

th

eu

niv

ersa

l sta

nd

ard

s,el

imin

atin

gin

equ

alit

ies

inac

cess

to

care

serv

ices

2.1.

1. D

isse

min

atio

n of

hom

e fo

llow

-up

and

care

serv

ice

acro

ss th

e co

untr

y,1.

Inc

reas

e in

the

num

ber

of e

lder

ly h

avin

g ac

cess

to s

ervi

ce2.

Ana

lysi

s of

FP

ISre

gist

rati

on (

aver

age

foll

ow-u

p, f

ollo

w-u

p by

prov

ince

s)3.

Res

ults

of

sati

sfac

tion

1.D

ecre

ase

inm

orbi

dity

and

mor

tali

ty2.

Inc

reas

e in

the

life

sati

sfac

tion

of

elde

rly

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Fam

ily

and

Soc

ial P

olic

ies

1 ye

ar

2.2.

Giv

ing

pri

orit

yto

th

e el

der

lyin

div

idu

als

wh

oh

ave

men

tal,

soci

alor

eco

nom

icd

iffi

cult

ies

inac

cess

ing

to h

ealt

hca

re s

ervi

ces

2.2.

Giv

ing

prio

rity

to th

e el

derl

y in

divi

dual

s w

ho h

ave

men

tal,

soci

al o

r ec

onom

ic d

iffi

cult

ies

in a

cces

sing

tohe

alth

car

e se

rvic

es

2.2.

1.In

crea

sing

the

num

ber

of in

stit

utio

ns a

ndor

gani

zati

ons

prov

idin

g he

alth

, soc

ial a

nd c

are

serv

ices

for

elde

rly

(dep

endi

ng o

f th

e lo

cal e

lder

ly p

opul

atio

nra

tios

)

Incr

ease

in th

e nu

mbe

r of

elde

rly

havi

ng p

hysi

cal,

men

tal,

soci

al o

r ec

onom

icpr

oble

ms

who

rec

eive

serv

ices

fro

mor

gani

zati

ons

and

inst

itut

ions

pro

vidi

nghe

alth

, soc

ial a

nd c

are

serv

ices

Incr

ease

in th

e qu

alit

yof

life

of

elde

rly

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Fam

ily

and

Soc

ial P

olic

ies

3. M

inis

try

ofIn

tern

al A

ffai

rs3

year

s

2.3.

Pro

vid

ing

pos

itiv

ed

iscr

imin

atio

n f

orel

der

ly in

hea

lth

inst

itu

tion

2.3.

1. E

stab

lish

men

t of

age-

frie

ndly

hea

lth

cent

res

and

faci

lita

tion

and

pri

orit

y fo

r el

derl

y to

acc

ess

to th

ese

serv

ices

(en

suri

ng th

at p

oor

elde

rly

can

part

icul

arly

get

mor

e ou

t of

thes

e so

urce

s)

Incr

ease

in th

e nu

mbe

r of

age-

frie

ndly

hea

lth

cent

res

Incr

ease

in th

esa

tisf

acti

on o

f li

fe f

orel

derl

y

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Fam

ily

and

Soc

ial P

olic

ies

3 ye

ars

2.1.

2. I

nclu

ding

hea

lth

and

soci

al s

uppo

rt s

ervi

ces

cont

aine

d in

the

serv

ice

mod

el (

hom

e m

edic

alm

onit

orin

g an

d tr

eatm

ent,

assi

stan

ce a

t hom

e,ho

usek

eepi

ng, f

ollo

w-u

p vi

a ph

one,

hom

e ca

teri

ng,

mai

nten

ance

and

rep

air)

in th

e sc

ope

of in

sura

nce

paym

ents

, and

sup

ervi

sion

of

thes

e se

rvic

es2.

1.3.

Col

lect

ion

of c

all c

entr

es in

a s

ingl

e ce

ntre

.P

rovi

sion

of

assi

stan

ce, c

onsu

ltan

cy a

nd g

uida

nce

serv

ices

for

eld

erly

fre

e of

cha

rge

in a

ll f

ield

s by

esta

blis

hing

a p

hone

ass

ista

nce

and

cons

ulta

ncy

line

.E

stab

lish

men

t of

an e

mer

genc

y ca

ll c

entr

e fo

r th

eel

derl

y li

ving

at t

heir

hom

es o

r st

ayin

g in

the

inst

itut

ions

by

mea

ns o

f el

ectr

onic

war

ning

or

assi

stin

gde

vice

s2.

1.4.

Incl

udin

g th

e co

urse

s of

eld

erly

hea

lth

care

serv

ices

in th

e cu

rric

ulum

of

the

educ

atio

nal i

nsti

tuti

ons

trai

ning

hea

lth

care

pro

fess

iona

ls a

nd s

uper

visi

on o

fth

ese

cour

ses

by s

uper

visi

ng c

omm

itte

e ac

cred

ited

at

nati

onal

and

inte

rnat

iona

l lev

el

2.1.

5.E

stab

lish

men

t of

mob

ile

team

s in

tend

ed f

orel

derl

y (m

edic

atio

n di

stri

buti

on, s

ocia

l act

ivit

y,nu

trit

ion,

etc

.) (

carr

ied

out b

y lo

cal a

utho

riti

es)

1. R

esul

ts o

f sa

tisf

acti

onan

d qu

alit

y of

life

2. T

he n

umbe

r of

mob

ile

team

s es

tabl

ishe

d

Incr

ease

in th

e qu

alit

yof

life

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Fam

ily

and

Soc

ial P

olic

ies

3. M

inis

try

of I

nter

nal

Aff

airs

4. M

inis

try

ofN

atio

nal E

duca

tion

3 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


69

Tar

get

3-Im

pro

vem

ent

of W

elfa

re

Str

ateg

y

3.1.

In

crea

sin

g sa

tisf

acti

onfo

r h

ealt

h c

are

pro

vid

ers

and

th

ose

rece

ivin

g se

rvic

ew

ith

th

e q

ual

ity

of h

ealt

hca

re

3.1.

1. D

eter

min

atio

n of

job

desc

ript

ion

ofw

orki

ng s

taff

3.1.

2.D

evel

opm

ent o

f re

gist

rati

on a

ndin

form

atio

n sy

stem

in th

e pr

ovis

ion

of h

ealt

hca

re

1. A

rran

gem

ent o

fle

gisl

atio

ns

2.In

crea

se in

the

num

ber

of r

egis

tere

d pa

tien

ts

3.In

crea

se in

the

qual

ity

of s

ervi

ce

1.In

crea

se in

the

sati

sfac

tion

of

pers

onne

l

2. I

ncre

ase

in th

esa

tisf

acti

on o

f se

rvic

epr

ovid

ers

and

thei

rfa

mil

ies

1.M

inis

try

of H

ealt

h2.

Min

istr

y of

Int

erna

lA

ffai

rs3.

SG

K4.

NG

O

Per

iodi

c

3.1.

3. P

rom

otin

g th

e do

mes

tic

and

abro

adtr

aini

ng o

ppor

tuni

ties

for

wor

king

sta

ffIn

crea

se in

the

num

ber

ofqu

alif

ied

heal

th c

are

prof

essi

onal

s

Incr

ease

in th

e qu

alit

yof

ser

vice

pro

vide

dfo

r el

derl

y an

d in

the

sati

sfac

tion

of

serv

ice

area

s

Min

istr

y of

Hea

lth

Per

iodi

c

3.1.

4. I

mpr

ovin

g th

e m

otiv

atio

n of

wor

king

staf

f In

crea

se in

the

wor

king

mot

ivat

ion

of th

e st

aff

wor

king

in th

e fi

eld

ofel

derl

y he

alth

Num

ber

of h

ealt

hca

re p

rofe

ssio

nals

pref

erri

ng to

wor

k in

the

fiel

d of

eld

erly

heal

th

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Fam

ily

and

Soc

ial P

olic

ies

Per

iodi

c

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


70

1.5. IMPLEMENTATION OF PLANS AND ACTIVITIES ON THE SUBJECT OF

NEUROPSYCHIATRIC DISORDERS, DEMENTIA, GERIATRIC PSYCHIATRY, DISABILITY,

ABUSE OF ELDERLY AND VIOLENCE IN OLD AGE


1. Neuropsychiatric Diseases, Dementia and Geriatric Psychiatry in Elderly

Dementia is a common problem in the elderly. Its incidence is 5 percent in over 65 years and 50

percent in over 80 years of age. Since the disease can start with an insidious forgetfulness, forgetfulness

in old age cannot be seen as normal. Today, with the existing medications, the duration of going to the last

point in the cases diagnosed in early stages can be extended, patient's self-care time can be extended and

caregiver burden can be reduced (21).

The number of patients with dementia worldwide in 2010 was 35,6 million, this figure is estimated

to rise to 65,7 million by 2030 and 115,4 million by 2050. The cost of dementia in the whole world was

604 billion dollars for the country economies in 2010, and 89 percent of this cost is stated to be covered

by the developed countries. Given the prevalence of dementia as of 2010; 4,6 percent of the total

population of Asia is expressed to suffer from dementia, 6,2 percent in Europe, 6,1 percent in Latin

America, 6,9 percent in North America and approximately 4,7 percent of the population worldwide. When

the countries having the patients with dementia are listed, China ranks in the first place with 5,4 million

patients, the USA with 3,9 million, India with 3,7 million, Japan with 2,5 million, Germany with 1,2

million, Russia with 1,1 million, France and Italy with 1 million each, followed by Brazil with 1 million

patients (22).

2. Abuse of Elderly, Negligence, and Violence against Elderly

According to the WHO, violence is defined as deliberate use of physical power and ferocity in an

actual or threatening way against another individual, group or community which results in injury, death,

psychological harm, loss or is likely to result in one of the foregoing predicaments (23).

Violence, while affecting all individual within a society, affects the elderly groups who are more

vulnerable (24). In the world health report of the WHO of 1998, aging is defined as the increase of

disability and being dependent to the others (25).

Violence against elderly is a common type of violence generally encountered in older age (75 and

above). Old age is a period in which the dependence of individuals and risk of accidents increase, physical

abilities decreases and many chronic diseases are experienced (26).

Abuse of Elderly

In general, abuse of elderly is defined as the whole physical and psychological behaviours causing

negligence that brings about injury and abuse of elderly (27). More than 5 percent of the elderly population

over 65 years of age in England is found to be orally ill-treated by their close relatives, 2 percent is

physically ill-treated and 2 percent is economically ill-treated (28).


71

According to the report of the United States National Adult Protective Services Agency (APS- Adult

Protective Services); abuse of elderly in the years 1986-1996 (from 117,000 cases to 293.000 cases) are

reported to rise by 150 percent. In the United States (1979-1994), 60 percent of the crimes committed

against the elderly is stated to be negligence and 15 percent to be physical abuse (29).

In our country, when we look at studies related to abuse of elderly; it is found that 26,6 percent of

the elderly suffers physical abuse, the abusers is made up of their close relatives and 86,72 percent

complains of the elderly and do not share this situation with other people (30).

Neglecting Elderly

Negligence is that the elderly experience emotional or physical difficulty in connection with the

knowingly or unknowingly refusal or deferral of the fulfilment of care process by caregiver (failure to meet

such requirements as nutrition, dressing, personal hygiene, heating, economic sources needed for elderly

to maintain their daily lives, avoiding communicating, leaving alone for a long time, ignoring health care

needs, not taking the finished drugs, ignoring the need for the use of assistive devices like hearing aids).

3. Disability

Disability is an ineffective situation of a person which is associated with physical and mental

illnesses, defining an important situation with legal and clinical aspects that disrupts basic life activities

(31). According to the International Classification of Functioning, Disability and Health (ICF), disability

is defined as any limitations or restrictions on the ability of an individual to perform an activity within the

acceptable limits (32).

Disability leads to the loss of works and social roles and the ability to take care of himself or herself

which are expected from an individual to perform him and the loss of social relations and disruption of

duties.

Social and legal consequences of this situation, which disrupts daily living activities, affect both the

elderly and their environment. In addition to degradation of the quality of life, this leads to the formation

of some new pathology and the new functional losses associated with this.

Practice on the Subjects of Neuropsychiatric Diseases, Dementia and Geriatric Psychiatry in Elderly

Department of Health of Britain and the United States and many Non-Governmental Organizations

have web pages in order to inform the public of such common diseases as Alzheimer's disease, depression

and neuropsychiatric disorders.

Implementations on the subject of Abuse of Elderly and Violence against the Elderly

Free telephone lines called “elder abuse hotline” have been opened in the United States to report the

abuse of elderly. This phone line directs the callers to the units called the "elderly protection services."

Similar phone lines are available in Australia, England, New Zealand and Canada. Upon complaints made

by telephone, “Elderly Protection Services” units visit the home of the elderly and prepare a report If

there is an abuse, the relocation of the elderly (admission to retirement homes, nursing homes, etc.) are

carried out and criminal proceedings are initiated against the person who has carried out abuse. In addition,

when the address http://www.ncea.aoa.gov/index.aspx describes in detail as to how to react in case an

abuse.

Implementations on the subjects of Disability

To prevent disability in the elderly, especially family physicians and nurses in primary health care

in the United States and England in England make the elderly undergo screening at least once a year. This

screening program includes the examination of cancer markers and application of vaccinations of the

elderly and the recommendations based on the findings (regular exercise and dietary advice).


72


73

Target and Strategies towards Neuropsychiatric Disorders, Dementia, Geriatric Psychiatry,

Disability, Abuse of Elderly and Violence in Old Age

Target 1- Ensuring provision of the necessary cooperation of all of the relevant institutions andpreparing the conditions required for the elderly to receive the most effective, accurate andcompetent service in the diagnosis and treatment of neuropsychiatric disorders

Strategy 1

Ensuring permanent access of geropsychiatric patient to treatment

Target 2- Taking necessary measures and performing rehabilitation to prevent, diagnose andeliminate disability resulting from neuropsychiatric disorders in the elderly

Strategy 1

Ensuring the diagnosis of geropsychiatric disorders as a disability by physicians and health careprofessionals

Strategy 2

Ensuring the reduction of disability in the elderly and the community

Target 3- Taking necessary measures to prevent and identify abuse of the elderly intended forcommunity, families and institutions

Strategy 1

Raising awareness of community about abuse and violence against elderly and violence

Strategy 2

Training health care professionals about elderly health and abuse and violence against elderly beforeand after graduation and increasing the service provision capacities

Strategy 3

Establishment of health care services for the elderly who have undergone abuse and violence


74

1.5.

Im

ple

men

tati

on o

f P

lan

nin

g an

d A

ctiv

itie

s ab

out

Neu

rop

sych

iatr

ic D

isor

der

s, D

emen

tia,

Ger

iatr

ic P

sych

iatr

y, D

isab

ilit

y, A

bu

se o

f

Eld

erly

an

d V

iole

nce

in O

ld A

ge

Tar

get

1- E

nsu

rin

g p

rovi

sion

of

the

nec

essa

ry c

oop

erat

ion

of

all o

f th

e re

leva

nt

inst

itu

tion

s an

d p

rep

arin

g th

e co

nd

itio

ns

req

uir

ed f

or t

he

eld

erly

to

rece

ive

the

mos

t ef

fect

ive,

acc

ura

te a

nd

com

pet

ent

serv

ice

in t

he

dia

gnos

is a

nd

tre

atm

ent

of n

euro

psy

chia

tric

dis

ord

ers

Str

ateg

y

1.1.

En

suri

ng

per

man

ent

acce

ss o

fge

rop

sych

iatr

ic p

atie

nt

to t

reat

men

t

1.1.

1. E

nsur

ing

faci

lita

tion

of

the

elde

rly

inou

tpat

ient

app

oint

men

ts

1.1.

2.A

llot

ting

wai

ting

cha

irs

to th

e el

derl

yin

out

pati

ent w

aiti

ng r

oom

s

1.1.

3. T

hat t

he c

lini

cs s

ervi

ng th

e el

derl

y ar

eon

the

firs

t flo

or

1.1.

4. A

llot

ting

sep

arat

e ro

oms

to th

e el

derl

yw

hen

perf

orm

ing

thei

r ex

amin

atio

n in

poly

clin

ics

and

givi

ng p

rior

ity

in e

xam

inat

ion

and

chec

k-up

1.1.

5.A

llot

ting

per

sonn

el to

acc

ompa

nyin

gth

e el

derl

y w

ith

dem

enti

a an

d ge

rops

ychi

atri

cdi

sord

er w

ho h

ave

com

e al

one

duri

ng th

epr

oces

s

1. N

umbe

r of

pat

ient

sac

cess

ing

to p

hysi

cian

s 2.

Num

ber

of th

eel

derl

y w

ho h

ave

been

prio

riti

zed

in p

olyc

lini

csan

d ex

amin

ed in

an

easy

and

qual

ity

way

3.N

umbe

r of

team

sse

rvin

g th

e el

derl

y w

ith

gero

psyc

hiat

ric

diso

rder

1. I

ncre

ase

in th

e nu

mbe

rof

pat

ient

s ac

cess

ing

toph

ysic

ians

2.In

crea

se in

the

num

ber

of n

umbe

r of

the

elde

rly

who

hav

e be

en p

rior

itiz

edin

pol

ycli

nics

and

exam

ined

in a

n ea

sy a

ndqu

alit

y w

ay3.

Incr

ease

in th

e nu

mbe

rof

team

s se

rvin

g th

eel

derl

y w

ith

gero

psyc

hiat

ric

diso

rder

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Fam

ily

and

Soc

ial P

olic

ies

3. M

inis

try

of J

usti

ce4.

Min

istr

y of

Int

erna

lA

ffai

rs5.

SG

K6.

Pre

ss a

ndB

road

cast

ing

Inst

itut

ions

7. D

epar

tmen

ts o

fG

eria

tric

s, N

euro

logy

and

Psy

chia

try

inU

nive

rsit

ies

8. P

riva

te H

ospi

tals

9.N

GO

2 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


75

Tar

get

1-E

nsu

rin

g p

rovi

sion

of

the

nec

essa

ry c

oop

erat

ion

of

all

of t

he

rele

van

t in

stit

uti

ons

and

pre

par

ing

the

con

dit

ion

s re

qu

ired

for

th

e el

der

ly t

o

rece

ive

the

mos

t ef

fect

ive,

acc

ura

te a

nd

com

pet

ent

serv

ice

in t

he

dia

gnos

is a

nd

tre

atm

ent

of n

euro

psy

chia

tric

dis

ord

ers

Str

ateg

y

1.1.

En

suri

ng

per

man

ent

acce

ss o

fge

rop

sych

iatr

icp

atie

nts

to

trea

tmen

t

1.1.

6. I

n in

pati

ent s

ervi

ces;

eld

erly

gero

psyc

hiat

ric

pati

ents

nee

d m

ore

atte

ntio

n,pe

rson

nel a

nd m

edic

al e

quip

men

t due

to th

eir

chro

nic

illn

ess.

The

refo

re, e

stab

lish

men

t of

gero

psyc

hiat

ric

serv

ices

in u

nive

rsit

ies

and

rese

arch

hosp

ital

s.

Est

abli

shm

ent o

f th

e te

ams

and

prov

isio

n of

trai

ning

for

thes

e te

ams

that

wil

l ser

ve th

epa

tien

ts in

thes

e se

rvic

es

Pro

visi

on o

f fa

cili

ties

like

“sh

elte

r” o

r“p

rote

ctio

n ho

uses

” fo

r ho

mel

ess

gero

psyc

hiat

ric

pati

ents

- G

ivin

g po

wer

and

dut

ies

to th

e pr

osec

utor

san

d la

w e

nfor

cem

ent u

nits

in o

rder

for

the

hom

eles

s el

derl

y w

ho s

uffe

r fr

om d

emen

tia,

and

are

wit

hout

any

rel

ativ

e an

d in

nee

d of

hous

ing

to b

e pl

aced

in

- F

or th

is s

itua

tion

, det

erm

inat

ion

a co

mm

onso

luti

on b

y M

inis

try

of H

ealt

h, M

inis

try

ofIn

tern

al A

ffai

rs, M

inis

try

of J

usti

ce a

ndM

inis

try

of F

amil

y an

d S

ocia

l Aff

airs

1.1.

7.E

nsur

ing

hom

e ca

re f

or g

erop

sych

iatr

icpa

tien

ts w

ho a

re n

ot li

kely

to a

cces

s to

med

icat

ion

and

heal

th s

ervi

ces

1. N

umbe

r of

the

pati

ents

acce

ssin

g to

phy

sici

ans

2. D

eter

min

atio

n of

inst

itut

ions

for

bei

ng a

ssig

ned

to h

ost t

he g

erop

sych

iatr

icpa

tien

ts w

ho h

ave

no r

elat

ive

and

are

in n

eed

of h

ousi

ng3.

Num

ber

of g

erop

sych

iatr

yse

rvic

es in

uni

vers

itie

s an

dre

sear

ch h

ospi

tals

4. N

umbe

r of

qua

lifi

ed te

ams

prov

idin

g se

rvic

e fo

rge

rops

ychi

atri

c pa

tien

ts5.

Num

ber

of p

rote

ctio

nho

uses

6. N

umbe

r of

pat

ient

s w

hoca

n co

ntin

uous

ly a

cces

s to

med

icat

ion

7. M

onth

ly a

nd a

nnua

lly

stat

isti

cs o

f in

stit

utio

ns r

elat

edin

hou

sing

8.D

ata

stud

y co

nduc

ted

wit

hli

ving

qua

lity

sca

les

9. N

umbe

r of

med

icat

ions

of

gero

psyc

hiat

ric

pati

ents

and

reim

burs

emen

t sta

tist

ics

10.N

umbe

r of

gero

psyc

hiat

ric

pati

ents

who

rece

ive

hom

e ca

re s

ervi

ces

11.N

umbe

r of

pat

ient

sm

onit

ored

in in

pati

ent s

ervi

ce

1. I

ncre

ase

in th

e nu

mbe

rof

the

elde

rly

acce

ssin

g to

phys

icia

ns

2. I

ncre

ase

in th

epl

acem

ent o

fge

rops

ychi

atri

c pa

tien

tsw

ho h

ave

no r

elat

ive

and

are

in n

eed

of h

ousi

ng in

inst

itut

ions

3. I

ncre

ase

in th

e nu

mbe

rof

ger

opsy

chia

try

serv

ice

in u

nive

rsit

ies

and

rese

arch

hosp

ital

s4.

Inc

reas

e in

the

num

ber

of q

uali

fied

team

spr

ovid

ing

serv

ice

for

gero

psyc

hiat

ric

pati

ents

5. I

ncre

ase

in th

e nu

mbe

rof

pro

tect

ion

hous

es6.

