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Aging, Social Isolation of Seniors Discussed with Danish Leaders

As generations age, how do different countries and cultures plan and provide for them? Information and ideas about senior support and preventing social isolation spanned the Atlantic when a group of 12 health care leaders from Denmark spent the afternoon at the Palo Alto Medical Foundation’s Druker Center for Health Systems Innovation on October 10, 2012.  

Danish and American physicians, executives and directors from large health systems, government, universities, senior centers, hospitals and hospices joined for the four-hour exchange at the Innovation Center. The goal of the visit was to share knowledge of and opinions about the diverse challenges of aging populations in Denmark and the United States. From the many dynamic conversations underway at any given time, it appeared that that goal was met or exceeded.

 

Paul Tang, M.D., vice president and chief innovation and technology officer, Palo Alto Medical Foundation

Paul Tang, M.D., vice president and chief innovation and technology officer for PAMF’s Innovation Center presented on the health care system in the United States, including the changes required to adapt for the Affordable Care Act of 2010 and accommodate the needs of the enormous and growing aging population.

“Already about 13 percent of the U.S. population are seniors, the vast majority of whom are covered by Medicare,” Dr. Tang said. “The U.S. faces several challenges somewhat unique in the world: a fee-for-service care delivery model, the lack of universal health care, and health information systems that are not connected or, in some places, nonexistent.”

“In Denmark, 16 percent of our people are 65 or older,” explained Mikkel Bülow Skovborg, Research Attaché, Danish Ministry of Science, Innovation and Higher Education, outlined the health care system and focus on care for the elderly in Denmark. “We have a highly structured and well-funded system to provide long-term care at home for our elders. We haven’t built a nursing home in our country since 1987.”

Comparing Senior Support in the United States and Denmark

In Denmark, a high percentage of the gross domestic product is spent on social services and a lower percentage on health care. All health care policies are set on a national level but are implementing regionally via hospitals, clinics, rehabilitation centers and other health service centers. The municipal level tends to home care and preventive care services. Because of this comprehensive system, people rarely if ever “fall through the cracks.” There is a continuum of care with coordinated services.

Danish seniors have access to a wide range of services provided at the local, regional and national level, by people whose specific job it is to care for the elderly and support their ability to live in the community. A number of meeting attendees, however, observed that the high-level benefits, free at the point of delivery, may create a level of dependence on the system that enables families to “check-out” of their important caregiver roles. This relates particularly to their role in providing emotional support, the absence of which may contribute to isolation.

By contrast, the United States spends a low percentage of its gross domestic product on social services and a high percentage is spent on health care. The burden of care is on the family, not the government – basically, a private sector approach in which every person or family must research available options. The system is more fragmented, with some communities and cultures more adapted to solutions for elder care than others.

The attendees were divided into several groups, each of which discussed a different query and then reported out to the entire group at the end of the afternoon. Lively, engaging discussions covered these questions:

  • What are the drivers of isolation?
  • How does isolation impact aging?
  • Who has the responsibility for tackling social isolation of seniors?
  • What solutions to social isolation are being implemented?
  • What are your “dream” solutions?

The discussions yielded a variety of perspectives and suggestions for the need to:

  • Reduce health care and senior care costs. For example, in the United Stages, five percent of the people use 50 percent of the care.
  • Reduce hospitalizations through overall improved health
  • Become more community-centered, with more multigenerational composition, and nurture the spirit of volunteerism
  • Improve transportation systems that effectively alleviate isolation, and use IT systems that support natural human interfaces
  • Focus on seniors as people, not patients
  • Embrace and support advanced care planning, beginning at an earlier age

 

“Seniors seek to maintain their independence and to live out their lives in the community,” Dr. Tang said. “We are committed to keep the dialog about successful aging going.”

Learn more about the Innovation Center at the Palo Alto Medical Foundation.