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The ageing population as a challenge for the healthcare system


Introduction

 

Until recently, old age was attributed to a relatively small fraction of the population and, as a result, little attention was paid to the needs of older people. Increased life expectancy has improved the number of older people in the general population. However, increased life expectancy does not automatically mean increased years of life in good health condition, since health problems hindering independent life intensify with age and as a result, the need for health services increase. The health problems of older people are a consequence of the ageing process. The causes of old age are to be found in the biological properties of the body, which with the passage of time reduces its capacity or loses particular functions. It is difficult to identify the moment when the old age of a person begins, entering old age is an individual matter. It is accepted that the old age begins when a person reaches retirement age, in Poland it is the age of 65. At the same time, the group of elderly people is not homogenous in terms of age, health condition or ability to function independently. The aim of the present study is to outline the challenges that arise from the increased need for health services and to present the implications of the ageing process for the health care system in Poland.

 

Population ageing

 

Population ageing is clearly observable in welfare societies around the world. The process of population ageing is considered as an increase in the number of elderly people in the total number of citizens with a simultaneous decline in fertility rates; it is the result of a number of interdependent factors, among which the main ones are: increased life expectancy, negative natural growth, increased emigration and lack of immigration. All these factors lead to a change in the demographic structure of society, which generates a number of serious problems and threats in almost all aspects of life, affecting the economy, the health care system, social security, social assistance, intergenerational relations, even state security. Therefore, the ageing process has become one of the most important problems of the 21st century in Europe and in Poland. In 2023, more than one-fifth of the continent's population (21.3%) was over the age of 65[1]. Currently, Polish society is one of the demographically youngest in Europe; however, the dynamics of ageing is the fastest among remaining European countries and according to demographic forecasts, in 2060 it will become one of the demographically oldest societies. Additionally, Poland's population is progressively declining, which will only deepen the demographic crisis.

 

World Health Organisation analyses indicate that the share of the population aged 60 years and over will increase from 1 billion in 2020 to 1.4 billion in 2030, while by 2050 this group will almost double to 2.1 billion[2]. Similar analyses carried out for Poland indicate that the population aged 60 years and over will increase to almost 11 million in 2030, and in 2050 Poland will become one of the European countries with the highest old-age ratio, which will double to almost 40% of the total population, meaning that the number of elderly people will be almost 13.7 million[3]. Data collected during the National Population and Housing Census conducted in 2021 shows that elderly people over 60 years of age, currently make up about 26% of Poland's population, which in absolute numbers means almost 10 million[4]. It is important to point out that between 2011 and 2021, the share of the population in the post-working age increased significantly - from 16.9% in 2011 to 21.8% in 2021, which means that just in a decade more than a million people aged 60 and over have become a part of the population. Poland's fertility rate, which refers to the number of children per woman of childbearing age, is also alarming. It is on a downward trend in Poland with a fertility rate of 1.261 in 2022 (it was 1.320 in 2021)[5]. Meanwhile, a low fertility rate only accelerates the ageing of society, as fewer children - future adults - are born, which does not ensure the natural replacement of generations.

 

Consequences of population ageing

 

Population ageing increases the costs of the state functioning, especially the health care and social security systems. The dynamic increase in the number of elderly people and the simultaneous decline in the total population result in the fact that the state’s budget income is decreasing while the need for treatment, care and rehabilitation is increasing. Additionally, an increase in the need for professional medical and care staff capable of meeting the health needs of the elderly should also be taken into account. It is obvious that older people are subjected to a greater risk of many chronic illnesses, which results in a reduced ability to live independently. In terms of the incidence of chronic diseases by people over 65, Poland is at the bottom of the list of all countries in the European Union. According to the report “Health at a Glance: Europe 2020,” as many as 58% of the elderly in Poland suffer from chronic diseases, far exceeding the EU average of 37%[6].

 

One of the main health problems of older people is multimorbidity, which along with the presence of atypical symptoms in the course of many diseases, makes diagnosis and treatment much more difficult. It is estimated that among people over 65 years of age, about 80% of them suffer from at least one somatic disease. The most common diseases of old age include diseases of the cardiovascular system, the osteoarticular system, the respiratory system, the digestive system and neurodegenerative diseases (especially Alzheimer's or Parkinson's disease). Furthermore, changes in sensory perception resulting from impaired hearing and vision can be a cause of depression and psychiatric disorders. Cancer is also a problem associated with ageing process as the age is a serious risk factor for this type of disease. The variety of health problems forces people to seek help from many different specialists, which increases the number of medicines they take. Each specialist treats the patient for a different condition and prescribes further medication. This not only reduces the effectiveness of treatment, but can also damage further organs and systems. The lack of coordinated and holistic care for the elderly patient makes such a treatment ineffective; moreover, it is often the cause of worsening of the health condition and the need of re-hospitalisation[7], which only increases the costs of maintaining the health care system. Elderly people with multimorbidity require a special approach, characterized by comprehensive diagnosis of all diseases and implementation of simultaneous treatment of all disease diagnoses.

 

The way of diagnosing and treating the elderly is significantly important due to the constant reduction of incomes to the National Health Fund (the body responsible for financing common health care services) and the consequent reduction of expenses on health care services due to the process of shifting the population from the working age group to the post-working age group, which results in a decrease in the number of people paying health insurance payments and maintaining the health care system. Currently, the health care system in Poland is not adapted to the health needs and expectations of the elderly, both in terms of organisation, infrastructure and staff.

 

Attempts to improve the health care system

 

Providing effective health care for the elderly is currently the greatest challenge for the state, which is obliged to provide citizens with equal access to health care services financed from public funds, including the provision of special health care to the elderly and persons with disabilities (Article 68(2-3) of the Constitution of the Republic of Poland of 2 April 1997).