Inc

reas

e in

the

num

ber

of p

atie

nts

who

can

cont

inuo

usly

acc

ess

tom

edic

atio

n7.

Clo

sely

mon

itor

ing

cost

anal

ysis

stu

dies

of

neur

opsy

chia

tric

dis

ease

s

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Fam

ily

and

Soc

ial P

olic

ies

3. M

inis

try

of J

usti

ce4.

Min

istr

y of

Int

erna

l A

ffai

rs5.

SG

K6.

Pre

ss a

nd

Bro

adca

stin

g In

stit

utio

ns7.

Dep

artm

ents

of

Ger

iatr

ics,

N

euro

logy

an

d P

sych

iatr

y in

U

nive

rsit

ies

8. P

riva

te H

ospi

tals

9. N

GO

2 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


76

Tar

get

2- T

akin

g n

eces

sary

mea

sure

s an

d p

erfo

rmin

g re

hab

ilit

atio

n t

o p

reve

nt,

dia

gnos

e an

d e

lim

inat

e d

isab

ilit

y re

sult

ing

from

neu

rop

sych

iatr

ic

dis

ord

ers

in t

he

eld

erly

Str

ateg

y

2.1.

En

suri

ng

the

dia

gnos

is o

fge

rop

sych

iatr

icd

isor

der

s as

ad

isab

ilit

y b

yp

hys

icia

ns

and

hea

lth

car

ep

rofe

ssio

nal

s

2.2.

En

suri

ng

the

red

uct

ion

of

dis

abil

ity

in t

he

eld

erly

an

d c

reat

ion

awar

enes

s in

th

eco

mm

un

ity

2.1.

1. S

peci

alis

ts a

nd p

hysi

cian

s se

rvin

g in

the

fiel

d of

ger

iatr

ics

in u

nive

rsit

ies

and

trai

ning

and

res

earc

h ho

spit

als

who

are

acti

vely

ass

igne

d to

arr

ange

per

iodi

ctr

aini

ng a

ctiv

itie

s an

d co

urse

s an

d pr

epar

epr

inte

d an

d vi

sual

doc

umen

ts

2.2.

1.A

rran

ging

the

acti

viti

es in

whi

ch th

eel

derl

y ca

n pa

rtic

ipat

e fo

r in

crea

sing

thei

rph

ysic

al a

ctiv

itie

s, s

uppo

rtin

g th

e ac

tivi

ties

such

eve

nts

as c

hess

tour

nam

ents

, mus

icev

ents

and

phy

sica

l exe

rcis

e ac

tivi

ties

2.2.

3. E

nsur

ing

the

part

icip

atio

n of

the

elde

rly

in th

e ac

tivi

ties

in w

hich

cog

niti

vere

habi

lita

tion

is p

erfo

rmed

, sup

port

ing

the

lear

ning

pro

cess

of

the

elde

rly

by o

peni

ngho

bby

cour

ses,

com

pute

r us

e, c

raft

s an

dha

ndic

raft

s, o

ccup

atio

nal t

hera

py a

ndre

adin

g co

urse

s

2.2.

4.In

crea

sing

the

num

ber

of p

ubli

cga

rden

s en

hanc

e ph

ysic

al e

xerc

ise

acti

viti

esof

the

elde

rly

2.2.

5. G

ivin

g au

thor

ity

and

supp

ort t

om

unic

ipal

itie

s to

pro

vide

the

acti

viti

es

2.2.

6.In

trod

ucin

g el

derl

y qu

otas

for

the

cult

ural

act

ivit

ies

to b

e fu

rthe

r pe

rfor

med

(10

perc

ent o

f au

dien

ce)

2.2.

7.P

rovi

ding

on-

line

trai

ning

pro

gram

sfo

r th

e el

derl

y

2.2.

8.P

rovi

ding

5 p

erce

nt q

uota

and

esta

blis

hing

par

t-ti

me

wor

king

con

diti

ons

for

the

pers

ons

over

65

year

s of

age

to s

erve

in p

ubli

c an

d pr

ivat

e in

stit

utio

ns

1. H

ealt

h ca

re p

rofe

ssio

nal

that

can

use

eva

luat

ion

scal

ein

tend

ed f

or d

isab

ilit

y2.

Inc

reas

e in

the

out-

of-h

ome

acti

viti

es o

f el

derl

y3.

Re-

plan

ning

of

serv

ice

prov

isio

ns o

f m

unic

ipal

itie

sin

tend

ed f

or th

e el

derl

y an

din

crea

se in

the

serv

ice

prov

isio

n4.

Incr

ease

in th

e se

rvic

epr

ovis

ion

aim

ed a

t org

aniz

ing

the

elde

rly

5. I

ncre

ase

in th

e ra

tio

of th

eus

e of

hea

lth

care

ser

vice

s by

the

elde

rly

6. I

ncre

ase

in th

e ps

ycho

-so

cial

leve

ls o

f th

e el

derl

y7.

Incr

ease

in th

e pa

rtic

ipat

ion

of th

e el

derl

y in

the

acti

viti

esor

gani

zed

in p

rovi

nces

8.In

crea

se in

the

volu

ntee

ran

d pa

id e

mpl

oym

ent

oppo

rtun

itie

s9.

Inc

reas

e in

the

publ

icat

ion

in th

e m

edia

for

the

elde

rly

1. A

dvan

cem

ent i

nre

cogn

itio

n an

d pr

even

tion

of d

isab

ilit

y2.

Dec

reas

e in

anx

iety

,de

pres

sion

and

sle

epdi

sord

ers

and

incr

ease

inqu

alit

y of

life

3. I

ncre

ase

in th

e pr

oble

ms

of th

e pa

tien

ts w

ith

dem

enti

a an

d th

e fa

mil

ies

wit

h de

men

tia

pati

ents

and

decr

ease

in th

e is

olat

ion

ofth

e pa

tien

ts f

rom

the

com

mun

ity

4. I

ncre

ase

in th

e el

derl

yor

gani

zati

ons

and

esta

blis

hmen

t of

rele

vant

inst

itut

ions

for

eld

erly

soli

dari

ty

5. I

ncre

ase

in th

e ra

tio

ofth

e us

e of

hea

lth

care

serv

ices

by

the

elde

rly

6. D

ecre

ase

in m

orbi

dity

of

syst

emic

and

neur

opsy

chia

tric

dis

ease

s7.

Incr

ease

in th

e so

cial

com

mun

icat

ion

of th

eel

derl

y 8.

Inc

reas

e in

the

prod

ucti

vity

and

soc

ial

func

tion

ing

of th

e el

derl

y9.

Incr

ease

in k

now

ledg

ean

d aw

aren

ess

leve

ls o

f th

eel

derl

y an

d in

the

acqu

isit

ion

of k

now

ledg

e

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Fam

ily

and

Soc

ial P

olic

ies

3.M

inis

try

of L

abou

r an

d S

ocia

l Sec

urit

y4.

Uni

vers

itie

s5.

Pre

ss a

nd

Bro

adca

stin

g In

stit

utio

ns6.

NG

O

4 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


77

Tar

get

3- T

akin

g n

eces

sary

mea

sure

s to

pre

ven

t an

d id

enti

fy a

bu

se o

f th

e el

der

ly in

ten

ded

for

com

mu

nit

y, f

amil

ies

and

inst

itu

tion

s

Str

ateg

y

3.1.

Rai

sin

gaw

aren

ess

ofco

mm

un

ity

abou

tab

use

an

dvi

olen

ce a

gain

stel

der

ly

3.1.

1. C

ampa

igni

ng to

pre

vent

the

abus

e an

dvi

olen

ce a

gain

st e

lder

ly a

nd to

rai

se c

omm

unit

yaw

aren

ess

1.In

crea

se in

the

num

ber

ofpo

ster

s re

late

d to

the

subj

ect o

fab

use

and

viol

ence

aga

inst

eld

erly

whi

ch a

re h

ange

d on

cit

y bo

ards

2.In

crea

se in

the

publ

icat

ions

rela

ted

to a

buse

and

vio

lenc

eag

ains

t eld

erly

in p

rint

ed a

ndvi

sual

med

ia

3.N

umbe

r of

abu

se a

nd v

iole

nce

agai

nst e

lder

ly4.

Num

ber

of e

lder

abu

se r

epor

ted

by p

hysi

cian

s an

d he

alth

car

epr

ofes

sion

als

1. I

ncre

ase

in th

enu

mbe

r of

indi

vidu

als

repo

rtin

g ab

use

and

viol

ence

aga

inst

elde

rly

in c

omm

unit

y2.

Dec

reas

e in

abu

sean

d vi

olen

ce a

gain

stel

derl

y in

com

mun

ity

1. M

inis

try

of F

amil

y an

d S

ocia

l Pol

icie

s2.

Min

istr

y of

Hea

lth

3.M

inis

try

of I

nter

nal

Aff

airs

4.P

ress

and

B

road

cast

ing

Org

aniz

atio

ns5.

NG

O

Per

iodi

c

3.2.

Tra

inin

gh

ealt

h c

are

pro

fess

ion

als

abou

t el

der

lyh

ealt

h a

nd

ab

use

and

vio

len

ceag

ain

st e

lder

lyb

efor

e an

d a

fter

grad

uat

ion

an

din

crea

sin

g th

ese

rvic

e p

rovi

sion

cap

acit

ies

3.2.

1. E

nsur

ing

to in

clud

e th

e su

bjec

t of

abus

e an

dvi

olen

ce a

gain

st e

lder

ly in

the

unde

rgra

duat

ecu

rric

ulum

of

facu

lty

of m

edic

ine,

nur

sing

, soc

ial

serv

ices

and

oth

er r

elat

ed d

isci

plin

es3.

2.2.

Ens

urin

g to

incl

ude

the

subj

ect o

f ab

use

and

viol

ence

aga

inst

eld

erly

in th

e ed

ucat

ion

of f

amil

yph

ysic

ians

, em

erge

ncy

med

icin

e, in

tern

alm

edic

ine,

psy

chia

try

and

med

ical

spe

cial

ity

3.2.

3 In

clud

ing

the

subj

ect o

f ab

use

and

viol

ence

agai

nst e

lder

ly in

the

in-s

ervi

ce tr

aini

ngs

of h

ealt

hca

re p

rofe

ssio

nal i

nten

ded

for

the

elde

rly

3.2.

4. P

repa

rati

on o

f in

form

atio

n do

cum

ents

inte

nded

for

hea

lth

care

pro

fess

iona

ls a

nddi

stri

buti

on o

f th

ese

to a

ll o

f th

e re

leva

ntin

stit

utio

ns a

nd o

rgan

izat

ions

1.In

crea

se in

the

num

ber

ofin

stit

utio

ns th

at g

ive

plac

e to

this

subj

ect

2. N

umbe

r of

spe

cial

izat

ion

area

sth

at g

ive

plac

e to

this

sub

ject

infa

cult

y of

med

icin

e cu

rric

ulum

3. N

umbe

r of

in-s

ervi

ce tr

aini

ngs

4.N

umbe

r of

info

rmat

ion

docu

men

ts p

repa

red

and

dist

ribu

ted

1. I

ncre

ase

in th

enu

mbe

r of

rep

orts

abou

t abu

se a

ndvi

olen

ce a

gain

stel

derl

y m

ade

bypr

ofes

sion

als

ser

ving

in th

e fi

eld

of e

lder

lyhe

alth

2. R

aisi

ng a

war

enes

sof

hea

lth

care

prof

essi

onal

s ab

out

abus

e an

d vi

olen

ceag

ains

t eld

erly

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Fam

ily

and

Soc

ial P

olic

ies

3.Y

OK

4.U

nive

rsit

ies

5.N

GO

2 ye

ars

3.3.

Est

abli

shm

ent

ofh

ealt

h c

are

serv

ices

for

th

eel

der

ly w

ho

hav

eu

nd

ergo

ne

abu

sean

d v

iole

nce

3.3.

1. M

akin

g ne

cess

ary

prom

otio

ns f

or e

lder

abus

e to

be

repo

rted

to H

otli

ne A

LO

183

3.

3.2.

Usi

ng a

ppro

ache

s to

ear

ly d

etec

t eld

er a

buse

in th

e ho

me

visi

ts b

y pr

imar

y he

alth

car

e fa

mil

yph

ysic

ians

and

fam

ily

heal

th s

taff

and

soc

ial

serv

ice

spec

iali

sts

3.

3.3.

Cre

atio

n of

alg

orit

hm o

f se

rvic

e fl

ow th

atw

ill e

nsur

e th

at e

mer

genc

y st

aff

can

take

appr

opri

ate

appr

oach

es to

the

hosp

ital

adm

issi

ons

due

to th

e tr

aum

a ar

isin

g fr

om a

buse

/vio

lenc

e 3.

3.4.

Pro

vidi

ng in

stit

utio

nal s

uppo

rt to

the

elde

rly

plac

ed in

the

inst

itut

ions

due

to a

buse

and

viol

ence

1. N

umbe

r of

cas

e of

eld

er a

buse

and/

or v

iole

nce

agai

nst e

lder

lyre

port

ed to

hot

line

AL

O 1

83

2. N

umbe

r of

eld

er a

buse

and

viol

ence

det

ecte

d by

fam

ily

phys

icia

ns a

nd s

ocia

l ser

vice

spec

iali

sts

in h

ome

visi

ts

3. N

umbe

r of

eld

er a

buse

and

viol

ence

whi

ch is

det

ecte

d in

supe

rvis

ions

mad

e to

the

inst

itut

ions

(pr

ovid

ing

serv

ice

for

elde

rly)

1. N

umbe

r of

the

pers

ons

who

hav

eco

mm

itte

d el

der

abus

ean

d vi

olen

ce a

nd h

ave

been

reh

abil

itat

ed

2. E

stab

lish

men

t of

livi

ng c

ondi

tion

sad

dres

sing

the

nest

inte

rest

s of

eld

erly

1.M

inis

try

of F

amil

y an

d S

ocia

l Pol

icie

s2.

Min

istr

y of

Hea

lth

2 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


78

1.6. ENSURING ORGANIZATION IN ACUTE CARE AND EMERGENCY IN GERIATRICS


Increase in aging population brings about the increased access to and utilization of health care

services for the elderly population. In this context, studies associated with how the elderly will benefit from

a more effective and reliable emergency health care are increasing. Because emergency regulations in

health care are in consistent with the level and development of health systems of countries.

As well as country, city and regional differences, such many factors as existing health system,

localization of hospital and emergency departments, population characteristics of region and extent of

ambulance network affect the rate of utilization of emergency departments. The rate of utilization of

emergency departments in urban areas is higher than rural rates.

In recent years, the frequency of applying to emergency departments has been increasing, the elderly

are often subject to negative discrimination in the crowd and fast cycles and the optimal intervention and

initiatives are performed less, so the elderly is thought to respond less to treatment. That the elderly are

special groups as children and the requirements of different approaches and assessment for them are now

recognized all over the world. Because the elderly often have multiple disorders (multiple comorbidities).

Symptoms and findings of chronic diseases may be obscure and show complex and atypical course.

Besides, particularly the elderly applying to emergency department are usually found to have a reduction

in cognitive and functional abilities. All of these reasons are required for the elderly to be evaluated with

a different perspective in emergency departments than those of classical approach.

The elderly usually apply to emergency departments due to cardiovascular, cerebrovascular and

metabolic disorders associated with chronic diseases or fulminant acute diseases. Therefore the elderly are

admitted to hospital and monitored more than young people, period of hospitalization of the elderly is

longer and they need 5-6 times more intensive care.

Although physicians and emergency medical technician are available in ambulance services of our

country, new approaches are also required for ideal ambulance services. When providing ambulance

services, as well as safe and fast transportation of the elderly to emergency department, the systems related

to intervention at the scene and transmitting the information and data about the elderly to the hospital to

be reached should be developed and the systems providing communication with emergency departments

should be established and disseminated.

In relation to the period after ensuring the access of the elderly to emergency services, new models

indented for the formation of geriatric emergency units have been started to be established and applied in

different countries across the world. However, whereas geriatric polyclinic services are provided in

outpatient clinics, a separate structure model for this is not currently exist in emergency services in our

country.

When we look at the examples in the world and Turkey, the traditional emergency services are

known to be localized on the ground floor of hospitals and to have poor conditions in terms of physical

circumstances. The evaluation of the patients and emergency approach are in the form of the evaluation

and interventions aimed at the existing diseases. However, this system is not a current application of the


79

elderly patients Today, in the modern concept of emergency services and in the applications of new

geriatric emergency units to be established, the proper approach protocols on the basis of evidence-based

medicine, staff training and physical space changes should be carried out. In this context, emergency

department clinical staff should be trained in geriatrics and geriatric emergency medicine, should be

informed of common geriatric syndromes, and awareness on these subjects should be provided. Structural

changes and measures that can decrease the frequency of cases that may cause significant morbidity and

mortality in the elderly, such as delirium, falls and pressure sores, should be established in emergency

services,. The programs that decrease functional loss and iatrogenic complications which reduce long

hospitalization periods should be developed. Physical space should not have a restricted area and should

be in such a way to ensure optimal care of the complex geriatric patients and in a plan to provide optimal

placement of the patients. As new buildings may be constructed, new arrangements, where available areas

can be found, may be performed with appropriate modifications to the existing emergency service.

When we look at the examples in the world, the hospitals with geriatric emergency units are

available in the US, Canada and Australia. In some of these emergency services, the presence of

geriatricians is of top priority, and geriatric nurses are also serving in these units. These nurses apply

comprehensive geriatric assessment to the elderly and provide necessary coordination in the event of

discharge of these patients. Besides, they perform the necessary planning after discharge, direct the patients

to the relevant institutions if necessary, and communicate with their families.

A geriatric consultation team has been established in a centre in Montreal, Canada. In this team are

geriatricians, full-time nurses, part-time physiotherapist and occupational therapists. This team evaluate

all of the elderly and make treatment and rehabilitation plans in a coordinated way.

In yet another centre located in Melbourne, Australia, interdisciplinary coordination team has been

formed. This team has organized complex emergency assessment and discharge planning for elderly

patients. Similar applications have been made in some hospitals in Italy. Emergency services in these

centres are in the form of mixed emergency services and have been arranged in a way to allocate a certain

number of beds to elderly patients. While geriatric emergency departments are being established in all

these models, triage, clinical evaluation and treatment, discharge planning elements should be taken into

consideration.

Geriatric emergency application model can be summarized in four stages;

- In the first stage, information about patients admitted to emergency department should be

available.

- In the second stage, infrastructures related to transfer and automatic reception of the data related

to the patient to and from hospital database should be established. The important data should

be electronically registered in emergency service records by receiving from this database. For

instance; by transferring such information of the patients as existing diseases, previous

laboratory parameters, imaging tests, medications, allergy status, reasons for previous

admissions to hospital, social and functional status and habits, comprehensive geriatric

assessment of the patient can be accelerated.

- In the third stage, emergency room physician determine the proper diagnosis and create the

treatment plan after the evaluations and examinations by discussing the patients themselves and

their families. Since it is difficult for an emergency room physician to perform all of these

himself or herself, a geriatric team should be established in an interdisciplinary approach.

- The physician of the patient, emergency room nurse or geriatric nurse if any, or other assistant

health care professional should be available in this team.

- In the fourth and final stage, an emergency environment with minimum noise and maximum

safety and comfort should be created. To attain this, urgent architecture and landscaping should

be discusses and all structure should be arranged in a way to consider the elderly features, the

patients and their relatives, emergency room physicians and employees should be ensured to be

in a comfortable and relaxed environment. The appropriate consultation atmosphere, lightings

and other instruments required for the patients should be ensured.

As a result; as all over the world, the elderly population is increasing in our country, and in parallel

to this, particularly geriatric syndromes and chronic diseases show increase, bringing the new problems

to agenda. Due to the exacerbations of these chronic diseases with increasing frequency or the addition

of new acute diseases to this, the rate of geriatric applications to emergency services is increasing as well.

Therefore, new approaches and arrangements should be performed for more efficient, reliable and

productive provision of emergency services for geriatric age groups and organization of these in a way to

increase the quality of health care services.


80


81

Target and Strategies towards Ensuring Organizations of Acute Care and Emergency Services in

geriatrics

Target 1- Creating awareness in community and all health care professionals about acute careand emergency services in geriatrics

Strategy 1

Dissemination of awareness about acute care and emergency services in geriatrics; ensuringcooperation with universities, public and private institutions and NGO’s

Target 2- Ensuring to increase the quality of emergency health services provided for the elderlyand to conduct these within the framework of accessibility and efficiency principles

Strategy 1

Taking measures to provide positive discrimination towards the elderly in emergency services

Strategy 2

Establishing geriatric emergency departments in our country

Strategy 3

Rearrangement of the existing emergency services in a proper way in terms of appropriate approachto geriatric patients

Target 3- Provision of trainings related to the differences in emergence, diagnosis and treatmentof the acute complications of chronic diseases in the elderly, and establishment ofstandardization towards approaches to the geriatric patients

Strategy 1

Creating algorithm in diagnosis and treatment of the elderly patients in emergency services

Strategy 2

Ensuring to arrange certified training programs and courses under the coordination of Ministry ofHealth, universities and relevant specialist associations

Target 4- Ensuring that the geriatric patients admitted to emergency service can access to healthregistration

Strategy 1

Provision of common health registration and database for all patients

Target 5- Preventing unnecessary drug use in geriatric patients and ensuring effective drug use

Strategy 1

Determining the medication used by the elderly patient admitted to emergency services, detectingunnecessarily use of medication with inappropriate doses and preventing polypharmacy


82

1.6.

En

suri

ng

Org

aniz

atio

n o

f Acu

te C

are

and

Em

erge

ncy

Ser

vice

s in

Ger

iatr

ics

Tar

get

1- C

reat

ing

awar

enes

s in

com

mu

nit

y an

d a

ll h

ealt

h c

are

pro

fess

ion

als

abou

t ac

ute

car

e an

d e

mer

gen

cy s

ervi

ces

in g

eria

tric

s

Str

ateg

y

1.1.

Dis

sem

inat

ion

of

awar

enes

s ab

out

acu

teca

re a

nd

em

erge

ncy

serv

ices

in g

eria

tric

s;en

suri

ng

coop

erat

ion

wit

h u

niv

ersi

ties

,p

ub

lic

and

pri

vate

inst

itu

tion

s an

d N

GO

’s

1.1.

1. H

oldi

ng a

cade

mic

mee

ting

s on

appr

oach

es to

acu

te g

eria

tric

pat

ient

s

1.1.

2.T

rain

ing

heal

th c

are

prof

essi

onal

s on

geri

atri

c ap

proa

ches

by

orga

nizi

ng lo

cal

sem

inar

s

1.1.

