I discovered some very disappointing, yet unsurprising facts this week: there are no national statistics on the prevalence or incidence of falls in the elderly, nor any information on the costs associated with a fall that requires hospitalisation. This may not seem like a big deal to the reader, but it is. It is a very big deal when T&T is now faced with an aging population, whose health needs are extensive and expensive. Five years ago 12 percent of Trinidad and Tobago was over the age of 60.
Preventative care is an indispensable approach to improving the quality of life and decreasing the costs of healthcare for the elderly.
But how can we understand their unique health situation in order to provide relevant preventative measures without collecting statistics and information about them? If we fail to understand their challenges (which are certainly different to those of the elderly in the US), the interventions they may need, and the costs of such, how can they receive the proper healthcare at acceptable costs to themselves and the country?
How can the Ministry of Health improve the current interventions and preventative care available to senior citizens and implement necessary new ones if there is little information to help them determine what is working…or not?
Suffice to say that we do not understand (or know) the details of the needs of the elderly in T&T because we have few statistics on them. We only know the basics: average lifespan, top causes of death, mortality rates. The most detailed information about the elderly that I managed to locate on the internet was the following from the “Health in the Americas” 2012 publication by the Pan American Health Organisation:
“Studies over the past two decades point to arthritis, eye problems, hypertension, diabetes mellitus, and heart disease as the major health issues faced by the elderly. Loneliness, reflected in low levels of interaction, is an area of concern, although only 16 percent of the elderly live alone. Another issue affecting the elderly is the need for primary health care programs that promote their health and well-being.”
I suppose one can argue that the above brief synopsis reflects the state of the elderly in Trinidad. I agree with this statement, especially regarding the comment on poor social integration and the need for primary healthcare systems. But WHY is it so? Are they lonely because they have mental disorders such as depression, Alzheimers, or have lost their independence from a fall or illness?
What kinds of primary healthcare programs are needed apart from the usual education on prevention of common noncommunicable diseases? More detailed statistics are required to create a better understanding of the situation of the elderly and what can be done to improve care and reduce costs.
The absence of data on falls is a perfect example of how gathering a bit more information on this population can help steer the national health agenda for the elderly in a better direction. Let’s take the situation of a 68 year old gentleman who slipped and fell on an uneven pavement on Frederick Street and fractured his hip. He is carted off to the Port-of-Spain General Hospital and undergoes surgery where a screw is inserted to stabilise the fracture.
I have been unable to find statistics about what such a situation would cost the government. These are however available from private hospitals. The total average cost for such a procedure in a private hospital, including physician fees, implant costs and hospital fees for four days stay is between $60,000-$70,000. That does not even include physical therapy or any issues that may arise from complications. There is also the emotional cost to the patient and the family who has to care for a dependent loved one.
While I have been unable to find statistics on the costs to the government of the same procedure in the public hospitals, I have been told by reliable sources that it is significantly more than the private sector because hospital stays are usually longer and these patients tend to suffer more complications. However, the sources said that such statistics are not documented, and in any case, are difficult to accurately record. So if there are no statistics, how can we really know the problem and justify improvement?
Just imagine…if we had statistics that would allow us to analyse the problem of geriatric healthcare in T&T…just imagine…how much money we could save, and what a better quality of life our seniors could attain. We could put effective measures in place for prevention and proper intervention.
In the case of falls, it could be as simple as education on how to decrease the risk of falling. For every fall prevented, the government could easily save upwards of $70,000.
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Carla Rauseo, DPT, CSCS, ATRIC is a Doctor of Physical Therapy and a Certified Aquatic Therapy Rehabilitation Instructor at Total Rehabilitation Centre in San Juan. http://www.totalrehabtt.com