 

Preventing the demographic crisis and limiting the negative consequences of the ageing of society requires undertaking systemic reforms, first of all, the creation of a system supporting fertility, e.g. through an appropriately designed tax system, labour law (providing for flexible working time, remote job), development of the infrastructure supporting families with children (nurseries, kindergartens), simultaneously facilitating the participation of family members in the labour market. It is also necessary to take measures increasing professional activity by limiting unemployment and the underground economy and extending the period of professional activity, which, however, requires the creation of a two-dimensional system of incentives, on the one hand for employers to employ such people, and on the other hand for employees, convincing them to delay the moment of leaving the labour market.

 

The phenomenon of population ageing should undoubtedly be regarded as a civilisational achievement, which has exposed the huge potential of older people but still not fully exploited. However, the engagement of older people depends on their physical and mental condition. Physical activity has a beneficial effect on physical condition and on slowing down the effects of ageing, which reduces the need of older people for health services and prolongs their independence, reducing the dependence of older people on younger generations. In other words, the longer older people remain in good health, the longer they will be able to work and, consequently, the longer they will be able to contribute to the country's economic growth. This, consequently, will ensure the financing of health services as older people are the main consumers, at least at the current level. Longer activity, especially professional activity, protects against poverty and, on a broader scale, reduces income redistribution in favour of the elderly. It is also worth taking care of prevention, which, alongside the health care, is a key element in the lives of older people. This is because even the largest investment in the health care system, targeted at medical measures, will not bring the expected benefits in terms of improving the health of the population if preventive measures are not implemented. Prevention is the key to a long and healthy life. A condition for this is health education, raising awareness of healthy lifestyles, financial planning for the future or understanding the importance of physical and social activity. Properly formed habits and an active lifestyle have a huge impact on everyone's health, especially in old age. This can contribute to a decrease in the need for health services by older people.

 

It is significant to develop several issues such as a coordinated and comprehensive pattern of care for the elderly, cooperation between the health and the social welfare sectors and organising appropriately prepared medical staff. Health care services provided to the elderly are uncoordinated and allocated; therefore, the burden of caring for the elderly, who are often dependent and suffer from multiple diseases and disabilities, has been passed on the immediate family, which, however, is not guaranteed sufficient medical and financial support. As a result, family members of the elderly person need to reorganise their performed functions and therefore, they often reduce or even end their professional activity, which only expands the scale of the problem.

 

The increasing demand of older people for health services means not only the need to reorganize the health care system, but also to develop geriatric care. Diagnosis and treatment of the elderly should be based on a comprehensive geriatric assessment, which should assess performance in activities of daily living, instead of being diagnosed and treated simultaneously by several different specialists who do not cooperate with each other. This approach would be much more beneficial for the patient and, at the same time, much cheaper for the health care system. Currently, geriatric care in Poland does not meet basic standards such as accessibility, universality, comprehensiveness and quality of health services provided. This is indicated both by the small number of doctors and nurses with a specialisation in geriatrics and the equally low number of geriatric wards[8]. One of the most pressing needs arising from the aging population is therefore the creation of a stable and accessible system of geriatric care.

 

Modern medical technologies cannot be unnoticed. The quality of life of older people and the efficiency of medical services can be improved by the use of modern medical technologies. Intelligent systems that monitor basic vital functions and health parameters ensure safety and guarantee a quick reaction in case of worrying changes. They also reduce the burden on carers and improve the independence of older people, supporting them to function in their current living environment, which is familiar to them and where they feel comfortable.

 

Therefore, only systemic, long-term actions provide a chance to limit the negative consequences of demographic changes, although eliminating them permanently over the next few decades seems to be very difficult.


[2] World Health Organization, Aging and Health, https://www.who.int/news-room/fact-sheets/detail/ageing-and-health, accessed: 30.10.2024.

[3] Główny Urząd Statystyczny, The situation of the elderly in Poland in 2021, https://stat.gov.pl/files/gfx/portalinformacyjny/pl/defaultaktualnosci/6002/2/4/1/sytuacja_osob_starszych_w_polsce_w_2021_r.pdf, accessed: 30.10.2024.

[4] Główny Urząd Statystyczny, The residence population – the results of the National Population and Housing Census 2021, https://stat.gov.pl/obszary-tematyczne/ludnosc/ludnosc/ludnosc-rezydujaca-dane-nsp-2021,44,1.html, accessed: 30.10.2024.

[5] Główny Urząd Statystyczny, Demographic Yearbook of Poland 2022, https://stat.gov.pl/obszary-tematyczne/roczniki-statystyczne/roczniki-statystyczne/rocznik-demograficzny-2022,3,16.html, accessed: 30.10.2024.

[6] OECD/European Union, Health at a Glance: Europe 2020: State of Health in the EU Cycle, OECD Publishing, Paris 2020, p. 133.

[7] Główny Urząd Statystyczny, Life expectancy tables of Poland 2018, Warsaw 2019, p. 50 and  further.

[8] J. Haczyński, Skutki starzenia się polskiego społeczeństwa, [in:] Ochrona zdrowia i gospodarka. Pacjenci, świadczeniodawcy, turystyka medyczna, J. Haczyński, K. Ryć, Z. Skrzypczak (eds.), Warsaw 2018, p. 50 and further. In Poland, according to the Chamber of Physicians and Dentists, in 2024 there were only 590 doctors specializing in geriatrics, see more: the Chamber of Physicians and Dentists, Numerical summary of doctors and dentists by field and degree of specialization, https://nil.org.pl/rejestry/centralny-rejestr-lekarzy/informacje-statystyczne, accessed: 30.10.2024.

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