3.P

repa

rati

on o

f ad

vert

isin

g an

dpr

omot

iona

l pos

ters

and

fil

ms

1. N

umbe

r of

emer

genc

y ro

omph

ysic

ians

and

hea

lth

care

pro

fess

iona

ls w

ith

enha

nced

aw

aren

ess

abou

t the

eva

luat

ion

ofel

derl

y pa

tien

t 2.

Cre

atio

n of

aw

aren

ess

in c

omm

unit

y

1.C

reat

ion

of e

mer

genc

yro

om p

hysi

cian

s an

dhe

alth

car

e pr

ofes

sion

als

wit

h en

hanc

ed a

war

enes

sab

out t

he e

valu

atio

n of

elde

rly

pati

ent

2.S

ocia

l aw

aren

ess

surv

eys

(to

be p

erfo

rmed

for

a pe

riod

of

5 ye

ars)

3.In

crea

se in

soc

ial

awar

enes

s of

the

pati

ents

adm

itte

d to

em

erge

ncy

serv

ices

1.M

inis

try

of H

ealt

h2.

Uni

vers

itie

s3.

Pre

ss a

nd

Bro

adca

stin

g O

rgan

izat

ions

4.N

GO

1 ye

ar

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


83

Tar

get

2- E

nsu

rin

g to

in

crea

se t

he

qu

alit

y of

em

erge

ncy

hea

lth

ser

vice

s p

rovi

ded

for

th

e el

der

ly a

nd

to

con

du

ct t

hes

e w

ith

in t

he

fram

ewor

k o

f

acce

ssib

ilit

y an

d e

ffic

ien

cy p

rin

cip

les

Str

ateg

y

2.1.

Tak

ing

mea

sure

s to

pro

vid

e p

osit

ive

dis

crim

inat

ion

tow

ard

sth

e el

der

ly in

em

erge

ncy

serv

ices

2.2.

Est

abli

shin

g ge

riat

ric

emer

gen

cy d

epar

tmen

tsin

ou

r co

un

try

2.3.

Rea

rran

gem

ent

of t

he

exis

tin

g em

erge

ncy

serv

ices

in a

pro

per

way

in t

erm

s of

ap

pro

pri

ate

app

roac

h t

o ge

riat

ric

pat

ien

ts

2.1.

1.E

stab

lish

men

t of

geri

atri

c em

erge

ncy

unit

s in

em

erge

ncy

depa

rtm

ents

in th

eho

spit

als

unde

r M

inis

try

of H

ealt

h an

dun

iver

siti

es a

nd c

ompl

etio

n of

thei

rph

ysic

al in

fras

truc

ture

2.2.

1. I

ncre

asin

g th

e nu

mbe

r of

per

sonn

el to

prov

ide

geri

atri

c he

alth

car

e se

rvic

es in

emer

genc

y se

rvic

es, i

mpl

emen

ting

the

enco

urag

ing

acti

viti

es f

or p

erso

nnel

(per

form

ance

, nig

ht s

hift

pre

miu

ms,

leav

esan

d et

c.)

2.3.

1.In

tegr

atio

n of

ger

iatr

ic e

mer

genc

yun

its

wit

h ho

me

care

uni

ts

1.In

clud

ing

geri

atri

cem

erge

ncy

unit

s in

the

hosp

ital

pro

ject

s to

be

cons

truc

ted

2.C

ompl

etin

gre

stru

ctur

ing

wor

ks to

be p

erfo

rmed

in th

eex

isti

ng h

ospi

tal i

n a

shor

t per

iod

3.E

stab

lish

ing

geri

atri

cem

erge

ncy

unit

s in

the

emer

genc

y de

part

men

tsin

cer

tain

hos

pita

ls4.

Dec

reas

ing

stay

ing

peri

od in

em

erge

ncy

serv

ices

1. N

umbe

r of

the

hosp

ital

sw

ith

geri

atri

c em

erge

ncy

serv

ices

2.

Inc

reas

e of

the

sati

sfac

tion

of

the

elde

rly

adm

itte

d to

em

erge

ncy

serv

ices

3. D

ecre

ase

in th

e ra

te o

fm

orta

lity

1. M

inis

try

of H

ealt

h2.

Uni

vers

itie

s

1 ye

ar

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


84

Tar

get

3- P

rovi

sion

of

trai

nin

gs r

elat

ed t

o th

e d

iffe

ren

ces

in e

mer

gen

ce, d

iagn

osis

an

d t

reat

men

t of

th

e ac

ute

com

pli

cati

ons

of c

hro

nic

dis

ease

s in

th

e

eld

erly

, an

d e

stab

lish

men

t of

sta

nd

ard

izat

ion

tow

ard

s ap

pro

ach

es t

o th

e ge

riat

ric

pat

ien

ts

Str

ateg

y

3.1.

Cre

atin

g al

gori

thm

ind

iagn

osis

an

d t

reat

men

tof

th

e el

der

ly p

atie

nts

inem

erge

ncy

ser

vice

s

3.2.

En

suri

ng

to a

rran

gece

rtif

ied

tra

inin

gp

rogr

ams

and

cou

rses

un

der

th

e co

ord

inat

ion

of

Min

istr

y of

Hea

lth

,u

niv

ersi

ties

an

d r

elev

ant

spec

iali

st a

ssoc

iati

on

3.1.

1.T

rain

ing

of e

mer

genc

y ro

omph

ysic

ians

, hea

lth

care

pro

fess

iona

lsan

d 11

2 am

bula

nce

staf

f

3.1.

2.E

stab

lish

men

t of

a co

mm

issi

onto

cre

ate

algo

rith

m in

dia

gnos

is a

ndtr

eatm

ent o

f th

e el

derl

y pa

tien

ts in

emer

genc

y se

rvic

es

3.2.

1.P

erfo

rmin

g in

-ser

vice

trai

ning

sat

per

iodi

c in

terv

als

1. F

orm

atio

n of

pos

itiv

edi

ffer

ence

s in

app

roac

hof

em

erge

ncy

room

prof

essi

onal

s to

the

elde

rly

pati

ents

indi

agno

sis

and

trea

tmen

tst

ages

2.

Num

ber

of c

erti

fied

pers

onne

l

1. E

nsur

ing

stan

dard

izat

ion

inap

proa

ches

of

emer

genc

yro

om p

rofe

ssio

nals

toge

riat

ric

pati

ents

2. S

atis

fact

ion

surv

eys

3. D

ecre

ase

in m

orta

lity

and

mor

bidi

ty

1. M

inis

try

of H

ealt

h2.

Uni

vers

itie

s3.

Rel

evan

t Spe

cial

ist

Ass

ocia

tion

s T

o be

appl

ied

wit

hin

1 ye

aran

dim

plem

ente

dat

per

iodi

cin

terv

als

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


85

Tar

get

4- E

nsu

rin

g th

at t

he

geri

atri

c p

atie

nts

ad

mit

ted

to

emer

gen

cy s

ervi

ce c

an a

cces

s to

hea

lth

reg

istr

atio

n

Str

ateg

y

4.1.

Pro

visi

on o

f co

mm

onh

ealt

h r

egis

trat

ion

an

dd

atab

ase

for

all p

atie

nts

4.1.

1. D

isse

min

atio

n of

com

mon

hea

lth

regi

stra

tion

dat

abas

e an

d in

tegr

atio

n of

this

wit

h ho

spit

al a

utom

atio

n sy

stem

s

Abl

e to

acc

ess

to p

atie

ntre

cord

sD

isse

min

atio

n of

use

of

pati

ent r

ecor

ds in

dete

rmin

ing

the

sust

aina

ble

heal

th p

olic

ies

1.M

inis

try

of H

ealt

h2.

SG

K

1 ye

ar

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n

Tar

get

5- P

reve

nti

ng

un

nec

essa

ry d

rug

use

in g

eria

tric

pat

ien

ts a

nd

en

suri

ng

effe

ctiv

e d

rug

use

Str

ateg

y

5.1.

Det

erm

inin

g th

em

edic

atio

n u

sed

by

the

eld

erly

pat

ien

t ad

mit

ted

to e

mer

gen

cy s

ervi

ces,

det

ecti

ng

un

nec

essa

rily

use

of

med

icat

ion

wit

hin

app

rop

riat

e d

oses

an

dp

reve

nti

ng

pol

yph

arm

acy

5.1.

1. E

nter

ing

the

med

icat

ions

use

d by

the

pati

ent i

n th

e da

taba

se to

be

esta

blis

hed

and

upda

ting

thes

e

Eas

y ac

cess

tom

edic

atio

ns, r

epor

ts a

ndus

age

of th

e pa

tien

ts in

the

heal

th d

atab

ase

to b

ees

tabl

ishe

d

1. P

reve

ntin

gpo

lyph

arm

acy

in th

eel

derl

y an

d de

crea

sing

the

hosp

ital

adm

issi

ons

acco

rdin

gly

2. E

valu

atio

n of

pres

crip

tion

s in

the

data

base

of

SG

K a

ndM

inis

try

of H

ealt

h

1. M

inis

try

of H

ealt

h2.

SG

K

2 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


86

1.7. PROVISION OF APPROPRIATE AND EFFECTIVE PRACTICE OF DIAGNOSIS,TREATMENT, MONITORING SERVICES IN OLD AGE


With the effects of rapidly evolving technology and scientific studies that increase day by day,significant advances in health care have been recorded. Early diagnosis is important to distinguish thefindings related to diseases with aging-associated physiological changes occurred in organs. Earlydiagnosis is to detect illnesses or health problems through examination and laboratory methods before theyclinically occur. The aim is to improve the quality of life, to reduce morbidity and mortality reduction andto decrease the cost of treatment.

For this purpose, the original tests to be selected in screening should have the followingcharacteristics;

- Disease to be screened should be a common health problem in the community

- Disease should be able to be recognized by examination and laboratory tests before theydemonstrate clinical signs.

- When detected early, it should contribute to the success of treatment and life span of the patient.

- Natural history of the disease to be screened should be well known.

- When diagnosed in early period, disease can be treated.

- Screening method should be reliable and acceptable to the patient.

- Sensitivity and specificity should be proper and sufficient.

- Screening test should be accessible to every section of the community.

- It should be cost-effective.

Hypertension, type 2 diabetes mellitus, dyslipidaemia, abdominal aortic aneurysm, obesity andnutrition problems, breast, colon, cervix, prostate and other cancers, depression, Alzheimer's disease,dementia, Chronic Obstructive Pulmonary Disease (COPD), Visual-auditory problems, osteoporosis inelderly, violence against elderly and associated problems, accidents and injuries, hepatitis B andtuberculosis of infectious diseases are among the health problems that can be diagnosed early.

Appropriate and correct evaluation of geriatric patients is possible with the Comprehensive GeriatricAssessment. Comprehensive Geriatric Assessment; is a team assessment that can describe and revealvarious problems in the elderly, explain and classify reserves and resilience of individuals, and determinethe services required to respond to the individual's problems and develop a co-ordinated treatment plan.

Revealing diseases that can be hidden, helping definite diagnosis, planning and implementingappropriate care, providing consultancy for optimum environmental and social support, monitoring theprogress of the disease by anticipating results, protecting and improving the functional level and reducingcosts in hospitalization, mortality, nursing home needs can be possible as a result of ComprehensiveGeriatric Assessment.

In the evaluation of geriatric patients, the concepts of interdisciplinary and multidisciplinary teams

are important. In evaluation of the elderly, evaluation and monitoring conducted by an interdisciplinary


87

geriatric team specialized in different fields instead of one person is a modern thought carried out in the

world.

Interdisciplinary team members are comprised of;

- Geriatric specialist or, if not available, internal medicine

- Nurse

- Social Worker

- Dietician

- Psychologist

- Occupational Therapist

- Physiotherapist

Interdisciplinary team members determine the patient's treatment plan by evaluating the patient

together. When the elderly's health is considered to be determined as three parts, physical, mental and

social; how important the concepts of roles, functions and team spirit of the team members for evaluation

of the elderly, protection of the elderly health, treatment of the disease will be is understood. Whereas the

team is generally guided by geriatrician and elderly nurse, the role, place and mission of each person of

the team is different and complementary. Social service specialist, nurses, physiotherapists, occupational

therapists, psychologists, audiologists, dentists, pharmacists, speech therapists and nutrition should be

included in and ideal team.

Although elderly patients do not constitute the majority of the population, they have become the

most frequent users of medications in the society. While they constitute 13 percent of the total population

in the US, about 30 percent of prescribed drug belongs to the elderly population (33). In community-

based researches, it is found that the elderly people use daily average of 1,5 to 2,2 drugs, most of them

are cardiovascular, central nervous system and analgesic drugs. In a study involving 2,500 patients, the

most medication is observed to be used in the women older than 65 years, 12 percent of which is found

to use at least ten drugs and 23 percent at least five drugs. Although aged over 60 is representing one fifth

of the entire population in the UK, this group includes 52 percent of all prescriptions (34, 35).

Although there is no precise idea of a common definition for polypharmacy, it usually means the

usage of lots of medication for multiple indications at the same time (36). Polypharmacy may be

appropriate or inappropriate. Due to overprescribing of drugs, prescribing drugs that have unacceptable

side effects for patients, prescribing simultaneously drugs that can harm with drug-drug and drug-disease

interactions and several reasons, polypharmacy may be inappropriate.

In a study wherein 1253 patients were assessed in Hacettepe University Faculty of Medicine, Internal

Medicine Department, Geriatrics Unit clinics, the average number of 3,79 of medications is found to be

used before the patients’ visit to polyclinics and the average number of 6,13 of medications is found to

be suggested to the patients after clinic assessment (37).

One of the most important problems that may be caused by polypharmacy is the side effects and

interactions of drugs. This problems result in drug incompatibility, increased risk of hospitalization,

medication errors and the increased cost of medication due to the treatment of side effects of the drugs.

The more medication, the higher probability of occurrence of side effects.

While polypharmacy can be seen at any age, its incidence increase in the elderly. The excess ofcomorbidities in the elderly population leads to multiple drug prescribing and potentially dangerous resultsof polypharmacy. The inappropriate drug prescribing was found in 12-40 percent of patients staying innursing homes and 14-23,5 percent of the patients living in the community (38, 39). Other risk factors forpolypharmacy are the elements related to age, sex, lifestyle and caregiver of patients.

As the number of drugs used by patients increases, so the risk of side effects increases exponentially.While the risk of potential adverse effects of the use of two drug is 6 percent, this rate reaches up to 50percent in the use of five drugs and almost reaches up to 100 percent in the use of more drugs (40). Withthe presence of multiple comorbidities that render the elderly more sensitive to drug-drug interactionsand drug side effects, there are many factors such as the change in the pharmacokinetics andpharmacodynamics of the drugs due to aging-associated physiological changes (41). Drug side effectsare among the serious health problems that can be prevented after heart disease, breast cancer, hypertensionand pneumonia (42). The number of drugs received has a linear relationship with the frequency of sideeffects. However, whether side effects of medication are due to a drug-drug interaction or a drug receivedcannot be determined clearly

Another important consequence of polypharmacy is the increase in hospital admissions andhospitalizations. According to a meta-analysis, four times as much elderly people are hospitalised byadverse drug reactions related problems than non-elderly. On the other hand, the cause of 18- 24 percentof hospitalizations in the elderly is serious drug side effects and complications (43). 6-21 percent of thestanding of the applicant, if the applicant in patients hospitalized constitute 18-24 percent of the drug's sideeffects and complications (44-45). In a study conducted in Canada, iatrogenic syndrome due topolypharmacy was found to be responsible for 19 percent of hospital admissions in the elderly (46).

In another study, it was found that 7 percent of hospital admissions is due to drug-related and 2/3of these can be avoided (47).

Fall caused by polypharmacy is an important cause of morbidity and mortality in respect of theirconsequences. Falls occur in 1/3 of the population over 65 years of age and half of them occurs again. Fallcaused by polypharmacy cases is more common in those taking four or more drugs and using serotoninreuptake inhibitors, tricyclic antidepressants, neuroleptics, benzodiazepines, anticonvulsants, class IAantiarrhythmic agents, digoxin and diuretic. Occurring in hospitalized patients due to many reasons,delirium, whose formation has been shown to be caused by means of the important role of polypharmacy,is an important problem that increases mortality and hospitalization period and decrease the functionalityof patients. In the studies, polypharmacy is shown to a well-known cause in the etiology of delirium andto be particularly striking as an independent risk factor for those taking three and more medications (48,49, 50).

As a result; polypharmacy is one of the important geriatric syndromes seen quite often in the elderlyin both developed and developing countries which increase morbidity, mortality and costs, and impairthe quality of life. Appropriate geriatric assessment with interdisciplinary approach should be performedto try to reduce polypharmacy.


88


89

Target and Strategies towards ensuring the proper and effective functioning of diagnosis,

treatment, Monitoring Services in old age

Target 1- Promotion of national geriatric diagnosis and treatment guidelines

Strategy 1

Ensuring the use of geriatric diagnosis and treatment guidelines

Target 2- Ensuring the policies for “Rational Use of Medicines” in the elderly

Strategy 1

Organizing training activities in the light of international guidelines to develop the policies for rationaluse of medicines

Strategy 2

Ensuring the share of medical information belonging to the elderly within the ethical framework byconsidering the privacy of patient

Strategy 3

Developing medication monitoring system that foresees the follow-up of drugs from manufacturer toend user

Strategy 4

Decreasing polypharmacy

Target 3- Determining the problems related to the proper diagnosis of elderly diseases

Strategy 1

Performing Comprehensive Geriatric Assessment to reduce the problems in diagnosis in the elderly

Target 4- Ensuring the researches for diagnosis and treatment of the diseases affecting elderly

Strategy 1

Ensuring proper infrastructure and funding for research

Target 5- Ensuring solutions for reimbursement problems in diagnosis, treatment and follow-up

Strategy 1

Eliminating the problems of reimbursement of drug costs, access to treatment, prescribing andreporting of the elderly

Target 6- Ensuring the development of diagnosis and treatment with postgraduate trainings

Strategy 1

Increasing training activities to develop diagnosis and treatment

Target 7- Ensuring geriatric assessment in a comprehensive way by sparing sufficient time

Strategy 1

Establishing interdisciplinary geriatric team

Strategy 2

Ensuring continuity in the quality and accessible provision of Comprehensive Geriatric Assessments


90

1.7.

Pro

visi

on o

f Ap

pro

pri

ate

and

Eff

ecti

ve P

ract

ice

of D

iagn

osis

, Tre

atm

ent,

Mon

itor

ing

Ser

vice

s in

old

age

Tar

get

1- P

rom

otio

n o

f n

atio

nal

ger

iatr

ic d

iagn

osis

an

d t

reat

men

t gu

idel

ines

Str

ateg

y

1.1.

En

suri

ng

of n

atio

nal

geri

atri

c d

iagn

osis

an

dtr

eatm

ent

guid

elin

es

1.1.

1. O

rgan

izin

g re

gula

r tr

aini

ng a

ndpr

omot

ions

for

the

usab

ilit

y of

dia

gnos

isan

d tr

eatm

ent g

uide

line

s

1.1.

2.P

erfo

rmin

g th

e tr

aini

ng a

ndm

onit

orin

g of

Rat

iona

l use

of

med

icin

es

1.1.

3.C

oope

rati

on w

ith

SG

K to

take

into

acco

unt t

he g

uide

line

s in

the

reim

burs

emen

ts

1.1.

4. R

e-as

sess

men

t of

such

issu

es a

sC

ompr

ehen

sive

Ger

iatr

ic A

sses

smen

t,sc

reen

ing

test

s, s

cale

s, e

lder

ly p

atie

nts

exam

inat

ion,

fam

ily

inte

rvie

ws,

edu

cati

onof

pat

ient

and

rel

ativ

es in

per

form

ance

eval

uati

on s

yste

m o

f M

inis

try

of H

ealt

h

1. I

ncre

ase

in th

enu

mbe

r of

trai

ned

phys

icia

ns2.

Incr

ease

in th

enu

mbe

r of

the

elde

rly

that

can

acc

ess

to th

em

edic

ally

rec

omm

ende

dtr

eatm

ent

3. I

ncre

ase

in th

enu

mbe

r of

the

accu

rate

lydi

agno

sed

elde

rly

4. A

rran

ging

the

perf

orm

ance

sys

tem

for

geri

atri

c pa

tien

ts

1. I

ncre

ase

in a

ccur

ate

diag

nosi

s an

d pr

oper

trea

tmen

t rel

ated

todi

seas

es2.

Eva

luat

ion

ofpr

escr

ipti

on n

umbe

rs in

the

data

base

of

SG

K a

ndM

inis

try

of H

ealt

h

1.M

inis

try

of H

ealt

h2.

SG

K3.

Uni

vers

itie

s

Per

iodi

c

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


91

Tar

get

2- E

nsu

rin

g im

pro

vem

ent

of t

he

pol

icie

s fo

r “R

atio

nal

Use

of

Med

icin

es”

in t

he

eld

erly

Str

ateg

y

2.1.

Org

aniz

ing

trai

nin

gac

tivi

ties

in t

he

ligh

t of

inte

rnat

ion

al g

uid

elin

es t

od

evel

op t

he

pol

icie

s fo

rra

tion

al u

se o

f m

edic

ines

2.2.

En

suri

ng

the

shar

e of

med

ical

info

rmat

ion

bel

ongi

ng

to t

he

eld

erly

wit

hin

th

e et

hic

alfr

amew

ork

by

con

sid

erin

g th

e p

riva

cy o

fp

atie

nt

2.3.

Dev

elop

ing

med

icat

ion

mon

itor

ing

syst

em t

hat

for

esee

s th

efo

llow

-up

of

dru

gs f

rom

man

ufa

ctu

rer

to e

nd

use

r

2.4.

Dec

reas

ing

pol

yph

arm

acy

2.1.

1.O

rgan

izin

g tr

aini

ngs

inte

nded

for

rati

onal

use

of

med

icin

es b

y r

elev

ant

inst

itut

ions

2.1.

2.In

clud

ing

rati

onal

use

of

med

icin

esed

ucat

ion

in th

e cu

rric

ula

of f

acul

ty o

fm

edic

ine,

den

tist

ry a

nd p

harm

acy

2.2.

1.E

nsur

ing

dete

ctio

n an

d ve

rifi

cati

on o

fth

e dr

ugs

that

are

use

d by

the

elde

rly

inth

eir

each

app

lica

tion

to th

e ho

spit

al

2.3.

1. E

nsur

ing

the

regu

lar

exch

ange

of

info

rmat

ion

wit

h ph

arm

acol

ogis

t;es

tabl

ishi

ng p

rogr

ams

wit

h th

e pu

rpos

e of

redu

cing

dru

g in

tera

ctio

ns

2.4.

1. P

rovi

ding

info

rmat

ion

to th

e pa

tien

tab

out t

he n

ame,

dos

age

and

usag

e in

terv

als,

pote

ntia

l adv

erse

eff

ects

of

the

med

icat

ions

used

1. D

ecre

ase

in th

enu

mbe

r of

dru

g us

age

2. D

ecre

ase

in s

ide

effe

cts

of d

rugs

3. D

ecre

ase

in h

ealt

hco

sts

per

pati

ent

4.In

crea

se in

qua

lity

of

life

1. D

ecre

ase

inun

nece

ssar

y ap

plic

atio

nsto

hea

lth

care

inst

itut

ions

and

orga

niza

tion

s 2.

Dec

reas

e in

unne

cess

ary

usag

e of

drug

s in

fam

ily

prac

tice

info

rmat

ion

syst

ems

3. M

onit

orin

g co

sts

inS

GK

dat

abas

e 4.

Im

plem

enta

tion

of

sati

sfac

tion

sur

veys

1.M

inis

try

of H

ealt

h2.

SG

K3.

YO

K4.

Uni

vers

itie

s5.

NG

O

Per

iodi

c

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


92

Tar

get

3- D

eter

min

ing

the

pro

ble

ms

rela

ted

to

the

pro

per

dia

gnos

is o

f el

der

ly d

isea

ses

Str

ateg

y

3.1.

Per

form

ing

Com

pre

hen

sive

Ger

iatr

icA

sses

smen

t to

red

uce

th

ep

rob

lem

s in

dia

gnos

is in

the

eld

erly

3.1.

1. D

isse

min

atio

n of

com

preh

ensi

vege

riat

ric

asse

ssm

ent

3.1.

2. E

valu

atio

n of

the

elde

rly

byin

terd

isci

plin

ary

team

3.1.

3.Im

plem

enta

tion

of

imm

uniz

atio

n an

dsc

reen

ing

inte

nded

for

the

elde

rly

in a

nef

fect

ive

way

3.1.

4.R

e-as

sess

men

t of

such

issu

es a

sC

ompr

ehen

sive

Ger

iatr

ic A

sses

smen

t,sc

reen

ing

test

s, s

cale

s, e

lder

ly p

atie

nts

exam

inat

ion,

fam

ily

inte

rvie

ws,

edu

cati

onof

pat

ient

and

rel

ativ

es in

per

form

ance

eval

uati

on s

yste

m o

f M

inis

try

of H

ealt

h

1. I

ncre

ase

in th

e pe

riod

of d

iagn

osis

2.

Impl

emen

tati

on o

fpr

oper

tech

niqu

es a

ndm

etho

ds in

dia

gnos

is

3.N

umbe

r of

imm

uniz

ed e

lder

ly4.

Num

ber

of e

lder

lyun

derg

oing

CG

A(c

ompr

ehen

sive

ger

iatr

icas

sess

men

t)

1. D

ecre

ase

inun

nece

ssar

y te

st s

pend

ing

2.E

arly

dia

gnos

is o

fdi

seas

es

3.In

crea

sing

pre

vent

ive

med

icin

e ap

plic

atio

ns

4. F

aste

r de

fini

tive

diag

nosi

s 5.

Red

ucti

on in

mor

tali

tyan

d m

orbi

dity

rat

es

6. D

ecre

ase

inho

spit

aliz

atio

n pe

riod

s 7.

Dec

reas

e in

the

num

ber

of h

ospi

tal a

ppli

cati

ons

8. I

ncre

ase

in th

efr

eque

ncy

of d

iagn

osis

of

geri

atri

c sy

ndro

mes

1. M

inis

try

of H

ealt

h2.

SG

K3.

Uni

vers

itie

s

1 ye

ar

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


93

Tar

get

3- D

eter

min

ing

the

pro

ble

ms

rela

ted

to

the

pro

per

dia

gnos

is o

f el

der

ly d

isea

ses

Str

ateg

y

3.1.

Per

form

ing

Com

pre

hen

sive

Ger

iatr

icA

sses

smen

t to

red

uce

th

ep

rob

lem

s in

dia

gnos

is in

the

eld

erly

3.1.

5. U

se o

f di

agno

stic

met

hods

in p

rim

ary

heal

th c

are

in a

ppro

pria

te w

ay

3.1.

6. F

acil

itat

ion

of a

cces

s of

the

elde

rly

tohe

alth

car

e in

stit

utio

ns

3.1.

7.P

rovi

sion

of

nece

ssar

y su

ppor

t to

faci

lita

te th

e ex

amin

atio

n an

d tr

eatm

ent o

fth

e el

derl

y w

itho

ut h

ospi

tal a

tten

dant

in th

ehe

alth

inst

itut

ions

3.1.

8.D

eter

min

atio

n an

d di

ssem

inat

ion

ofst

anda

rds

in th

e fi

elds

of

imag

eco

mm

unic

atio

ns, t

ele-

med

icin

e an

d te

le-

heal

th

3.1.

9.P

rovi

sion

of

info

rmat

ion

exch

ange

betw

een

phys

icia

ns f

or a

ccur

ate

diag

nosi

sby

est

abli

shin

g in

form

atio

n an

dco

mm

unic

atio

n pl

atfo

rm v

ia p

orta

l

1.A

ccel

erat

ion

indi

agno

sis

proc

ess

2. P

reve

ntio

n of

unne

cess

ary

exam

inat

ion

3.N

umbe

r of

imm

uniz

ed e

lder

lypa

tien

ts

4. N

umbe

r of

eld

erly

unde

rgoi

ng C

GA

(com

preh

ensi

ve g

eria

tric

asse

ssm

ent)

1. D

ecre

ase

inun

nece

ssar

y te

st s

pend

ing

2. E

arly

dia

gnos

is o

fdi

seas

es

3. I

ncre

asin

g pr

even

tive

med

icin

e ap

plic

atio

ns

4.F

aste

r de

fini

tive

diag

nosi

s 5.

Red

ucti

on in

mor

tali

tyan

d m

orbi

dity

rat

es6.

Dec

reas

e in

hosp

ital

izat

ion

peri

ods

7. D

ecre

ase

in th

e nu

mbe

rof

hos

pita

l app

lica

tion

s 8.

Inc

reas

e in

the

freq

uenc

y of

dia

gnos

is o

fge

riat

ric

synd

rom

es

1.M

inis

try

of H

ealt

h2.

SG

K3.

Uni

vers

itie

s

3 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


94

Tar

get

4-E

nsu

rin

g th

e re

sear

ches

for

dia

gnos

is a

nd

tre

atm

ent

of t

he

dis

ease

s af

fect

ing

eld

erly

Str

ateg

y

4.1.

En

suri

ng

pro

per

infr

astr

uct

ure

an

dfu

nd

ing

for

rese

arch

4.1.

1. M

akin

g ne

cess

ary

arra

ngem

ents

tobo

ost i

nves

tmen

ts

4.1.

2. E

nhan

cing

coo

pera

tion

in th

e fi

eld

ofhe

alth

res

earc

hes

betw

een

publ

ic a

ndpr

ivat

e se

ctor

s at

eve

ry le

vel t

o pr

omot

eth

ese

inve

stm

ents

4.1.

3. I

ncre

asin

g th

e fu

nds

allo

cate

d fo

rre

sear

ches

of

Min

istr

y of

Hea

lth

and

Uni

vers

itie

s on

eld

erly

4.1.

4. P

erfo

rmin

g re

liab

ilit

y an

d va

lidi

ty o

fth

e te

sts

used

for

Com

preh

ensi

ve G

eria

tric

Ass

essm

ent

1. N

umbe

r of

qua

lifi

edre

sear

ches

2.

Est

abli

shm

ent o

fda

taba

se in

tend

ed f

orth

e el

derl

y in

our

coun

try

1.In

crea

se in

aca

dem

icpu

blic

atio

ns2.

Act

ivat

ing

and

rene

win

g di

agno

sis

and

trea

tmen

t met

hods

3.P

rovi

sion

of

reli

able

data

rel

ated

to th

edi

seas

es a

nd f

unct

iona

lity

of th

e el

derl

y

1. M

inis

try

of H

ealt

h2.

Uni

vers

itie

s3.

NG

O4.

Pri

vate

Sec

tor

3 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


95

Tar

get

5- E

nsu

rin

g so

luti

ons

for

reim

bu

rsem

ent

pro

ble

ms

in d

iagn

osis

, tre

atm

ent

and

fol

low

-up

Str

ateg

y

5.1.

Eli

min

atin

g th

ep

rob

lem

s of

reim

bu

rsem

ent

of d

rug

cost

s, a

cces

s to

tre

atm

ent,

pre

scri

bin

g an

d r

epor

tin

gof

th

e el

der

ly

5.1.

1. E

stab

lish

men

t of

a se

para

te g

eria

tric

sub-

com

mit

tee

unde

r re

imbu

rsem

ent

com

mis

sion

5.1.

2. R

earr

ange

men

t of

eval

uati

on te

sts

used

in d

iagn

osis

and

trea

tmen

t of

the

elde

rly

in p

erfo

rman

ce s

yste

m o

f M

inis

try

of H

ealt

h

1. E

lim

inat

ing

the

prob

lem

s oc

curr

ed in

the

reim

burs

emen

t sys

tem

whe

n so

me

med

icin

esus

ed in

the

trea

tmen

t of

elde

rly

are

pres

crib

ed b

yge

riat

ric

pati

ents

2. E

lim

inat

ing

the

prob

lem

s oc

curr

ed in

the

perf

orm

ance

sys

tem

1. E

lim

inat

ing

the

reim

burs

emen

t pro

blem

sre

late

d to

med

icat

ions

2.In

crea

sing

the

num

ber

of e

valu

atio

n te

sts

used

inth

e di

agno

sis

and

trea

tmen

t of

the

elde

rly

3. I

ncre

ase

in th

edi

agno

sis

of g

eria

tric

synd

rom

es

1.M

inis

try

of H

ealt

h2.

SG

K3.

Uni

vers

itie

s4.

NG

O

1 ye

ar

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n

Tar

get

6- E

nsu

rin

g th

e d

evel

opm

ent

of d

iagn

osis

an

d t

reat

men

t w

ith

pos

tgra

du

ate

trai

nin

gs

Str

ateg

y

6.1.

In

crea

sin

g tr

ain

ing

acti

viti

es t

o d

evel

opd

iagn

osis

an

d t

reat

men

t

6.1.

1. O

rgan

izin

g co

urse

s fo

r he

alth

car

epr

ofes

sion

als

serv

ing

in e

lder

ly c

are

inco

oper

atio

n w

ith

rele

vant

ass

ocia

tion

s

1. N

umbe

r of

org

aniz

edco

urse

s

2.In

crea

se in

the

num

ber

of e

lder

ly w

hoha

ve b

een

accu

rate

lydi

agno

sed

and

trea

ted

1.In

crea

se in

impl

emen

tati

on o

fac

cura

te d

iagn

osis

and

trea

tmen

t of

elde

rly

dise

ases

2. E

ffic

ient

use

of

the

sour

ces

for

diag

nosi

s an

dtr

eatm

ent

1. M

inis

try

of H

ealt

h2.

Uni

vers

itie

s3.

NG

O

Per

iodi

c

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


96

Tar

get

7- E

nsu

rin

g ge

riat

ric

asse

ssm

ent

in a

com

pre

hen

sive

way

by

spar

ing

tim

e

Str

ateg

y

7.1.

Est

abli

shin

gin

terd

isci

pli

nar

y ge

riat

ric

team

7.2.

En

suri

ng

con

tin

uit

yin

th

e q

ual

ity

and

acce

ssib

le p

rovi

sion

of

Com

pre

hen

sive

Ger

iatr

icA

sses

smen

ts

7.1.

1.E

nsur

ing

effi

cien

t tra

inin

g fo

r th

epr

ofes

sion

als

in th

e in

terd

isci

plin

ary

team

7.1.

2.Im

plem

enta

tion

of

geri

atri

cas

sess

men

t in

line

wit

h th

e di

agno

sis

and

trea

tmen

t gui

deli

nes

7.2.

1. R

earr

ange

men

t of

such

issu

es a

s

Com

preh

ensi

ve G

eria

tric

Ass

essm

ent,

scre

enin

g te

sts,

sca

les,

eld

erly

pat

ient

sex

amin

atio

ns, f

amil

y in

terv

iew

s, e

duca

tion

of p

atie

nt a

nd r

elat

ives

in p

erfo

rman

ceev

alua

tion

sys

tem

of

Min

istr

y of

Hea

lth

7.2.

2.E

nsur

ing

faci

lita

tion

in a

ppoi

ntm

ents

of e

lder

ly a

nd g

ivin

g pr

iori

ty to

thei

rho

spit

al a

dmis

sion

s

7.2.

3.E

nsur

ing

ease

of

tran

spor

tati

on to

elde

rly

to r

each

hea

lth

inst

itut

ions

7.2.

4. P

rovi

sion

of

nece

ssar

y pe

rson

nel

supp

ort f

or e

ase

of d

iagn

osis

and

trea

tmen

tto

the

elde

rly

wit

hout

hos

pita

l att

enda

nt

1. D

isse

min

atio

n of

com

preh

ensi

ve g

eria

tric

asse

ssm

ent

2. I

ncre

ase

in th

enu

mbe

r of

inte

rdis

cipl

inar

yge

riat

ric

team

s

1.E

nhan

ced

awar

enes

sab

out g

eria

tric

syn

drom

es

2. E

nhan

ced

qual

ity

of li

fein

eld

erly

3.

Red

ucti

on in

mor

tali

tyan

d m

orbi

dity

rat

es

4. R

educ

tion

in c

ost o

fdi

agno

stic

test

s5.

Red

ucti

on in

hosp

ital

izat

ion

peri

ods

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Int

erna

l A

ffai

rs3.

Uni

vers

itie

s4.

NG

O

3 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


97

1.8. ARRANGEMENT OF TRAINING OF HEALTH CARE PROFESSIONALS AND HEALTHCARE PROVIDERS


While the population aged over 65 years in our country was 7,5 percent in 2012, it is estimated torise to 20,8 percent by 2050 and 27,7 percent by 2075 (1). In 2025, the population over 65 years throughoutthe world is stated to constitute 10 percent of the world's population, reaching 800 million (51).

Elderly population in western countries constitute 15 percent of the total population. However, this15 percent part utilizes more than 50 percent hospital admissions and about 40 percent of health sources.30 percent of the spending of the US Medicare is used by a very small part as 6 percent (terminally illelderly) (52). In parallel with the growing elderly population, the need for trained staff as well asinstitutions and organizations providing services to the elderly is increasing. The training of qualifiedprofessionals serving the elderly about elderly health and services to be provided is becoming more of anissue.

It is known that the WHO initiated a study in 1999 in order for the students of medical schools allover the world to identify geriatric issues and to assess their attitudes towards the elderly. Localrepresentatives of the medical faculties from 79 countries, in which Turkey is also included, took part inthis study and the results were published in 2002 (53). In the light of the data obtained from this study,such recommendations as creation of pilot models considering cultural differences, understanding theimportance of healthy and active aging, taking social and political measures to perform this as well asfocusing on issues related to geriatrics in training programs in medical schools were listed.

In the studies conducted abroad, geriatric training given in the undergraduate period was shown toaffect the skills and attitudes related to students’ approaches to the elderly in a positive direction (54, 55).In the European Union, in the light of the policies produced by the EAMA (European Academy forMedicine of Ageing) and the EUGMS (European Union Geriatric Medicine Society) dealing withgeriatrics, the issues that are envisaged to be mainly targeted in undergraduate and postgraduate educationissues are empathy with the elderly, healthy aging, interdisciplinary teamwork and approaches to ethicaland geriatric syndromes. As in many countries, geriatrics, whether it may be discipline or not in ourfaculties, is included in undergraduate medical education program in our country (56).

The final declaration of the Study Group of European Academy of Yuste Foundation regarding theneed for geriatric education in European countries was presented on 8-9 June 1998. In this declarationhaving the characteristics of a guideline, in what manner geriatric training will be contained within theeducations of other specialization areas, and in-service trainings in geriatrics are discoursed. With suchtraining, change and adaptation of students among European countries in both undergraduate andpostgraduate periods are stated to be facilitated (57).


98

Target and Strategies towards Arrangement of Training of Health Care Professionals and Health

Care Provider

Target 1- Including the education of geriatrics and gerontology in the curricula of medicalfaculties

Strategy 1

Including the education of geriatrics and gerontology in the curricula of medical faculties anddisseminating this throughout the country

Target 2- Ensuring the presence of the qualified medical personnel providing services to theelderly

Strategy 1

Including the education of geriatrics and gerontology in the curricula of the relevant departments ofthe universities that educate the nurses, social workers, dieticians, psychologists, physiotherapistsand occupational serving the elderly, and disseminating this throughout the country

Target 3- Promotion of sub-specialization in geriatrics

Strategy 1

Disseminating the sub-specialization in geriatrics under the department of internal medicine of themedical faculties throughout all of the universities and training and research hospitals

Target 4- Organizing geriatric training intended for primary health care physicians

Strategy 1

Allowing for geriatric rotation in the trainings of family practice specialization and adding andupdating geriatric module in Remote Health Training System (RHTS) trainings

Target 5- Organizing geriatric training for health care professionals (physicians, geriatricians,geriatric nurse, social worker, dietitian, psychologist, physiotherapist, occupational therapist)

Strategy 1

Starting and developing the training programs for the health care professionals (physicians,geriatricians, geriatric nurse, social worker, dietitian, psychologist, physiotherapist, occupationaltherapist) and caregivers serving the elderly in coordination with the relevant institutions, ensuringthe periodicity of the training, training the personnel in effective communication techniques with theelderly and supporting the associated projects

Target 6- Organizing the training of the caregivers serving the elderly, apart from health careprofessionals (physicians, geriatricians, geriatric nurse, social worker, dietitian, psychologist,physiotherapist, occupational therapist)

Strategy 1

Ensuring a periodic standard training with a holistic approach related to psychological, social aspectsof the elderly for the families, family relatives, caregivers and other persons apart from health careprofessionals that provide care services to the elderly, and carrying out necessary organizations


99

Target 7- Ensuring rational use of medicines in the elderly

Strategy 1

Ensuring training for all of the health care professionals serving the elderly about rational use ofmedicines

Target 8- Raising awareness of health aging in the elderly

Strategy 1

Performing awareness works about healthy aging, physiological aging, diseases and rational use ofmedicines intended for the elderly in coordination with the relevant institutions and organizations

Target 9- Certifying the health care professionals serving the elderly

Strategy 1

Developing certified training programs about monitoring and care of the elderly for the health careprofessionals (physicians, geriatricians, geriatric nurse, social worker, dietitian, psychologist,physiotherapist, occupational therapist) serving the elderly

Target 10- Disseminating effective teamwork

Strategy 1

Disseminating and implementing the concept of interdisciplinary geriatric team (geriatrics physician,nurse, social worker, dietitian, psychologist, physiotherapist etc.)


100

1.8.

Arr

ange

men

t of

Tra

inin

g of

Hea

lth

Car

e P

rofe

ssio

nal

s an

d H

ealt

h C

are

Pro

vid

ers

Tar

get

1- I

ncl

ud

ing

the

edu

cati

on o

f ge

riat

rics

an

d g

eron

tolo

gy in

th

e cu

rric

ula

of

med

ical

fac

ult

ies

Str

ateg

y

1.1.

In

clu

din

g th

eed

uca

tion

of

geri

atri

csan

d g

eron

tolo

gy in

th

ecu

rric

ula

of

med

ical

facu

ltie

s an

dd

isse

min

atin

g th

isth

rou

ghou

t th

e co

un

try

1.1.

1.R

enov

atio

n an

d ex

pans

ion

of g

eria

tric

and

gero

ntol

ogy

trai

ning

pro

gram

1.1.

2.E

stab

lish

ing

and

incr

easi

ng th

enu

mbe

r of

ger

iatr

ic d

isci

plin

es in

all

med

ical

fac

ulti

es

1.1.

3.D

isse

min

atio

n of

ger

iatr

ic a

ndge

ront

olog

y co

urse

s in

cur

ricu

la

1.In

clus

ion

of g

eria

tric

and

gero

ntol

ogy

trai

ning

s in

cur

ricu

la

2. N

umbe

r of

ger

iatr

ican

d ge

ront

olog

y co

urse

sin

cur

ricu

la o

f m

edic

alfa

cult

ies

1.K

now

ledg

e, b

ehav

iour

and

atti

tude

s ac

hiev

ed b

ygr

adua

te p

hysi

cian

s 2.

Eva

luat

ion

of c

hang

edin

the

appr

oach

es o

fph

ysic

ians

to th

e el

derl

ypa

tien

ts

3. E

valu

atio

n w

orks

of

elde

rly

pati

ents

sati

sfac

tion

1. Y

OK

2.M

inis

try

of H

ealt

h

Per

iodi

c

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n

Tar

get

2- E

nsu

rin

g th

e p

rese

nce

of

the

qu

alif

ied

med

ical

per

son

nel

pro

vid

ing

serv

ices

to

the

eld

erly

Str

ateg

y

2.1.

In

clu

din

g th

eed

uca

tion

of

geri

atri

csan

d g

eron

tolo

gy in

th

ecu

rric

ula

of

the

rele

van

td

epar

tmen

ts o

f th

eu

niv

ersi

ties

th

at e

du

cate

the

nu

rses

, soc

ial

wor

ker

s, d

ieti

cian

s,p

sych

olog

ists

,p

hys

ioth

erap

ists

an

doc

cup

atio

nal

ser

vin

g th

eel

der

ly, a

nd

dis

sem

inat

ing

this

th

rou

ghou

t th

eco

un

try

2.1.

1. D

eter

min

atio

n of

the

dist

ribu

tion

of

task

s of

inte

rdis

cipl

inar

y te

ams

2.1.

2.D

isse

min

atio

n an

d up

dati

ng o

fge

riat

ric

and

gero

ntol

ogy

trai

ning

pro

gram

sap

prop

riat

e to

eac

h pr

ofes

sion

al g

roup

2.1.

3. I

nclu

sion

of

geri

atri

c an

d ge

ront

olog

ycu

rric

ula

2.1.

4.In

crea

sing

und

ergr

adua

te g

eria

tric

and

gero

ntol

ogy

trai

ning

s

2.1.

5.In

crea

sing

the

num

ber

of p

rofe

ssio

nal

grou

ps, e

spec

iall

y th

ose

serv

ing

the

elde

rly

1. I

nclu

sion

of

geri

atri

can

d ge

ront

olog

ytr

aini

ngs

in c

urri

cula

2.

Inc

reas

e in

the

num

ber

of tr

aine

dpe

rson

nel o

n ge

riat

rics

and

gero

ntol

ogy

1. I

ncre

ase

in th

e nu

mbe

rof

inte

rdis

cipl

inar

y te

ampe

rson

nel

2.In

crea

se in

the

num

ber

of th

e po

stgr

adua

test

uden

ts

3. E

valu

atio

n w

orks

for

the

sati

sfac

tion

of

the

heal

th c

are

prof

essi

onal

sse

rvin

g th

e el

derl

y

1. M

inis

try

of H

ealt

h2.

YO

K3.

Uni

vers

itie

s4.

NG

O

2 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


101

Tar

get

3- P

rom

otio

n o

f su

b-s

pec

iali

zati

on o

n g

eria

tric

s

Str

ateg

y

3.1.

Dis

sem

inat

ing

the

sub

-sp

ecia

liza

tion

inge

riat

rics

un

der

th

ed

epar

tmen

t of

inte

rnal

med

icin

e of

th

e m

edic

alfa

cult

ies

thro

ugh

out

all o

fth

e u

niv

ersi

ties

an

dtr

ain

ing

and

res

earc

hh

osp

ital

s

3.1.

1. I

ncre

asin

g ge

riat

ric

disc

ipli

nes

in th

eun

iver

siti

es

3.1.

2.O

peni

ng g

eria

tric

cli

nics

in tr

aini

ngan

d re

sear

ch h

ospi

tals

und

er th

e M

inis

try

ofH

ealt

h

3.1.

3. I

ncre

asin

g ge

riat

ric

sub-

spec

iali

stpo

siti

ons

3.1.

4. C

reat

ion

and

Dev

elop

men

t of

perf

orm

ance

app

lica

tion

s in

ger

iatr

ictr

aini

ng a

nd im

plem

enta

tion

act

ivit

ies

1.In

crea

se in

ger

iatr

icdi

scip

line

s an

d ge

riat

ric

clin

ics

2.In

crea

se in

the

num

ber

of g

eria

tric

ians

3.

Red

ucti

on in

the

num

ber

of d

iffe

rent

bran

ches

and

exam

inat

ion

that

the

elde

rly

unde

rgo

1.In

crea

se in

the

qual

ity

ofth

e se

rvic

es p

rovi

ded

for

the

elde

rly

2.

Ens

urin

g th

at th

e el

derl

yca

n re

ceiv

e th

e se

rvic

esfr

om a

sin

gle

cent

re3.

Red

ucti

on in

chr

onic

dise

ases

-ass

ocia

ted

deat

hsof

com

plic

atio

ns in

the

elde

rly

pati

ents

4.

Enh

ance

the

life

span

expe

cted

in th

e he

alth

stat

isti

cs

1.M

inis

try

of H

ealt

h2.

Min

istr

y of

D

evel

opm

ent

(TU

IK)

3. Y

OK

4. U

nive

rsit

ies

6. S

TK

Per

iodi

c

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n

Tar

get

4- O

rgan

izin

g ge

riat

ric

trai

nin

g in

ten

ded

for

pri

mar

y h

ealt

h c

are

ph

ysic

ian

s

Str

ateg

y

4.1.

All

owin

g fo

r ge

riat

ric

rota

tion

in t

he

trai

nin

gsof

fam

ily

pra

ctic

esp

ecia

liza

tion

an

d a

dd

ing

and

up

dat

ing

geri

atri

csm

odu

le in

Rem

ote

Hea

lth

Tra

inin

g S

yste

m (

RH

TS

)

4.1.

1. I

ncre

asin

g un

derg

radu

ate

and

post

grad

uate

ger

iatr

ic tr

aini

ngs

4.1.

2. I

nclu

sion

of

geri

atri

c ro

tati

on in

the

curr

icul

a of

fam

ily

prac

tice

4.1.

3.E

nsur

ing

thes

e tr

aini

ngs

duri

ngin

tern

al d

isea

ses

rota

tion

whe

re g

eria

tric

clin

ics

are

not a

vail

able

4.1.

4. P

repa

ring

trai

ning

mod

ule

in th

eF

amil

y P

ract

ice

RH

TS

4.1.

5.P

rovi

ding

in-s

ervi

ce tr

aini

ngs

abou

tel

derl

y he

alth

and

arr

angi

ng s

tand

ard

cert

ifie

d tr

aini

ng p

rogr

ams

4.1.

6. P

osit

ive

perf

orm

ance

impl

emen

tati

onin

trai

ning

act

ivit

ies

1. G

eria

tric

s m

odul

e in

RH

TS

pra

ctic

es

2. C

hang

ing

the

curr

icul

um in

a w

ay to

cove

r ge

riat

ric

cour

ses

in f

amil

y pr

acti

ce

3. E

nsur

ing

the

prep

arat

ion

of c

ours

ean

d ce

rtif

icat

ion

prog

ram

s

4. N

umbe

r of

the

prim

ary

care

phy

sici

ans

who

hav

e ac

quir

edge

riat

ric

know

ledg

e,be

havi

ours

and

att

itud

es

1.A

ccur

ate

diag

nosi

s,tr

eatm

ent a

nd f

ollo

w-u

p of

the

elde

rly

in p

rim

ary

heal

th c

are

2. D

ecre

ase

in th

e nu

mbe

rof

the

elde

rly

pati

ent w

hoha

ve b

een

disp

atch

ed b

ypr

imar

y he

alth

car

e

3. M

onit

orin

g of

RH

TS

mod

ule

1. M

inis

try

of H

ealt

h2.

SG

K3.

YO

K4.

Uni

vers

itie

s 5.

NG

O

2 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


102

Tar

get

5- O

rgan

izin

g ge

riat

ric

trai

nin

g fo

r h

ealt

h c

are

pro

fess

ion

als

(ph

ysic

ian

s, g

eria

tric

ian

s, g

eria

tric

nu

rse,

soc

ial w

ork

er, d

ieti

tian

, psy

chol

ogis

t,

ph

ysio

ther

apis

t, o

ccu

pat

ion

al t

her

apis

t) s

ervi

ng

the

eld

erly

Str

ateg

y

5.1.

Sta

rtin

g an

dd

evel

opin

g th

e tr

ain

ing

pro

gram

s fo

r th

e h

ealt

hca

re p

rofe

ssio

nal

s(p

hys

icia

ns,

ger

iatr

icia

ns,

geri

atri

c n

urs

e, s

ocia

lw

ork

er, d

ieti

tian

,p

sych

olog

ist,

ph

ysio

ther

apis

t,oc

cup

atio

nal

th

erap

ist)

and

car

egiv

ers

serv

ing

the

eld

erly

in c

oord

inat

ion

wit

h t

he

rele

van

tin

stit

uti

ons,

en

suri

ng

the

per

iod

icit

y of

th

etr

ain

ing,

tra

inin

g th

ep

erso

nn

el in

eff

ecti

veco

mm

un

icat

ion

tech

niq

ues

wit

h t

he

eld

erly

an

d s

up

por

tin

gth

e as

soci

ated

pro

ject

s

5.1.

1. P

repa

rati

on o

f ge

riat

ric

and

gero

ntol

ogy

prog

ram

s

5.1.

2. E

nsur

ing

the

peri

odic

ity

of in

-ser

vice

prog

ram

s

5.1.

3.S

uppo

rtin

g th

e re

aliz

atio

n of

nat

iona

lan

d in

tern

atio

nal p

roje

cts

5.1.

4. M

akin

g in

-ser

vice

trai

ning

of

heal

thca

re p

rofe

ssio

nal s

ervi

ng th

e el

derl

yco

mpu

lsor

y on

a r

egul

ar b

asis

5.1.

5.E

stab

lish

men

t or

impr

ovem

ent o

fpe

rfor

man

ce a

ppli

cati

ons

agai

nst g

eria

tric

trai

ning

act

ivit

ies

1. I

ncre

ase

in th

enu

mbe

r of

pro

fess

iona

lspa

rtic

ipat

ing

in i

n-se

rvic

e-tr

aini

ngs

2.In

crea

se in

the

num

ber

of p

roje

cts

rela

ted

to th

e su

bjec

t

1. G

aini

ng g

eria

tric

know

ledg

e an

d at

titu

des

tohe

alth

car

e pr

ofes

sion

als

serv

ing

the

elde

rly

2. S

usta

inab

le tr

aini

ngac

tivi

ties

3.

Eva

luat

ion

of q

uali

ty o

fli

fe r

elat

ed to

the

elde

rly

4.

Eva

luat

ion

ofsa

tisf

acti

on o

f he

alth

car

epr

ofes

sion

als

serv

ing

the

elde

rly

1. M

inis

try

of H

ealt

h2.

SG

K3.

YO

K4.

Uni

vers

itie

s5.

NG

O

Per

iodi

c

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


103

Tar

get 6

- Org

aniz

ing

the

trai

nin

g of

the

care

give

rs s

ervi

ng

the

eld

erly

, ap

art f

rom

hea

lth

car

e p

rofe

ssio

nal

s (p

hys

icia

ns,

ger

iatr

icia

ns,

ger

iatr

ic n

urs

e,

soci

al w

ork

er, d

ieti

tian

, psy

chol

ogis

t, p

hys

ioth

erap

ist,

occ

up

atio

nal

th

erap

ist)

Str

ateg

y

6.1.

En

suri

ng

a p

erio

dic

stan

dar

d t

rain

ing

wit

h a

hol

isti

c ap

pro

ach

rel

ated

to p

sych

olog

ical

, soc

ial

asp

ects

of

the

eld

erly

for

the

fam

ilie

s, f

amil

yre

lati

ves,

car

egiv

ers

and

oth

er p

erso

ns

apar

t fr

omh

ealt

h c

are

pro

fess

ion

als

that

pro

vid

e ca

re s

ervi

ces

to t

he

eld

erly

an

dca

rryi

ng

out

nec

essa

ryor

gan

izat

ion

s

6.1.

1.D

isse

min

atio

n of

sta

ndar

d tr

aini

ngpr

ogra

ms

6.1.

2.P

repa

rati

on o

f el

derl

y ca

re g

uide

line

san

d di

stri

buti

on o

f th

is to

the

unit

s re

quir

ed

6.1.

3. P

rovi

ding

pub

lic

trai

ning

sem

inar

s

6.1.

4.P

rovi

ding

trai

ning

abo

ut e

ffec

tive

com

mun

icat

ion

wit

h th

e el

derl

y

6.1.

5. E

nsur

ing

stan

dard

and

per

iodi

ctr

aini

ngs

for

tech

nici

ans

serv

ing

the

elde

rly

Num

ber

of tr

aini

ngor

gani

zed

for

care

give

rsse

rvin

g th

e el

derl

y

1.G

aini

ng g

eria

tric

know

ledg

e an

d at

titu

des

tohe

alth

car

e pr

ofes

sion

als

serv

ing

the

elde

rly

2.D

ecre

ase

in th

ein

dica

tors

of

neg

lect

,ab

use

and

viol

ence

aga

inst

the

elde

rly

3. I

ncre

ase

in th

e qu

alit

y of

elde

rly

care

ser

vice

s 4.

Red

ucti

on i

n th

epr

oble

ms

of c

areg

iver

s

1. M

inis

try

of F

amil

y an

d S

ocia

l Pol

icie

s 2.

Min

istr

y of

Hea

lth

3. M

inis

try

of I

nter

nal

Aff

airs

4. U

nive

rsit

ies

5.N

GO

Per

iodi

c

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n

Tar

get

7- E

nsu

rin

g ra

tion

al u

se o

f m

edic

ines

in t

he

eld

erly

Str

ateg

y

7.1.

En

suri

ng

trai

nin

g fo

ral

l of

the

hea

lth

car

ep

rofe

ssio

nal

s se

rvin

g th

eel

der

ly a

bou

t ra

tion

al u

seof

med

icin

es

7.1.

1. P

repa

ring

trai

ning

pro

gram

s

7.1.

2. C

arry

ing

out c

ours

e, s

emin

ars

and

trai

ning

pro

gram

s

7.1.

3.In

crea

sing

the

num

ber

of r

atio

nal u

seof

med

icin

e pa

nels

in th

e co

ngre

sses

7.1.

4.P

rom

otin

g ra

tion

al u

se o

f m

edic

ine

sym

posi

a an

d in

crea

sing

its

freq

uenc

y

1.R

atio

nal u

se o

fm

edic

ine

by th

e el

derl

y

2. R

atio

nal u

se o

fm

edic

ine

prom

oted

by

phys

icia

ns

3.In

crea

se in

the

num

ber

of tr

aini

ngs

carr

ied

out

4. I

ncre

ase

in th

enu

mbe

r of

sym

posi

a5.

Inc

reas

e in

the

num

ber

of p

erso

nnel

trai

ned

1. P

rofi

cien

cy a

bout

rati

onal

dru

g us

e, d

rug

inte

ract

ions

and

sid

eef

fect

s ac

quir

ed b

y he

alth

care

pro

fess

iona

ls2.

Red

ucti

on o

fpo

lyph

arm

acy

in th

eel

derl

y3.

Red

ucti

on in

the

hosp

ital

adm

issi

ons

aris

ing

from

drug

-rel

ated

com

plic

atio

ns4.

Red

ucti

on o

f dr

ug c

osts

1. M

inis

try

of H

ealt

h2.

SG

K3.

Uni

vers

itie

s4.

NG

O

Per

iodi

c

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


104

Tar

get

8- R

aisi

ng

awar

enes

s of

hea

lth

agi

ng

in t

he

eld

erly

Str

ateg

y

8.1.

Per

form

ing

awar

enes

s w

ork

s ab

out

hea

lth

y ag

ing,

ph

ysio

logi

cal a

gin

g,d

isea

ses

and

rat

ion

al u

seof

med

icin

es in

ten

ded

for

the

eld

erly

inco

ord

inat

ion

wit

h t

he

rele

van

t in

stit

uti

ons

and

orga

niz

atio

ns

8.1.

1.O

rgan

izin

g he

alth

agi

ng a

ndph

ysio

logi

cal a

ging

trai

ning

s in

tend

ed f

orth

e el

derl

y

8.1.

2. O

rgan

izin

g tr

aini

ngs

abou

t rat

iona

lus

e of

med

icin

es a

nd th

e di

seas

es f

requ

entl

yse

en in

the

elde

rly

1.In

crea

se o

f th

epr

ogra

ms

inte

nded

for

the

elde

rly

2. N

umbe

r of

the

elde

rly

trai

nees

Enh

ance

d co

nsci

ousn

ess

abou

t agi

ng in

the

elde

rly

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

F

amil

y an

d S

ocia

l P

olic

ies

3. U

nive

rsit

ies

4. N

GO

Per

iodi

c

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n

Tar

get

9- C

erti

fyin

g th

e h

ealt

h c

are

pro

fess

ion

als

serv

ing

the

eld

erly

Str

ateg

y

9.1.

Dev

elop

ing

cert

ifie

dtr

ain

ing

pro

gram

s ab

out

mon

itor

ing

and

car

e of

the

eld

erly

for

th

e h

ealt

hca

re p

rofe

ssio

nal

s(p

hys

icia

ns,

ger

iatr

icia

ns,

geri

atri

c n

urs

e, s

ocia

lw

ork

er, d

ieti

tian

,p

sych

olog

ist,

ph

ysio

ther

apis

t,oc

cup

atio

nal

th

erap

ist)

serv

ing

the

eld

erly

9.1.

1.O

rgan

izat

ion

and

impl

emen

tati

on o

fst

anda

rd c

erti

fied

trai

ning

pro

gram

s

9.1.

2.Im

plem

enta

tion

of

posi

tive

perf

orm

ance

in tr

aini

ng a

ctiv

itie

s

9.1.

3.D

evel

opm

ent o

f pr

ojec

ts a

nd s

tudi

esby

the

team

s

1. N

umbe

r of

sta

ndar

dce

rtif

ied

trai

ning

prog

ram

s 2.

Inc

reas

e in

the

qual

ity

of s

ervi

ce p

rovi

sion

of

the

pers

onne

l ser

ving

the

elde

rly

1. I

ncre

ase

in th

e qu

alit

y of

elde

rly

care

2.

Sca

le o

f qu

alit

y of

life

3.

Incr

ease

in th

e nu

mbe

rof

the

qual

ifie

d pe

rson

nel

serv

ing

the

elde

rly

1.M

inis

try

of H

ealt

h2.

SG

K3.

Uni

vers

itie

s4.

NG

O

2 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


105

Tar

get

10-

Dis

sem

inat

ing

effe

ctiv

e te

amw

ork

Str

ateg

y

10.1

. Dis

sem

inat

ing

and

imp

lem

enti

ng

the

con

cep

tof

inte

rdis

cip

lin

ary

geri

atri

c te

am (

geri

atri

csp

hys

icia

n, n

urs

e, s

ocia

lw

ork

er, d

ieti

tian

,p

sych

olog

ist,

ph

ysio

ther

apis

t et

c.)

10.1

.1. D

efin

itio

n of

inte

rdis

cipl

inar

yte

am in

ger

iatr

ics

10.1

.2.I

nclu

sion

of

the

inte

rdis

cipl

inar

y co

ncep

t in

geri

atri

csin

all

of

the

trai

ning

pro

gram

s

10.1

.3. E

nsur

ing

effi

cien

tco

mm

unic

atio

n be

twee

n te

amm

embe

rs

10.1

.4.D

evel

opm

ent o

f pr

ojec

ts a

ndre

sear

ches

by

the

team

s

10.1

.5. E

nsur

ing

the

nece

ssar

y le

gal

regu

lati

ons

for

that

inte

rdis

cipl

inar

yte

am m

embe

rs s

houl

d be

ful

l-ti

me

empl

oyee

s an

d sh

ould

ser

ve th

eel

derl

y in

the

sam

e pl

aces

1.In

crea

se in

the

qual

ity

of s

ervi

ce p

rovi

ded

for

the

elde

rly

2.

Num

ber

of p

roje

cts

3.N

umbe

r of

the

full

-ti

me

team

s op

erat

ing

regu

larl

y an

d in

uni

son

1.In

crea

se in

the

sati

sfac

tion

of

the

elde

rly

2.

Sus

tain

able

trai

ning

acti

viti

es3.

Red

ucti

on o

fho

spit

aliz

atio

n pe

riod

s4.

Red

ucti

on o

f re

curr

ing

hosp

ital

izat

ions

5. D

ecre

ase

in m

orta

lity

and

mor

bidi

ty6.

Red

ucti

on o

f he

alth

cost

s

1. M

inis

try

of H

ealt

h2.

SG

K3.

Uni

vers

itie

s4.

NG

O

Dis

sem

inat

ion

wit

hin

1 ye

ar a

ndpe

riod

icim

plem

enta

tion

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


106

1.9. PROVISION OF SUFFICIENT NUTRITION AND ACCESS TO FOOD FOR THE ELDERLY


Unhealthy nutrition and obesity growing out of this cause the formation nutrition-related chronic

diseases (cardiovascular disease, cancer, diabetes, osteoporosis, etc.). Although these diseases are caused

by the interaction of multiple factors, scientific studies has shown that incorrect nutrition habits carrying

on since childhood are an important factor for these. For example; the effects of rickets developing in

childhood as a result of vitamin D deficiency demonstrate themselves more, increasing the risk of

development of some chronic diseases (respiratory failure, etc.) on account of skeletal malformations.

Malnutrition in the Elderly Population in Turkey

In a study conducted by İstanbul University Faculty of Medicine, Department of Internal Medicine,

the nutritional status of the elderly patients monitored in the Geriatrics Outpatient Clinic was scanned

with the Mini Nutritional Assessment Test, malnutrition rate was found to be 13 percent and the risk of

malnutrition rate was found to be 31 percent as an addition. Especially those with malnutrition, the increase

in the incidence of depression, faecal incontinence, loss of cognitive function and physical dependency

was identified (58).

In two cross-sectional studies conducted with the scanning of the elderly in a large-scale nursing

home located within the boundaries of İstanbul in 2009 and 2010, malnutrition rate was found to be 9.8

percent, and the risk of malnutrition rate was found to be 22,8 as an addition. The incidence of other

geriatric syndromes has a significant increase in the elderly detected to have malnutrition.

In 2010, in a screening conducted on 349 nursing home residents, malnutrition rate was found to

be 13,5 percent, and the risk of malnutrition was found to be 33,5 percent as an addition. Significant

relationship was observed between malnutrition and dementia and sarcopenia. In study conducted on

hospitalized patients in İstanbul Faculty of Medicine, Geriatrics Clinic of Internal Medicine in 2010,

malnutrition rate at the time of hospitalization was found to be 44,5 percent. Hospitalization periods (18.9

± 19.1 vs. 11.3 ± 11.3 days, p <0.0001) and incidence rate of hospital infection (45 percent vs. 7 percent,

P <0.001, OR: 3,298) were found to be significantly increased in the group at risk of malnutrition (59).

The results of current food consumption studies show that the elderly residing in nursing homes and

at homes have deficiencies in consumption of protein, vitamin A, B1 and B2, niacin and vitamin C and

the minerals like iron, calcium and zinc.

Although the incidence of the folate and vitamin B12 deficiencies in the elderly in the whole

population is not known, the deficiency of these two vitamins is known to be a major cause of the

formation of cardiovascular diseases.

Malnutrition in the Elderly Population in the World

In a study conducted by Kaiser MJ et al., malnutrition rate was found to be 5,8 percent in the elderly

living in society, 13,8 percent in those living in nursing homes and 38,7 percent in hospitalized patients

(60).


107

In the recommendations of ESPEN (European Society for Clinical Nutrition and Metabolism), which

was published in 2002, all individuals over 65 years are targeted to be screened. Similar proposal is

included in the subsequently issued guidelines (61).

In line with the decision taken by the European Parliament in 2007, obesity and malnutrition have

been recognized as the most important public health problem and this issue was included in the official

political agenda of the European Union in 2008. 2009 was declared by ESPEN as the year of fighting

malnutrition. Based on these data, all the elderly living in the community and hospitalized in geriatric

clinics should be screened for nutritional status, and treatment plan should be developed by making

detailed assessments in risky individuals (59).

In a study examining the subject of individualized dietary, the quality of life and physical activity

gains of the individuals with head and neck cancer who receive radiotherapy treatment was revealed with

3 nutrition branches (individualized diet prepared by a dietitian, standard hospital food and enteral nutrition

support, and standard hospital food alone), the most effective results in this study were obtained on the

first branch (62). This reveals the importance of personal diet support under dietitian supervision and

individualized diet menu selection.

With the establishment of clinical nutrition teams in hospitals, it will be possible to identify the

patients who need nutritional support and to determine their malnutrition degree, to plan appropriate

treatment, to provide efficient and safe nutrition support, to prevent sarcopenia developed as secondary

upon malnutrition in the elderly and obese patients, to closely monitor the patients until discharge, and to

maintain home care by planning a polyclinic-based follow-up procedure after discharge.

Physicians (internal medicine, general surgery and neurology specialists), nutritionists, nurses,

psychologists, physiotherapists and dentists are to be recommended to be involved within the structure of

the team. Monitoring and documentation of clinical nutritional status, evaluation of the relation between

hospitalization periods and nutritional status, determination of the relation between the complications

occurring during the disease and national status, and revealing the role of efficient nutritional support in

wound healing and tissue repair speed retaining are included in study protocols of the team.

In our country, the reimbursement of nutritional support is made to the hospitalized patients and out

patients with nutrition problems. Nutritional problems of outpatients are reported and they can be provided

with supportive care at home. In the reporting stage of nutritional products, it is important that daily energy

requirements of the patient and how much of this requirement can be taken orally should be written in the

report. Thus, daily amount of the requirement for the support products can be determined healthier. In this

way, unnecessary prescription can be prevented.


108

Target and Strategies towards Provision of Sufficient Nutrition and Access to Food Product for

the Elderly

Target 1- Gaining healthy nutrition habits to all age groups until the old age period

Strategy 1

Promotion of sufficient and balanced diet beginning from childhood by paying attention to meetingindividualized nutrition needs during the course of lifetime

Target 2- Prevention of malnutrition in the elderly and implementation of effective treatmentfor malnutrition

Strategy 1

Determination of malnutrition rates of the elderly living in society and in nursing homes andhospitalized patients through health screening and assessment test, identification of the causes ofmalnutrition and creation of effective treatment plan

Target 3- Development of Turkey-specific nutrition policies for the individuals over 65 years ofage

Strategy 1

Development of the awareness in the elderly about healthy and balanced diet.

Target 4- Early detection of tooth and gum problems in the elderly and strengthening of accessto treatment services

Strategy 1

Performing periodic checks of dental health of the individuals over 65 years of age

Target 5- Ensuring sufficient and balanced diet in the elderly

Strategy 1

Ensuring the sufficient and balanced diet which do not cause micro and macro nutrient deficiencies,provides sufficient energy and is appropriate to national nutrition targets and the needs of the elderlystaying in the hospital and other care institutions by presenting set of choices in food

Target 6- Establishment of clinical nutrition teams in hospitals and identification of serviceareas of these teams in Communiqué of Health Application (CHA)

Strategy 1

Identification of the patients who need nutritional support, determination of their malnutrition degree,planning of appropriate treatment, provision of efficient and safe nutrition support, prevention ofsarcopenia developed as secondary upon malnutrition in the elderly and obese patients, closelymonitoring of patients until discharge and provision of home care by planning a polyclinic-basedfollow-up procedure

Target 7- Education of health care professionals about health nutrition principles and supports

Strategy 1

Ensuring the inclusion of special nutritional needs of the elderly in the curricula for training all healthcare professionals

Strategy 2

Ensuring the training of the elderly about healthy nutrition and eating habits within the scope of homecare

Target 8- Ensuring the solution to the reimbursement of implementation problems of nutritionalproducts for the patients with nutritional problems

Strategy 1

Minimization of reimbursement losses and elimination of the deficiencies of the existing application


109

1.9.

Pro

visi

on o

f S

uff

icie

nt

Nu

trit

ion

an

d A

cces

s to

Foo

d P

rod

uct

s fo

r th

e E

lder

ly

Tar

get

1- I

ncl

ud

ing

the

edu

cati

on o

f ge

riat

rics

an

d g

eron

tolo

gy in

th

e cu

rric

ula

of

med

ical

fac

ult

ies

Str

ateg

y

1.1.

Pro

mot

ion

of

suff

icie

nt

and

bal

ance

dd

iet

beg

inn

ing

from

chil

dh

ood

by

pay

ing

atte

nti

on t

o m

eeti

ng

ind

ivid

ual

ized

nu

trit

ion

nee

ds

du

rin

g th

e co

urs

eof

life

tim

e

1.1.

1. P

repa

rati

on o

f di

stan

cetr

aini

ng m

odul

e of

Fam

ily

Pra

ctic

e

1.1.

2. H

oldi

ng p

ubli

ced

ucat

ion

mee

ting

s

1.1.

3.P

repa

rati

on o

f tr

aini

ngpr

ogra

ms

on T

V

1.1.

4.P

rovi

sion

of

trai

ning

prog

ram

s in

vis

ual m

edia

1.1.

5. A

rran

gem

ent o

fed

ucat

iona

l act

ivit

ies

insc

hool

s

1. I

ncre

ase

in th

ekn

owle

dge

leve

l on

heal

thy

eati

ng in

all

age

s2.

Inc

reas

e in

the

num

ber

ofth

e in

divi

dual

s w

ho h

ave

rece

ived

trai

ning

on

nutr

itio

n3.

Dec

reas

e in

the

num

ber

of c

hron

ic d

isea

ses

asso

ciat

ed w

ith

mal

nutr

itio

n 4.

Dec

reas

e in

the

num

ber

of o

bese

5. D

ecre

ase

in th

e nu

mbe

rof

the

elde

rly

wit

hm

alnu

trit

ion

1. I

ncre

ase

in th

e nu

mbe

r of

the

elde

rly

who

can

car

ry o

utac

tivi

ties

of

dail

y li

ving

inde

pend

entl

y2.

Incr

ease

in th

e av

erag

e li

fe s

pan

3.R

educ

tion

of

hosp

ital

adm

issi

ons

of th

e el

derl

y 4.

Dec

reas

e in

the

num

ber

ofch

roni

c di

seas

es

5.R

educ

tion

of

the

shar

e of

chro

nic

dise

ases

in d

eath

s 6.

Mak

ing

asse

ssm

ents

by

usin

gm

alnu

trit

ion

scre

enin

g sc

ales

7.

Ant

hrop

omet

ric

mea

sure

men

ts

8. Q

uali

ty o

f li

fe s

cale

s9.

Num

ber

of a

cute

hos

pita

lad

mis

sion

s in

the

elde

rly

10

. Inc

iden

ce o

f ge

riat

ric

synd

rom

es

11.I

ncid

ence

of

sarc

open

ia12

.Fol

low

-up

of c

ogni

tive

synd

rom

es a

nd in

cide

nce

ofde

pend

ency

1.M

inis

try

of H

ealt

h2.

Min

istr

y of

Nat

iona

l E

duca

tion

3. M

inis

try

of F

ood,

A

gric

ultu

re a

nd L

ives

tock

4. M

inis

try

of F

amil

y an

d S

ocia

l Pol

icie

s5.

Min

istr

y of

Int

erna

lA

ffai

rs6.

Rel

igio

us A

ffai

rs7.

Uni

vers

itie

s8.

Pre

ss a

nd B

road

cast

ing

Org

aniz

atio

ns9.

NG

O10

. Foo

d In

dust

ry

Per

iodi

c

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


110

Tar

get

2- P

reve

nti

on o

f m

aln

utr

itio

n in

th

e el

der

ly a

nd

imp

lem

enta

tion

of

effe

ctiv

e tr

eatm

ent

for

mal

nu

trit

ion

Str

ateg

y

2.1.

Det

erm

inat

ion

of

mal

nu

trit

ion

rat

es o

f th

eel

der

ly li

vin

g in

soc

iety

and

in n

urs

ing

hom

es a

nd

hos

pit

aliz

ed p

atie

nts

thro

ugh

hea

lth

scr

een

ing

and

ass

essm

ent

test

,id

enti

fica

tion

of

the

cau

ses

of m

aln

utr

itio

nan

d c

reat

ion

of

effe

ctiv

etr

eatm

ent

pla

n

2.1.

1. N

utri

tion

al s

cree

ning

and

trea

tmen

t of

the

indi

vidu

als

who

are

65

year

san

d ol

der

2.1.

2. C

reat

ion

of a

lgor

ithm

2.1.

3.A

dopt

ing

heal

thy

nutr

itio

n an

d li

fe s

tyle

inor

der

to s

trug

gle

wit

hm

alnu

trit

ion

in th

e el

derl

yan

d ob

esit

y

2.1.

4. E

stab

lish

men

t of

clin

ical

nut

riti

on te

ams

inho

spit

als,

and

ass

essm

ent o

fth

e pa

tien

ts b

y di

etit

ians

,w

here

thes

e te

ams

are

not

avai

labl

e

1. M

alnu

trit

ion

rate

d in

the

elde

rly

2.

Det

erm

inat

ion

of c

ause

sof

mal

nutr

itio

n 3.

Num

ber

of th

e el

derl

ydi

rect

ed to

die

titi

an f

orm

alnu

trit

ion

trea

tmen

t 4.

Num

ber

of th

e el

derl

yw

ho h

ave

been

con

sult

ed b

ycl

inic

al n

utri

tion

team

sdu

ring

mal

nutr

itio

ntr

eatm

ent

1.R

educ

tion

of

the

rela

tion

ship

betw

een

mal

nutr

itio

n an

dm

orbi

dity

and

mor

bidi

ty

2.In

crea

sing

the

num

ber

ofcl

inic

al n

utri

tion

team

s w

hich

are

succ

essf

ul in

trea

tmen

t of

mal

nutr

itio

n 3.

Det

erm

inat

ion

of c

ost-

effe

ctiv

enes

s of

eff

icie

ntm

alnu

trit

ion

trea

tmen

t 4.

Act

ivit

y of

dai

ly li

ving

of

the

elde

rly,

dai

ly in

stru

men

tal l

ivin

gac

tivi

ty a

nd it

s ef

fect

s on

qua

lity

of li

fe

1.M

inis

try

of H

ealt

h2.

Min

istr

y of

Fam

ily

and

Soc

ial P

olic

ies

3.M

inis

try

of I

nter

nal

Aff

airs

4. U

nive

rsit

ies

5. N

GO

1 ye

ar

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


111

Tar

get

3- D

evel

opm

ent

of T

urk

ey-s

pec

ific

nu

trit

ion

pol

icie

s f

or t

he

ind

ivid

ual

s ov

er 6

5 ye

ars

of a

ge

Str

ateg

y

3.1.

Dev

elop

men

t of

th

eaw

aren

ess

in t

he

eld

erly

abou

t h

ealt

hy

and

bal

ance

d d

iet

3.1.

1. D

eter

min

atio

n of

the

mos

t com

mon

nut

rien

tde

fici

enci

es in

the

elde

rly

3.1.

2.P

repa

rati

on o

f el

derl

y-sp

ecif

ic h

ealt

h nu

trit

ion

guid

elin

es

1. M

akin

g as

sess

men

ts b

yus

ing

mal

nutr

itio

n sc

reen

ing

scal

es

2.N

umbe

r of

acu

te h

ospi

tal

adm

issi

ons

in th

e el

derl

y

3. N

umbe

r of

chr

onic

dise

ases

1. R

epla

cem

ent o

f th

e ab

sent

dat

a(n

utri

ent e

nric

hmen

t act

ivit

ies)

inth

e li

ght o

f T

urke

y N

utri

tion

and

Hea

lth

Sur

vey

(TN

HS

) D

ata

2. D

eter

min

atio

n en

ergy

and

nutr

ient

inta

ke le

vels

3.D

eter

min

atio

n of

con

sum

ptio

nam

ount

s of

fun

dam

enta

l nut

riti

ongr

oups

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Foo

d,A

gric

ultu

re a

nd L

ives

tock

3.M

inis

try

of S

cien

ce,

Indu

stry

and

Tec

hnol

ogy

4.

Min

istr

y of

Int

erna

lA

ffai

rs5.

Uni

vers

itie

s6.

Pre

ss a

nd B

road

cast

ing

Org

aniz

atio

ns7.

NG

O8.

Foo

d In

dust

ry

1 ye

ar

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n

Tar

get

4- E

arly

det

ecti

on o

f to

oth

an

d g

um

pro

ble

ms

in t

he

eld

erly

an

d s

tren

gth

enin

g of

acc

ess

to t

reat

men

t se

rvic

es

Str

ateg

y

4.1.

Per

form

ing

per

iod

icch

eck

s of

den

tal h

ealt

h o

fth

e in

div

idu

als

over

65

year

s of

age

4.1.

1.D

eter

min

atio

n of

the

curr

ent s

itua

tion

s by

perf

orm

ing

peri

odic

che

cks

of d

enta

l hea

lth

of th

ein

divi

dual

s ov

er 6

5 ye

ars

ofag

e

1. I

ncid

ence

of

oral

and

dent

al h

ealt

h pr

oble

ms

ofth

e in

divi

dual

ove

r 65

yea

rsof

age

in th

e co

mm

unit

y

2. R

elat

ion

betw

een

oral

and

dent

al h

ealt

h pr

oble

ms

and

the

inci

denc

e of

mal

nutr

itio

n

Red

ucin

g th

e in

cide

nce

ofm

alnu

trit

ion

by d

evel

opin

gef

fici

ent o

ral a

nd h

ealt

h po

licy

inte

nded

for

the

elde

rly

1.M

inis

try

of H

ealt

h2.

Min

istr

y of

Int

erna

lA

ffai

rs3.

Uni

vers

itie

s4.

Pre

ss a

nd B

road

cast

ing

Org

aniz

atio

ns

1 ye

ar

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


112

Tar

get

5- E

nsu

rin

g su

ffic

ien

t an

d b

alan

ced

die

t in

th

e el

der

ly

Str

ateg

y

5.1.

En

suri

ng

the

suff

icie

nt

and

bal

ance

dd

iet

wh

ich

do

not

cau

sem

icro

an

d m

acro

nu

trie

nt

def

icie

nci

es, p

rovi

des

suff

icie

nt

ener

gy a

nd

isap

pro

pri

ate

to n

atio

nal

nu

trit

ion

tar

gets

an

d t

he

nee

ds

of t

he

eld

erly

stay

ing

in t

he

hos

pit

alan

d o

ther

car

ein

stit

uti

ons

by

pre

sen

tin

gse

t of

ch

oice

s in

foo

d

5.1.

1. E

nsur

ing

the

suff

icie

nt n

umbe

r of

diet

itia

ns e

mpl

oym

ent i

n ho

spit

als

and

care

inst

itut

ions

5.1.

2.E

nsur

ing

men

u va

riet

y

5.1.

3.C

reat

ion

of th

e ne

xt d

ay m

enus

by

offe

ring

a la

car

te m

enus

of

the

foll

owin

gda

y to

the

hosp

ital

ized

pat

ient

s

5.1.

4.E

stab

lish

men

t of

clin

ical

nut

riti

onte

ams,

ther

eby

acti

vely

scr

eeni

ng th

eel

derl

y

5.1.

5.D

isse

min

atio

n of

inte

rdis

cipl

inar

yw

orks

, whi

ch c

an r

evea

l the

impo

rtan

ce o

fth

is s

ubje

ct, a

cros

s th

e co

untr

y

5.1.

6. I

ntro

duct

ion

of o

blig

atio

n fo

r th

epr

ivat

e ca

teri

ng c

ompa

nies

that

wil

lpr

ovid

e fo

od f

or h

ospi

tal a

nd in

stit

utio

nsto

em

ploy

die

titi

an

5.1.

7.D

efin

itio

n of

cli

nica

l nut

riti

onte

ams

and

thei

r se

rvic

es in

the

CH

A

1. N

umbe

r of

day

and

/or

resi

dent

ial c

are

inst

itut

ions

that

rea

ch s

uffi

cien

t and

bala

nced

men

u va

riet

y fo

r th

eel

derl

y2.

Num

ber

of th

e el

derl

yre

ceiv

ing

supp

ort t

reat

men

t3.

Num

ber

of h

ospi

tal

nutr

itio

n un

its

4. D

efin

itio

n nu

trit

ion

test

s in

the

CH

A a

nd th

eir

num

ber

1. I

ncre

ase

in q

uali

tyof

life

2.

Dec

reas

e in

mor

bidi

ty a

ndm

orta

lity

3.

Red

ucti

on o

f th

ein

cide

nce

ofm

alnu

trit

ion

inho

spit

als

4. D

ecre

ase

in th

enu

mbe

r of

pat

ient

sdi

agno

sed

wit

hm

alnu

trit

ion

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Fam

ily

and

Soc

ial P

olic

ies

3. U

nive

rsit

ies

4. F

ood

Indu

stry

2 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


113

Tar

get 6

- Est

abli

shm

ent o

f cli

nic

al n

utr

itio

n te

ams

in h

osp

ital

s an

d id

enti

fica

tion

of s

ervi

ce a

reas

of t

hes

e te

ams

in C

omm

un

iqu

é of

Hea

lth

Ap

pli

cati

on

(CH

A)

Str

ateg

y

6.1.

Id

enti

fica

tion

of

the

pat

ien

ts w

ho

nee

dn

utr

itio

nal

su

pp

ort,

det

erm

inat

ion

of

thei

rm

aln

utr

itio

n d

egre

e,p

lan

nin

g of

ap

pro

pri

ate

trea

tmen

t, p

rovi

sion

of

effi

cien

t an

d s

afe

nu

trit

ion

su

pp

ort,

pre

ven

tion

of

sarc

open

iad

evel

oped

as

seco

nd

ary

up

on m

aln

utr

itio

n in

th

eel

der

ly a

nd

ob

ese

pat

ien

ts, m

onit

orin

g of

pat

ien

ts f

rom

pol

ycli

nic

un

til d

isch

arge

an

dp

rovi

sion

of

hom

e ca

re

6.1.

1. E

stab

lish

men

t of

clin

ical

nutr

itio

n te

ams

in h

ospi

tals

6.1.

2.D

efin

itio

n of

cli

nica

lnu

trit

ion

team

s an

d th

eir

serv

ices

in th

e C

HA

1. D

eter

min

atio

n of

mal

nutr

itio

nra

tes

of th

e ho

spit

aliz

ed p

atie

nts

2.

Eli

min

atio

n of

ris

ks w

ith

the

earl

y di

agno

sis

and

trea

tmen

t of

the

pati

ents

wit

h m

alnu

trit

ion

risk

s 3.

Dec

reas

e in

the

num

ber

ofin

fect

ion

due

to m

alnu

trit

ion

4. R

educ

tion

of

hosp

ital

izat

ion

peri

ods

as a

res

ult o

f m

alnu

trit

ion

5. N

umbe

r of

acu

te h

ospi

tal

adm

issi

ons

of th

e el

derl

y6.

Num

ber

of c

hron

ic d

isea

ses

7.N

umbe

r of

nut

riti

on te

sts

defi

ned

in th

e C

HA

1. D

ecre

ase

in th

e nu

mbe

rof

the

hosp

ital

ized

eld

erly

pati

ent w

ith

mal

nutr

itio

n

2. R

educ

tion

of

mal

nutr

itio

n-re

late

dm

orbi

dity

and

mor

tali

ty

3.In

crea

se in

qua

lity

of

life

4.

Elo

ngat

ed a

vera

geli

fesp

an

5. D

ecre

ase

in th

e nu

mbe

rof

acu

te h

ospi

tal

adm

issi

ons

of th

e el

derl

y

6. D

ecre

ase

in th

e nu

mbe

rof

chr

onic

dis

ease

s 7.

Incr

ease

in a

ctiv

itie

s of

dail

y li

ving

8.

Dec

reas

e in

the

inci

denc

e of

ger

iatr

icsy

ndro

mes

1.M

inis

try

of H

ealt

h2.

Uni

vers

itie

s3.

NG

O

3 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


114

Tar

get

7- E

du

cati

on o

f al

l hea

lth

car

e p

rofe

ssio

nal

s ab

out

hea

lth

nu

trit

ion

pri

nci

ple

s an

d s

up

por

ts

Str

ateg

y

7.1.

En

suri

ng

the

incl

usi

on o

f sp

ecia

ln

utr

itio

nal

nee

ds

of t

he

eld

erly

in t

he

curr

icu

lafo

r tr

ain

ing

all h

ealt

hca

re p

rofe

ssio

nal

s

7.1.

1. E

stab

lish

ing

and

supp

orti

ngpr

ofes

sion

al in

terd

isci

plin

ary

team

s of

hom

e ca

re (

phys

icia

ns,

nurs

es, d

ieti

tian

s an

d he

alth

car

epr

ofes

sion

als)

7.1.

2.A

sses

smen

t of

nutr

itio

nst

atus

of

mon

itor

ed p

atie

nts

atce

rtai

n in

terv

als

and

prov

isio

n of

indi

vidu

aliz

ed d

ieta

ry p

rogr

ams

1.In

crea

se in

the

know

ledg

e le

vel

of h

ealt

h ca

re p

rofe

ssio

nals

abo

uthe

alth

nut

riti

on

2.In

cide

nce

of g

eria

tric

synd

rom

es

3. I

ncre

ase

in d

aily

ora

l foo

din

take

am

ount

s

1. D

ecre

ase

in th

e nu

mbe

rof

the

hosp

ital

ized

eld

erly

wit

h m

alnu

trit

ion

2. R

educ

tion

of

mal

nutr

itio

n-re

late

dho

spit

al m

orbi

dity

and

mor

tali

ty

1.M

inis

try

of H

ealt

h2.

Min

istr

y of

Fam

ily

and

Soc

ial P

olic

ies

3.M

inis

try

of F

ood,

A

gric

ultu

re a

ndL

ives

tock

4.U

nive

rsit

ies

5. N

GO

3 ye

ars

7.2.

En

suri

ng

the

trai

nin

gof

th

e el

der

ly a

bou

th

ealt

hy

nu

trit

ion

an

dea

tin

g h

abit

s w

ith

in t

he

scop

e of

hom

e ca

re

7.2.

1. E

nsur

ing

in-s

ervi

cetr

aini

ngs

of h

ealt

h ca

repr

ofes

sion

als

Dec

reas

e in

mal

nutr

itio

n ra

tes

ofth

e el

derl

y li

ving

in s

ocie

ty1.

Red

ucti

on o

fm

alnu

trit

ion-

rela

ted

mor

bidi

ty a

nd m

orta

lity

of

the

elde

rly

livi

ng in

soc

iety

2.

Inc

reas

e in

phy

sica

lac

tivi

ties

and

qua

lity

of

life

of th

e el

derl

y li

ving

inso

ciet

y

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Fam

ily

and

Soc

ial P

olic

ies

3. M

inis

try

of I

nter

nal

Aff

air

4.U

nive

rsit

ies

5. N

GO

3 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n

Tar

get

8- E

nsu

rin

g th

e so

luti

on t

o th

e re

imb

urs

emen

t of

imp

lem

enta

tion

pro

ble

ms

of n

utr

itio

nal

pro

du

cts

for

the

pat

ien

ts w

ith

nu

trit

ion

al p

rob

lem

s

Str

ateg

y

8.1.

Min

imiz

atio

n o

fre

imb

urs

emen

t lo

sses

an

del

imin

atio

n o

f th

ed

efic

ien

cies

of

the

exis

tin

gap

pli

cati

on

8.1.

1. O

rgan

izat

ion

of d

aily

nutr

itio

n pr

oduc

t am

ount

whi

ch is

det

erm

ined

acco

rdin

g to

dai

ly e

nerg

yre

quir

emen

t

Ens

urin

g he

alth

ier

repo

rtsy

stem

Min

imiz

atio

n of

loss

es in

reim

burs

emen

ts

1. M

inis

try

of H

ealt

h2.

SG

K

3 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


115

1.10. PROVISION OF LONG-TERM HEALTH CARE AND FULL ACCESS TO HEALTH CARE

SERVICES IN GERIATRICS


It is a requirement of understanding of a social state to ensure that individuals can live in healthy,

good quality and longest possible period without being dependent on others. Accompanied by degrees of

illness and disability, the elderly individuals are facing many difficulties at various rates in daily living

and need support services. In this context, elderly care services aimed at supporting the elderly individuals,

who cannot resolve individual needs without someone else's help, emerge as a major concern.

When care needs are assessed, the needy groups with first priority are the adults with severe

disabilities in need of care and the elderly people who have become disabled who are very difficult to be

reclaimed to social life. The quality of care services for elderly and severely disabled people and improving

the quality of life of these individuals are of great importance. However, severely disabled adults and the

elderly often remain in the background in care services. These individuals, particularly the increasing

need for assistance and care with aging, are one of the first issues to be addressed on the basis of the

principle of the social state.

Care services are defined as professional support services that are provided for the people in need

of care at home or in institutions. Target priority in care service is to provide care service for the individuals

in need of care near their families without separating them from social environment and is that their

families provide moral and financial supports in this regard.

Care services are generally considered as institutional care and home care. Institutional care is a type

of care in which the personal, social, psychological and health needs of the individuals, who are in need

of help despite the support provided at home and cannot be cared beside their families, are met, there are

activities to help them spare their leisure times, and the social relations and activities are increased.

However, demand of the elderly in our country who need long-term care services still continue to

receive services from the agency. In our country, long-term care services are carried out by the Ministry

of Family and Social Policies, municipalities, public institutions, NGO’s and private sector organizations

dependent care. In this context, regarding the areas where the Ministry of Health perform the activities,

strategies, targets, activities, output, result indicators, responsible institutions and periods have been

determined. The importance of performing the activities carried out under the Ministry of Development

and the Ministry of Family and Social Policies that should be carried out in coordination has been

highlighted.


116

Target and Strategies towards the Provision of Long-Term Health Care in Geriatrics and Full

Access to Care Services

Target 1- Geriatric, gerontological multidisciplinary and interdisciplinary approach

Strategy 1

Ensuring referral and transfer flow

Strategy 2

Ensuring a sufficient number of full-time employment for all professional personnel that will berequired in the institutions serving the individual older than 65 years

Strategy 3

Designation of collaboration with health care institutions and organizations with the protocols(Universities, Ministry of Family and Social Policies, NGO’s and etc.)

Strategy 4

Development of teamwork concept in long-term care service

Strategy 5

Raising awareness about inter-professional respect, communication, trust, tolerance, the proper useof professional knowledge and skills and etc. which are the necessity of the concept of teamwork

Strategy 6

Ensuring interdisciplinary and multidisciplinary approach through communication with all healthunits, standardization and supervision accreditation

Strategy 7

Creating awareness on positive contribution of nutrition and physical activity to health

Strategy 8

Making job definitions of elderly care personnel

Target 2- Holistic approach towards preventive, protective, diagnostic and therapeutic follow-up and rehabilitation

Strategy 1

Ensuring continuity of services that include; meeting multivariate requirements of the elderly, usingresource allocation efficiently, protecting from diseases, controlling preventive factors, developingexisting health services, fundamental health care, emergency treatment, rehabilitation, psycho-socialsupport, long-term care and palliative treatment services

Target 3- Standardization in education and supervision

Strategy 1

Training for professionals

Strategy 2

Training for care personnel

Strategy 3

Training for elderly relatives

Strategy 4

Training for elderly people


117

1.10

. P

rovi

sion

of

Lon

g-T

erm

Hea

lth

Car

e in

Ger

iatr

ics

and

Fu

ll A

cces

s to

Car

e S

ervi

ces

Tar

get

1- G

eria

tric

, ger

onto

logi

cal m

ult

idis

cip

lin

ary

(mu

ltid

isci

pli

nar

y) a

nd

inte

rdis

cip

lin

ary

(mu

ltid

isci

pli

nar

y) a

pp

roac

h

Str

ateg

y

1.1.

En

suri

ng

refe

rral

an

d t

ran

sfer

flo

w

1.2.

En

suri

ng

a su

ffic

ien

t n

um

ber

of

full

-ti

me

emp

loym

ent

for

all p

rofe

ssio

nal

per

son

nel

th

at w

ill b

e re

qu

ired

in t

he

inst

itu

tion

s se

rvin

g th

e in

div

idu

al o

lder

than

65

year

s

1.3.

Des

ign

atio

n o

f co

llab

orat

ion

wit

hh

ealt

h c

are

inst

itu

tion

s an

d o

rgan

izat

ion

sw

ith

th

e p

roto

cols

(U

niv

ersi

ties

, Min

istr

yof

Fam

ily

and

Soc

ial P

olic

ies,

NG

O’s

an

det

c.)

1.4.

Dev

elop

men

t of

tea

mw

ork

con

cep

t in

lon

g-te

rm c

are

serv

ice

1.5.

Rai

sin

g aw

aren

ess

abou

t in

ter-

pro

fess

ion

al r

esp

ect,

com

mu

nic

atio

n,

tru

st, t

oler

ance

, th

e p

rop

er u

se o

fp

rofe

ssio

nal

kn

owle

dge

an

d s

kil

ls a

nd

etc.

wh

ich

are

th

e n

eces

sity

of

the

con

cep

t of

tea

mw

ork

1.6.

En

suri

ng

inte

rdis

cip

lin

ary

and

mu

ltid

isci

pli

nar

y ap

pro

ach

th

rou

ghco

mm

un

icat

ion

wit

h a

ll h

ealt

h u

nit

s,st

and

ard

izat

ion

an

d s

up

ervi

sion

accr

edit

atio

n

1.7.

Cre

atin

g aw

aren

ess

on p

osit

ive

con

trib

uti

on o

f n

utr

itio

n a

nd

ph

ysic

alac

tivi

ty t

o h

ealt

h

1.8.

Mak

ing

job

def

init

ion

s of

eld

erly

care

per

son

nel

1.1.

1.L

inki

ng d

atab

ase

of M

inis

try

ofH

ealt

h w

ith

auto

mat

ion

syst

em

1.1.

2. L

inki

ng d

epar

tmen

ts o

f ge

riat

rics

and

inte

rnal

med

icin

e w

ith

long

-ter

m h

ealt

h ca

reun

its

of o

ther

dis

cipl

ines

in p

rovi

nces

1.1.

3. E

nsur

ing

inte

rdis

cipl

inar

yco

ordi

nati

on, a

nd c

oord

inat

ion

wit

hm

ulti

disc

ipli

nary

team

whe

re n

eces

sary

1.1.

4. W

here

acc

essi

bili

ty to

hea

lth

care

inth

e in

stit

utio

ns in

whi

ch th

e pa

tien

t is

stay

ing

is n

ot p

ossi

ble,

impr

ovem

ent,

faci

lita

tion

and

sup

ervi

sion

of

chai

n of

refe

rral

s to

sec

onda

ry a

nd te

rtia

ry h

ealt

hca

re c

hain

s

1.1.

5. M

akin

g cl

ear

job

defi

niti

ons

ofpr

ofes

sion

als

in th

e te

am a

nd h

ighl

ight

ing

thei

r du

ty a

nd r

espo

nsib

ilit

ies

wit

h in

-se

rvic

e tr

aini

ngs

1.1.

6. E

stab

lish

men

t of

a co

mm

on v

isio

nan

d tr

aini

ng p

lann

ing

betw

een

the

inst

itut

ions

for

coo

pera

tion

wor

ks

1.1.

7. I

ncre

asin

g th

e nu

mbe

r of

ger

iatr

icde

part

men

ts in

pro

vinc

es

1.1.

8 C

reat

ion

of tr

aini

ng m

odul

es

1.E

ffec

tive

, rel

iabl

ean

d fa

st a

cces

s to

serv

ice

2. I

ncre

ase

in th

enu

mbe

r of

qua

lifi

edpe

rson

nel

3. H

arm

oniz

atio

n go

inst

itut

ions

and

orga

niza

tion

s4.

Ens

urin

g a

heal

thy

and

inde

pend

ent

elde

rly

popu

lati

on in

acti

viti

es o

f da

ily

livi

ng5.

Cli

nica

l qua

lity

wor

ks a

t reg

ular

inte

rval

s6.

Em

ploy

men

t of

qual

ifie

d pe

rson

nel

who

are

aw

are

ofth

eir

duti

es a

ndre

spon

sibi

liti

es7.

Cer

tify

ing

the

exis

ting

em

ploy

ees

wit

h in

-ser

vice

trai

ning

pro

gram

s

1.E

nhan

ced

qual

ity

of s

ervi

ce2.

Enh

ance

dpe

rson

nel

mot

ivat

ion

3. I

mpr

ovem

ent

in th

e m

easu

rabl

ecr

iter

ia in

asse

ssm

ent f

orm

s4.

Ens

urin

gac

cred

itat

ion

5. L

egit

imiz

ing

the

job

defi

niti

ons

ofhe

alth

nur

sing

1. M

inis

try

of H

ealt

h2.

Min

istr

y of

Fam

ily

and

Soc

ial P

olic

ies

3.U

nive

rsit

ies

4. N

GO

Per

iodi

c

2 ye

ars

3 ye

ars

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


118

Tar

get

2- H

olis

tic

app

roac

h t

owar

ds

pre

ven

tive

, pro

tect

ive,

dia

gnos

tic

and

th

erap

euti

c fo

llow

-up

an

d r

ehab

ilit

atio

n

Str

ateg

y

2.1.

En

suri

ng

con

tin

uit

y of

ser

vice

s th

atin

clu

de;

mee

tin

g m

ult

ivar

iate

req

uir

emen

ts o

f th

e el

der

ly, u

sin

gre

sou

rce

allo

cati

on e

ffic

ien

tly,

pro

tect

ing

from

dis

ease

s, c

ontr

olli

ng

pre

ven

tive

fact

ors,

dev

elop

ing

exis

tin

g h

ealt

hse

rvic

es, f

un

dam

enta

l hea

lth

car

e,em

erge

ncy

tre

atm

ent,

reh

abil

itat

ion

,p

sych

o-so

cial

su

pp

ort,

lon

g-te

rm c

are

and

pal

liat

ive

trea

tmen

t se

rvic

es

2.1.

1.D

eter

min

atio

n an

d sc

reen

ing

ofge

riat

ric

synd

rom

es (

dem

enti

a, e

tc.)

, the

risk

and

pro

tect

ive

fact

ors

(fal

ls,

poly

phar

mac

y, e

tc.)

, cre

atio

n of

aw

aren

ess

in th

e so

ciet

y ab

out h

ealt

hy a

nd s

ucce

ssfu

lag

ing

2.1.

2. P

erfo

rmin

g of

reg

ular

die

t, ex

erci

se,

soci

al, c

ogni

tive

act

ivit

ies

and

grou

p w

orks

2.1.

3. F

ull-

tim

e em

ploy

men

t of

corp

orat

eph

ysic

ian,

nur

se, s

ocia

l wor

ker,

psyc

holo

gist

, phy

siot

hera

pist

, die

tici

an a

ndas

sist

ant s

taff

to th

e ex

isti

ng a

nd f

utur

epo

siti

ons;

dev

elop

men

t of

know

ledg

e, s

kill

and

awar

enes

s le

vels

of

wit

hin

the

fram

ewor

k of

mod

ern

appr

oach

es

2.1.

4.W

ides

prea

d us

e of

for

ms,

suc

h as

Act

ivit

ies

of D

aily

Liv

ing

(AD

L)

scal

es,

Inst

rum

enta

l AD

L, M

ini N

utri

tion

alA

sses

smen

t (M

NA

) fo

rm, M

obil

ity-

Sta

bili

ty S

cree

ning

For

m, I

ncon

tine

nce

Eva

luat

ion

For

m, M

ini M

enta

l Tes

t (M

MT

),G

eria

tric

Dep

ress

ion

Sca

le (

GD

S),

Pre

ssur

eS

ore

Ris

k a

nd R

atin

g S

cale

, P

ain

Eva

luat

ion

She

et, P

hysi

cal a

nd F

unct

iona

lC

apac

ity

Eva

luat

ion

For

m o

f G

eria

tric

Sta

ndar

d A

sses

smen

t Ins

trum

ents

Num

ber

of th

e el

derl

yun

derg

oing

com

preh

ensi

ble

asse

ssm

ent

1.In

crea

se in

life

span

and

qual

ity

of li

fe in

old

age

2.R

educ

tion

of

geri

atri

csy

ndro

mes

,re

habi

lita

tion

need

, mor

bidi

tyan

d m

orta

lity

1. M

inis

try

of F

amil

y an

d S

ocia

l Pol

icie

s2.

Min

istr

y of

Hea

lth

3.S

GK

4.U

nive

rsit

ies

Per

iodi

c

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


119

Tar

get

3- S

tan

dar

diz

atio

n in

ed

uca

tion

an

d s

up

ervi

sion

Str

ateg

y

3.1

. Tra

inin

g fo

rp

rofe

ssio

nal

s

3.2

Tra

inin

g fo

r ca

rep

erso

nn

el

3.3.

Tra

inin

g fo

rel

der

ly r

elat

ives

3.4.

Tra

inin

g fo

rel

der

ly p

eop

le

3.1.

1. P

rovi

sion

of

trai

nin

gs f

or p

rofe

ssio

nal

s

-In-

serv

ice

trai

ning

-Cer

tifi

cate

trai

ning

on

long

-ter

m e

lder

ly a

ndel

derl

y pa

tien

t

3.2.

1. P

rovi

sion

of

trai

nin

gs f

or c

are

per

son

nel

-In-

serv

ice

trai

ning

-Cer

tifi

cate

trai

ning

on

long

-ter

m e

lder

ly a

ndel

derl

y pa

tien

t

3.3.

1. P

rovi

sion

of

trai

nin

g fo

r el

der

lyre

lati

ves

-Bio

-psy

chol

ogic

al c

hara

cter

isti

cs a

nd p

robl

ems

of o

ld a

ge

-Com

mun

icat

ion

wit

h el

derl

y

-Tra

inin

g of

eld

erly

dis

ease

s

- Aw

aren

ess

trai

ning

rel

ated

to b

io-p

sych

olog

ical

char

acte

rist

ics

and

prob

lem

s of

old

age

of

elde

rly

rela

tive

that

pro

vide

car

e se

rvic

es

-Tra

inin

g fo

r el

derl

y re

lati

ves

cari

ng f

or a

pat

ient

wit

h de

men

tia

-Reh

abil

itat

ion

of e

lder

ly r

elat

ives

car

ing

for

apa

tien

t wit

h de

men

tia

3.4.

1. T

rain

ing

for

eld

erly

peo

ple

- T

rain

ing

for

crea

ting

aw

aren

ess

of o

ld a

ge in

the

elde

rly

and

impr

ovin

g th

e aw

aren

ess

-Tra

inin

g fo

r el

derl

y on

eld

erly

dis

ease

s

-Tra

inin

g fo

r el

derl

y on

thei

r ow

n ri

ghts

and

pati

ent r

ight

s

-Tra

inin

g fo

r el

derl

y on

hea

lth

and

acti

ve a

ging

proc

ess,

and

ens

urin

g th

at N

GO

’s ta

kere

spon

sibi

lity

wit

hin

the

fram

ewor

k of

info

rmat

ion

and

stan

dard

izat

ion

for

all t

rain

ing

prog

ram

s in

whi

ch tr

aini

ng f

or e

lder

ly o

n he

alth

and

acti

ve a

ging

pro

cess

wil

l be

prov

ided

1. I

ncre

ase

in th

eed

ucat

iona

l lev

el o

f st

aff

serv

ing

in h

ealt

h ca

repr

ovid

ing

inst

itut

ions

2. I

ncre

ase

in th

e nu

mbe

r of

cert

ifie

d st

aff

3.D

ecre

ase

in b

urno

ut o

fth

e st

aff

who

hav

e be

enw

orki

ng in

long

-ter

m h

ealt

hca

re p

rovi

ding

inst

itut

ions

4.

Dec

reas

e in

bur

nout

of

elde

rly

rela

tive

s5.

Incr

ease

in s

ocia

lpa

rtic

ipat

ion

of e

lder

ly

6. I

ncre

ase

in c

ontr

ibut

ion

of e

lder

ly to

thei

r ow

ndi

seas

e an

d tr

eatm

ent

proc

ess

7. E

stab

lish

men

t of

stan

dard

izat

ion

of th

etr

aini

ng to

be

prov

ided

by

NG

O’s

8. Q

uali

ty in

dica

tors

9.S

atis

fact

ion

surv

eys

ofth

ose

(eld

erly

and

eld

erly

rela

tive

s) w

ho r

ecei

vese

rvic

e fr

om lo

ng-t

erm

car

epr

ovid

ing

inst

itut

ions

10

. Pre

- an

d po

st-

asse

ssm

ent s

urve

ysqu

esti

ons

of p

erso

nnel

trai

ning

11. S

atis

fact

ion

surv

eys

ofth

e pe

rson

nel s

ervi

ng in

long

-ter

m c

are

prov

idin

gin

stit

utio

ns

1. I

ncre

ase

in q

uali

tyof

car

e 2.

Inc

reas

e in

the

sati

sfac

tion

leve

l of

care

are

as3.

Mor

e w

illi

ngly

and

effi

cien

tly

wor

k of

the

pers

onne

l who

wor

k in

long

-ter

m h

ealt

h ca

repr

ovid

ing

inst

itut

ions

4. H

ealt

hier

com

mun

icat

ion

wit

hel

derl

y5.

Inc

reas

e in

pub

lic

awar

enes

s on

eld

erly

proc

ess

6. R

educ

tion

of

com

plic

atio

ns r

elat

edto

dis

ease

and

prob

lem

s re

late

d to

trea

tmen

t of

elde

rly

7. E

nsur

ing

the

unit

yin

all

type

s of

trai

ning

to b

e pr

ovid

ed8.

Adv

ance

men

t in

pers

onne

l sca

les

tow

ards

pal

liat

ive

care

1.M

inis

try

of F

amil

y an

d S

ocia

l Pol

icie

s 2.

Min

istr

y of

Hea

lth

3.U

nive

rsit

ies

4. N

GO

Per

iodi

c

Act

ivit

ies

Ou

tpu

t In

dic

ator

sR

esu

lt I

nd

icat

ors

Per

iod

Res

pon

sib

le I

nst

itu

tion

and

Org

aniz

atio

n


120

2. MONITORING AND EVALUATION

Objective

Monitoring and evaluation of the process and outputs of Turkey Healthy Aging Action Plan and

Implementation Program 2015-2020 and procurement of evidence-based scientific data for reporting this

Target

Establishment of a national data system to monitor, evaluate and report Turkey Healthy Aging Action Plan

and Implementation Program 2015-2020

Strategies

1. Evaluation of Turkey Healthy Aging Action Plan and Implementation Program 2015-2020 shall be

carried out in 2021 and an evaluation report shall be issued

2. Annual progress report of Turkey Healthy Aging Action Plan and Implementation Program 2015-2020

shall be issued

3. Determination the current situations of the persons benefitting from the services and the outputs related

to the service provided by taking into consideration the priority target group (persons in need of special

care due to physical, mental, social or economic conditions) in data analysis of elderly health care services

to be provided within the scope of Turkey Healthy Aging Action Plan and Implementation Program 2015-

2020

4. Establishment of a national data system and formation of a data flow system model through reporting

in our Institution Presidency in order to monitor, evaluate and report the process and outputs of Turkey

Healthy Aging Action Plan and Implementation Program 2015-2020


121

TA

RG

ET

SS

HO

RT

TE

RM

(1

YE

AR

)M

ED

IUM

TE

RM

(2

YE

AR

S)

LO

NG

TE

RM

(4

YE

AR

S)

1. 1

. Im

pro

vem

ent

of L

ifel

ong

Hea

lth

an

d H

ealt

hy

Agi

ng

1.2.

Im

pro

vem

ent

of E

xerc

ise,

Ph

ysic

al A

ctiv

ity

and

Reh

abil

itat

ion

Ser

vice

s fo

rE

lder

ly

Imp

rove

men

t of

hea

lth

yli

fest

yle

in t

he

eld

erly

an

dth

e so

ciet

y

Cre

atio

n o

f k

now

led

ge le

vel

and

soc

ial a

war

enes

s in

incr

easi

ng

ph

ysic

al a

ctiv

ity

and

pre

ven

tin

g se

den

tary

life

styl

e fo

r h

ealt

hy

agin

g

��


122

TA

RG

ET

SS

HO

RT

TE

RM

(1

YE

AR

)M

ED

IUM

TE

RM

(2

YE

AR

S)

LO

NG

TE

RM

(4

YE

AR

S)

1.3.

Im

pro

vem

ent

ofH

ome

Car

e S

ervi

ces

inte

nd

ed f

or t

he

eld

erly

1. D

evel

opm

ent

of S

tate

Hom

e C

are

Mod

el

2. I

mp

rove

men

t of

Hom

eC

are

Ser

vice

s

3. D

isse

min

atio

n o

f H

ome

Car

e S

ervi

ce

4. I

mp

rove

men

t of

th

ele

gisl

atio

n r

elat

ed t

o h

ome

care

5. I

mp

rove

men

t of

Hom

e C

are

Rei

mb

urs

emen

t (F

un

din

g)

6. M

eeti

ng

Ed

uca

tion

al N

eed

s of

Hom

e C

are

Per

son

nel

(h

ealt

h a

nd

soci

al)

and

Dev

elop

ing

Em

plo

ymen

t P

olic

ies

� � ��


123

��

�

��

�

�

� �

TA

RG

ET

SS

HO

RT

TE

RM

(1 Y

EA

R)

ME

DIU

M T

ER

M

(2 Y

EA

RS

)L

ON

G T

ER

M

(4 Y

EA

RS

)

1.4.

Im

pro

vem

ent

of H

ealt

hC

are

for

Eld

erly

an

d E

nsu

rin

gF

ull

Acc

ess

to H

ealt

h C

are

Ser

vice

for

th

e el

der

lyin

div

idu

als

1.5.

Im

ple

men

tati

on o

f P

lan

san

d A

ctiv

itie

s on

th

e S

ub

ject

of

Neu

rop

sych

iatr

ic D

isor

der

s,D

emen

tia,

Ger

iatr

icP

sych

iatr

y, D

isab

ilit

y, A

bu

se o

fE

lder

ly a

nd

Vio

len

ce in

Old

Age

1. I

mp

rove

men

t of

Hea

lth

Car

e fo

r E

lder

ly

2. E

nsu

rin

g F

ull

Acc

ess

to H

ealt

h C

are

Ser

vice

3. I

mp

rove

men

t of

Wel

fare

1. E

nsu

rin

g p

rovi

sion

of

the

nec

essa

ry c

oop

erat

ion

of

all o

f th

e re

leva

nt

inst

itu

tion

s an

d p

rep

arin

g th

eco

nd

itio

ns

req

uir

ed f

or t

he

eld

erly

to

rece

ive

the

mos

t ef

fect

ive,

acc

ura

te a

nd

com

pet

ent

serv

ice

in t

he

dia

gnos

is a

nd

tre

atm

ent

of n

euro

psy

chia

tric

dis

ord

ers

2. T

akin

g n

eces

sary

mea

sure

s an

d p

erfo

rmin

gre

hab

ilit

atio

n t

o p

reve

nt,

dia

gnos

e an

d e

lim

inat

ed

isab

ilit

y re

sult

ing

from

neu

rop

sych

iatr

ic d

isor

der

sin

th

e el

der

ly

3. T

akin

g n

eces

sary

mea

sure

s to

pre

ven

t an

d id

enti

fyab

use

of

the

eld

erly

inte

nd

ed f

or c

omm

un

ity,

fam

ilie

san

d in

stit

uti

ons


124

� � � � �

TA

RG

ET

SS

HO

RT

TE

RM

(1 Y

EA

R)

ME

DIU

M T

ER

M

(2 Y

EA

RS

)L

ON

G T

ER

M

(4 Y

EA

RS

)

1. C

reat

ing

awar

enes

s in

com

mu

nit

y an

d a

ll h

ealt

h c

are

pro

fess

ion

als

abou

t ac

ute

car

e an

d e

mer

gen

cy s

ervi

ces

inge

riat

rics

2. E

nsu

rin

g to

incr

ease

th

e q

ual

ity

of e

mer

gen

cy h

ealt

hse

rvic

es p

rovi

ded

for

th

e el

der

ly a

nd

to

con

du

ct t

hes

ew

ith

in t

he

fram

ewor

k o

f ac

cess

ibil

ity

and

eff

icie

ncy

pri

nci

ple

s

3. P

rovi

sion

of

trai

nin

gs r

elat

ed t

o th

e d

iffe

ren

ces

inem

erge

nce

, dia

gnos

is a

nd

tre

atm

ent

of t

he

acu

teco

mp

lica

tion

s of

ch

ron

ic d

isea

ses

in t

he

eld

erly

, an

des

tab

lish

men

t of

sta

nd

ard

izat

ion

tow

ard

s ap

pro

ach

es t

oth

e ge

riat

ric

pat

ien

ts

4. E

nsu

rin

g th

at t

he

geri

atri

c p

atie

nts

ad

mit

ted

to

emer

gen

cy s

ervi

ce c

an a

cces

s to

hea

lth

reg

istr

atio

n

5. P

reve

nti

ng

un

nec

essa

ry d

rug

use

in g

eria

tric

pat

ien

tsan

d e

nsu

rin

g ef

fect

ive

dru

g u

se

1.6.

En

suri

ng

Org

aniz

atio

n o

f Acu

teC

are

and

Em

erge

ncy

Ser

vice

s in

Ger

iatr

ics


125

� � �

TA

RG

ET

SS

HO

RT

TE

RM

(1 Y

EA

R)

ME

DIU

M T

ER

M

(2 Y

EA

RS

)L

ON

G T

ER

M

(4 Y

EA

RS

)

1. P

rom

otio

n o

f n

atio

nal

ger

iatr

ic d

iagn

osis

an

dtr

eatm

ent

guid

elin

es

2. E

nsu

rin

g th

e p

olic

ies

for

rati

onal

use

of

med

icin

es in

the

eld

erly

3. D

eter

min

ing

the

pro

ble

ms

rela

ted

to

the

pro

per

dia

gnos

is o

f el

der

ly d

isea

ses

4. E

nsu

rin

g th

e re

sear

ches

for

dia

gnos

is a

nd

tre

atm

ent

ofth

e d

isea

ses

affe

ctin

g el

der

ly

5. E

nsu

rin

g so

luti

ons

for

reim

bu

rsem

ent

pro

ble

ms

ind

iagn

osis

, tre

atm

ent

and

fol

low

-up

6. E

nsu

rin

g th

e d

evel

opm

ent

of d

iagn

osis

an

d t

reat

men

tw

ith

pos

tgra

du

ate

trai

nin

gs

7. E

nsu

rin

g ge

riat

ric

asse

ssm

ent

in a

com

pre

hen

sive

way

by

spar

ing

tim

e

1.7.

En

suri

ng

the

Pro

per

and

Eff

ecti

veF

un

ctio

nin

g of

Dia

gnos

is, T

reat

men

t,M

onit

orin

g S

ervi

ces

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ld A

ge

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126

� � ��

TA

RG

ET

SS

HO

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EA

R)

ME

DIU

M T

ER

M

(2 Y

EA

RS

)L

ON

G T

ER

M

(4 Y

EA

RS

)

1. I

ncl

ud

ing

the

edu

cati

on o

f ge

riat

rics

an

d g

eron

tolo

gy in

th

ecu

rric

ula

of

med

ical

fac

ult

ies

2. E

nsu

rin

g th

e p

rese

nce

of

the

qu

alif

ied

med

ical

per

son

nel

pro

vid

ing

serv

ices

to

the

eld

erly

3. P

rom

otio

n o

f s

ub

-sp

ecia

liza

tion

in g

eria

tric

s

4. O

rgan

izin

g ge

riat

ric

trai

nin

g in

ten

ded

for

pri

mar

y h

ealt

h c

are

ph

ysic

ian

s

5. O

rgan

izin

g ge

riat

ric

trai

nin

g fo

r h

ealt

h c

are

pro

fess

ion

als

(ph

ysic

ian

s, g

eria

tric

ian

s, g

eria

tric

nu

rse,

soc

ial w

ork

er, d

ieti

tian

,p

sych

olog

ist,

ph

ysio

ther

apis

t, o

ccu

pat

ion

al t

her

apis

t) s

ervi

ng

the

eld

erly

6. O

rgan

izin

g th

e tr

ain

ing

of t

he

care

give

rs s

ervi

ng

the

eld

erly

,ap

art

from

hea

lth

car

e p

rofe

ssio

nal

s (p

hys

icia

ns,

ger

iatr

icia

ns,

geri

atri

c n

urs

e, s

ocia

l wor

ker

, die

titi

an, p

sych

olog

ist,

ph

ysio

ther

apis

t, o

ccu

pat

ion

al t

her

apis

t)

7. E

nsu

rin

g th

e ra

tion

al u

se o

f m

edic

ine

in t

he

eld

erly

8. R

aisi

ng

awar

enes

s of

hea

lth

agi

ng

in t

he

eld

erly

9. C

erti

fyin

g th

e h

ealt

h c

are

pro

fess

ion

als

serv

ing

the

eld

erly

10. D

isse

min

atin

g ef

fect

ive

team

wor

k

1.8.

Arr

ange

men

tof

Tra

inin

g of

Hea

lth

Car

eP

rofe

ssio

nal

s an

dH

ealt

h C

are

Pro

vid

ers

�


127

�

TA

RG

ET

SS

HO

RT

TE

RM

(1 Y

EA

R)

ME

DIU

M T

ER

M

(2 Y

EA

RS

)L

ON

G T

ER

M

(4 Y

EA

RS

)

1. G

ain

ing

hea

lth

y n

utr

itio

n h

abit

s to

all

age

gro

up

su

nti

l th

e ol

d a

ge p

erio

d

2. P

reve

nti

on o

f m

aln

utr

itio

n in

th

e el

der

ly a

nd

imp

lem

enta

tion

of

effe

ctiv

e tr

eatm

ent

for

mal

nu

trit

ion

3. D

evel

opm

ent

of T

urk

ey-s

pec

ific

nu

trit

ion

pol

icie

sfo

r th

e in

div

idu

als

over

65

year

s of

age

4. E

nsu

rin

g su

ffic

ien

t an

d b

alan

ced

die

t in

th

eel

der

ly

5. E

stab

lish

men

t of

cli

nic

al n

utr

itio

n t

eam

s in

hos

pit

als

and

iden

tifi

cati

on o

f se

rvic

e ar

eas

of t

hes

ete

ams

in C

omm

un

iqu

é of

Hea

lth

Ap

pli

cati

on (

CH

A)

6. E

du

cati

on o

f al

l hea

lth

car

e p

rofe

ssio

nal

s ab

out

hea

lth

nu

trit

ion

pri

nci

ple

s an

d s

up

por

ts

1.9.

Pro

visi

on o

f S

uff

icie

nt

Nu

trit

ion

an

d A

cces

s to

Foo

dP

rod

uct

for

th

e E

lder

ly

� �

�

� �


128

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TA

RG

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RT

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(2 Y

EA

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)L

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G T

ER

M

(4 Y

EA

RS

)

1. G

eria

tric

, ger

onto

logi

cal m

ult

idis

cip

lin

ary

and

inte

rdis

cip

lin

ary

app

roac

h

2. H

olis

tic

app

roac

h t

owar

ds

pre

ven

tive

, pro

tect

ive,

dia

gnos

tic

and

th

erap

euti

c fo

llow

-up

an

dre

hab

ilit

atio

n

3. S

tan

dar

diz

atio

n in

ed

uca

tion

an

d s

up

ervi

sion

1.10

. Pro

visi

on o

f L

ong-

Ter

mH

ealt

h C

are

in G

eria

tric

s an

dF

ull

Acc

ess

to C

are

Ser

vice

s�

�


129

3. IMPLEMENTATION MODEL OF PROGRAM

Organization

Health Ministry Undersecretary is responsible for performing Turkey Healthy Aging Action Plan &Implementation Program on behalf of Minister of Health. Executive Board is responsible for performingthis plan to Ministry of Health.

General Assembly

General Assembly, comprised of the representatives of all participants, meets twice a year. Studygroups evaluate action plans, discuss study reports and activities submitted by Executive Board andexpress opinions on these. Meeting date, place and agenda of General Assembly are determined byExecutive Board and organized by Secretariat.

Executive Board

Executive Board is responsible for management of the program and determination of generalstrategies. It examines the proposals prepared by study groups before they are discussed in GeneralAssembly and submits these to General Assembly. Executive Board meets twice a year. Meeting date,place and agenda are determined by Executive Board and organized by Secretariat. Executive Board electsits chairman and vice chairman in itself. Duty terms of chairman and vice chairman are a period of twoyears and this can be performed for a maximum of two terms. Executive Board is comprised of chairmenand secretaries of study groups, Ministry of Health Turkish Public Health Institution, Vice Chairman ofNon-communicable Diseases, Programs and Cancer, Director of Chronic Diseases, Elderly Health andDisabled People Department and one representative each determined by the other relevant units.

Study Groups

These are the groups which are established according the program targets and are comprised ofGeneral Assembly members in accordance with their missions. Every Study Group prepares proposals inorder for the relevant studies related to their areas specified in the actions plans to be carried out, evaluatedand improved, submits these to Executive Board, and carries out the approved activities. It meets at leasttwice a year. Meeting date, place and agenda are determined by Executive Board and organized bySecretariat.

It prepares annual reports, which include the results of their studies, to submit to General Assembly.Chairmen and secretaries of Study Groups are elected by the group for a period of two years.

Public Health Directorate

Chronic disease units of each province and province program responsible to be determined shall beresponsible for the execution of action plan and implementation program activities in provinces and itscoordination within the province. Province program responsible or representatives are the natural memberof General Assembly.

Secretariat

Secretarial service is carried out by Ministry of Health, Turkish Public Health Institution, Head ofDepartment of Chronic Diseases, Elderly Health and Disabled People.


130

ORGANIZATION OF TURKEY HEALTHY AGING ACTION PLAN ANDIMPLEMENTATION PROGRAM

Action Plan and ImplementationProgram General Assembly

Study GroupsExecutive

BoardTurkish Public

Health Institution

ProvincialCommittees


131

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136

5. APPENDIXES

APPENDIX 1. CONTRIBUTING PUBLIC INSTITUTIONS AND ORGANIZATIONS

(In Alphabetical Order)

Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital

Ankara Metropolitan Municipality

Ankara Provincial Health Directorate

Ankara Training and Research Hospital

Çankaya Municipality

Ministry of Development, Turkish Statistical Institute

Ministry of Development, General Directorate of Social Sectors and Coordination

Ministry of Family and Social Policies, General Directorate of Disabled People and Elderly Services

Ministry of Finance

Ministry of Health

- General Directorate of Emergency Medical Services

- General Directorate of Health Research

- General Directorate of Health Information Systems

- General Directorate of Health Promotion

- Directorate General of Health Services

- Pharmaceuticals and Medical Devices Agency of Turkey

- Turkish Public Health Institution

- Public Hospitals Authority of Turkey

Ministry of Labour and Social Security, Department Social Security Institution

Ministry of National Education


137

APPENDIX 2. CONTRIBUTING UNIVERSITIES

Ankara University

Başkent University

Bilgi University

Gülhane Military Medical Academy (GATA)

Hacettepe University

İstanbul University

Marmara University

Mustafa Kemal University

Sütçü İmam University


138

APPENDIX 3. CONTRIBUTING NON-GOVERNMENTAL ORGANIZATIONS


Academic Geriatrics Society Association of Emergency Physicians

Association of Geriatric Physiotherapists

Association of Public Health Specialist (HASUDER)

Association of Public Health Specialist

Elderly Platform

Family Physicians Association of Turkey Federation of Family Physicians Associations

Home Care Association

Infectious Diseases and Clinical Microbiology Specialist Association of Turkey (EKMUD)

National Association of Social and Applied Research for Gerontology

Psychiatric Association of Turkey

Turkish Alzheimer Association

Turkish Association of Internal Medicine Specialists

Turkish Geriatrics Society

Turkish Medical Association

Turkish Neurological Society

Turkish Nurses Association

Turkish Psychologists Association


139

APPENDIX 4. CONTRIBUTING PERSONS


Federation of Family Physicians Associations

Psychiatric Association of Turkey

Elderly Platform

Social Security Institution, Department of General HealthInsurance and Health Services

Academic Geriatrics Society


Hacettepe University, Faculty of Medicine, Department ofPublic Health

Turkish Nurses Association, Elderly Platform


Association Geriatric Physiotherapist

Malatya Public Health Directorate

Hacettepe University Faculty of Letters, Department ofSociologyInfectious Diseases and Clinical Microbiology SpecialistAssociation of Turkey

Social Security Institution

Ankara Metropolitan Municipality

Turkish Geriatrics Society

Hacettepe University, Faculty of Health Science,Association of Physiotherapy and Rehabilitation, GeriatricPhysiotherapy

Turkish Psychologists Association

Ankara Dr. Abdurrahman Yurtaslan Oncology Training andResearch Hospital

Academic Geriatrics Society, Hacettepe University, Facultyof Medicine, Geriatric Unit


Elderly Platform

Ministry of Health, Turkish Public Health Institution,Department of Infectious Diseases

Family Physicians Association of Turkey


Phys. Mehmet AKÇA

Asst. Prof. Özlem Erden AKİ

Phys. İmatullah AKYAR

Phys. Banu ALBAYRAK

MD. Sevgi ARAS

Dr. Engin M. ARDOĞAN

Prof. Dr. Dilek ASLAN

Att.Nurse Güler DURU AŞİRET

Prof. Dr. Teslime ATLI

DPT Çiğdem AYHAN

Sociologist Meltem SEVEN

Prof. Dr. Aylin GÖRGÜN BARAN

Asst. Prof. Nurcan BAYKAM

Pharm. Mine BİLGE

SW. Salim BİRDİR

Asst. Prof. Pınar BORMAN

Prof. Dr. Filiz CAN

Prof. Dr. Banu CANGÖZ

Asst. Prof. Eylem ŞAHİN CANKURTARAN

Prof. Dr. Mustafa CANKURTARAN

Phys. İrem ÇAPRAZ

Asst. Prof. Sevilay Şenol ÇELİK

MD. Serap ÇETİN ÇOBAN

Asst. Prof. Serap ÇİFÇİLİ

Prof. Dr. Nesrin ÇİLİNGİROĞLU


140

Ministry of Health Turkish Public Health Institution, Divisionof Chronic Diseases, Disabled People and Elderly Health


Ministry of Health, Turkish Public Health Institution


Society of Clinical Parenteral Enteral Nutrition


Society of Clinical Microbiology and Infectious Diseasesof Turkey

Gülhane Military Medical Academy

Hacettepe University Faculty of Economics andAdministrative Sciences, Department of Social Services



Hacettepe University Faculty of Health Sciences,Department of Nursing




Ankara, Çankaya Municipality

Turkey Alzheimer's Association

Ministry of Health, General Directorate of ManagementServices

Retired



Turkish Nurses Association, Elderly Platform

Ministry of Family and Social Policies, GeneralDirectorate of Disabled People and Elderly Services


Geriatric Physiotherapy Association


Ministry of Health Turkish Public Health Institution, Departmentof Chronic Diseases, Disabled People and Elderly Health

Med. Tech. Nevin ÇOBANOĞLU

Prof. Dr. Aslı ÇURGUNLU

Rsr. İsmet DEDE

Pharm. Arıkan DEMİR

Asst. Prof. Kubilay DEMİRAĞ

Pharm. Güzin DİKMEOĞLU

MD. Başak DOKUZOĞUZ

Asst. Prof. Hüseyin DORUK

PhD. Bilge ÖNAL DÖLEK

MD. Alper DÖVENTAŞ

Res. A. Kadir EKİNCİ

MD. Banu EKİNCİ

Prof. Dr. Oya Nuran EMİROĞLU

Asst. Prof. Nüket PAKSOY ERBAYDAR

Prof. Dr. Deniz Suna ERDİNÇLER

Phys. Utku ERSÖZLÜ

Dt. Vildan ESEN

Selami GEDİK

Rsr. Ertuğrul GÖKTAŞ

Med.Tech. Ayşe GÜNDOĞAN

Asst. Prof. Meltem HALİL

Phys. İlhan Kadri KAHVECİ

Asst. Prof. Sevgisun KAPUCU

PhD. Yaprak KARAKOÇ

Prof. Dr. Yahya KARAMAN

Dr. Physiotherapist İlke KESER

Prof. Dr. Nuray KIRDI


141



Hacettepe University, Faculty of Health Sciences,Department of Nursing




Ministry of Health, Public Hospitals Authority of Turkey


Marmara University, Faculty of Medicine, Department ofPublic Health

Ministry of Health, General Directorate of Health Services

Association of Emergency Physicians

Home Care Association

Ministry of Finance

Hacettepe University, Faculty of Health Sciences,Department of Nursing, Division of Internal MedicineNursing





Ministry of National Education

Hacettepe University Faculty of Health Sciences,Department of Nutrition and Dietetics


National Social and Applied Research Association forGerontology

Turkish Medical Association

Association of Physical Medicine and RehabilitationSpecialist Physicians of TurkeyMinistry of Family and Social Policies, General Directorateof Disabled People and Elderly Services

Ministry of Health, General Directorate of Health Services

Pharm. Sevinç KIRDÖK

MD. Tuğba Erguvan KIZIL

Hülya KULAKÇI

Prof. Dr. Işıl

Asst. Prof. Zuhal KUNDURACILAR

Fügen KURAL

Dep.Mgr. Emine KURTLUK

Med.Asst. Aziz KÜÇÜK

Prof. Dr. Işıl MARAL

MD. Cevriye Karaca MÜLKOĞLU

Asst. Prof. Mehmet OKUMUŞ

Mehmet ONARCAN

Exp. Kenan ÖZCAN

Asst. Prof. Leyla ÖZDEMİR

S.Physio. Reyhan ÖZGÖBEK

MD. Gülistan Bahat ÖZTÜRK

DPCO Bekir PAKSOY

MD. Emel PEKÇETİN

Halil POLAT

Prof. Dr. Neslişah RAKICIOĞLU

Asst. Prof. Bülent SAKA

Zinnur SARIÖZ

Asst. Prof. Meral SAYGUN

Asst. Prof. Nebahat SEZER

SW. Gülay SEZGİN

MD. Peri SOHRABİ

BARAL

KULAKSIZOĞLU


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Association of Public Health Professionals

Mustafa Kemal University, Hatay Medical Vocational School

Ministry of Development, Turkish Statistical Institute

Family Physicians Association of Turkey

Hacettepe University, AIDS Treatment and ResearchCentreMinistry of Health Turkish Public Health InstitutionDepartment of Diabetes, Obesity and Metabolic Diseases

Association of Public Health Specialist

Hacettepe University Faculty of Health Sciences,Department of Physiotherapy and Rehabilitation



Ministry of Health Turkish Public Health InstitutionDepartment of Diabetes, Obesity and Metabolic Diseases

Ankara Training and Research Hospital



Ministry of Development, General Directorate of SocialSectors and Coordination

RD. Meltem SOYLU

Pharm. Meltem ŞAHİN

MD. Sevnaz ŞAHİN

Prof. Dr. Türker ŞAHİNER

Phys. Hatice ŞİMŞEK

PhD. Hatice TAMBAĞ

Exp. Meltem TAN

MD. Nil TEKİN

MD. Aygen TÜMER

Diet. Cansel TÜTÜNCÜOĞLU

Prof. Dr. Reyhan UÇKU

Prof. Dr. Mine UYANIK

MD. Zekeriya ÜLGER

MD. Murat VARLI

Asst. Prof. Nazan YARDIM

MD. Burcu BALAM YAVUZ

MD. Yusuf YEŞİL

Emine YILDIZ

Asst.Exp. Tarık YILMAZ

yaşlanma eylem planı:mizanpaj 1...2015-2020 ”, “republic of turkey ministry of health,...

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