* Available services for

the elderly in Egypt

* Dr.DoHA RASHEEDY ALY * Lecturer of Geriatric Medicine * Department of Geriatric and Gerontology * Ain Shams University

* Demography of geriatric population in

Egypt
* There are
currently 4,400,000 persons aged 60 and over representing 6.9% of the total population in 2006. The expected percentage of older people may reach 8.9% in 2016 and 10.9% in 2026. * Illiteracy in geriatric population in 81% in females and 64% in males in 2006. * Most males are married (86%) and most of females are widows (36%). * Working males are 28% and working females are 3% in 2006. * Life expectancy in females was 63.5 years in 1986 increased up to 73.6 years in 2006. * Life expectancy in males was 60.5 years in 1986 increased up to 69.2years in 2006. * Elderly abuse according to WHO is 4-6% * Elderly populations are at higher risk than adult population as a whole for health problems. The greatest risks for health problems are for people over the age of 75.

* Problems facing the geriatric population

in Egypt

*Health problems * Psychological problems *Socioeconomic problems

*
* As
the prevalence of most chronic disease increases with age, so does the prevalence of definite disability. The prevalence of functional impairment increases with age from 13% among persons aged 65 to 69 years to 35% among those aged 85 years and older. rates of functional disability are even higher among institutionalized elderly persons.

* The

*
* heart disease, cancer and cerebrovascular disease account for
75% of all deaths for both men and women aged 65 years and older. * Cancer is the second leading cause of death after heart diseases now, primarily because of the increased incidence of lung cancer for men aged 65 to 84 years while for men aged 85 years and older, prostate cancer is the most common cause of deaths. Breast cancer causes the most cancer death among women aged 65 to 74 years, but in women aged 75 years and older, colon cancer causes the most cancer deaths * Infections, especially influenza and pneumonia are still a major cause of mortality for frail older persons. Vaccination programs for influenza and pneumococcal disease have probably been effective in reducing the number of pulmonary deaths. * Accidents; with falls being the leading cause of accidental deaths

*Psychological disorders are common among

the elderly, especially depression .

*Dementia is the most serious disorder and

it shows much progression with aging

*Socio-economic

problems

* Elderly people also have a higher risk than the adult population
for social losses, including loss of income and loss of selfesteem(after retirement) loss of loved one (through death of the spouse), loss of social roles (through death of the spouse and friends. existing cultural and religions patterns of caring for the aged parents and grand parents is presumably the main reason for their acceptance in families. Pensions in 53%.

* Most elderly have no economically productive work, but the

the source of the income of the elderly:

1) 2) 3) 4)

Sons/daughters Help in 21.5% .

Assets revenue in 11.5% .

Help from other relatives in 6.4%.

* Many older people in Egypt lives in poor conditions (60% of less

than 150 Egyptian pounds).

*Needs of the elderly

*Needs of the elderly

1.Social needs: * The need for independenance is a result of discomfort experienced by the elderly within their families. To meet these needs, special houses have been established by the government. 2. Economic needs: * Senior citizens need a financial system which secures a balance between their income and the increasing cost of commodities and services. 3. Psychological needs: * As relevant pre-retirement orientations programs, introduction of courses on family relations and the right of senior citizens in schools. 4. Health needs: * Focus on primary prevention rather than disability management. * Focus on chronic diseases follows up rather than episodic and acute care. * Increased awareness about medical problems . * They also need a suitable rehabilitation system according to their mental and physical capabilities

* the services available for the elderly in Egypt in comparison to

their needs are inadequate both in quantity and quality. In addition, many essential needs are neglected especially those related to the functional and psycho-social aspects of the elderly.

* Those services are introduced in isolation from one another

* Services are both governmental and non governmental.

resulting in a decrease in efficacy and an increase in the cost of services.

*Governmental sector:
A. Ministry of health and population(MOHP): * Primary, secondary and tertiary services. 80% of services provided by MOHP are free and 20% paid. All Egyptian Citizens are eligible. * 267 urban health care centres and 3595 rural health care centres. * The health services were distributed all over the country. In each governorate, there are the three levels of health care, primary, secondary and tertiary; but the geriatric specialty is presented mostly in Cairo, and a few big cities. * In 2007 the Egyptian Ministry of health & population (MOHP) announced its plan to establish the geriatric medicine speciality by recruiting 89 doctors in 2008 to work as geriatricians in the various elderly health care units, Geriatric Medicine speciality was put in the urgently needed specialities:

* Cairo Boulaq Dakrour Geriatrics Unit Giza (10 beds) * Alexandria * Port Said Port Said Geriatrics Center (25 beds) * Ismailia Ismailyia General Hospital-Geriatrics Unit (4 beds) * Suez Suez Geriatrics Center (35 beds) * Matruh Matrouh General Hospital (10 beds) * Sharqia Geriatrics Unit - Hehyia Central Hospital * Dakahlia * Monufia Berket El-Sabaa Central Hospital - Geriatrics Unit (10
beds)

Secretairate of Mental Health (2007)

* Asyut Al-Eman General Hospital - Geriatrics Unit (12 beds) * North Sinai Al-Arish General Hospital * South Sinai El-Tor General Hospital * Minya * Kafr el-Sheikh * Luxor Luxor International Hospital

* Al-Matariyyah

teaching hospital and Elsahel teaching hospital are establishing its departments.

* Boulaq Al-Dakror Hospital opened a new department in 2007. * Elderly rehabilitation & treatment center in Helwan (26 beds)
one of the single speciality centers of ministry of health and population.

* The

national institute of neuromotor disabilities also contain a geriatrics outpatient clinic. Internal medicine curricula includes a training module on Geriatric medicine as a part of the Egyptian fellowship programs provided by the Ministry of health and Population. Covering the cost of healthcare is another major challenge for seniors. Currently, 62 percent of elderly men have health insurance compared to 35 percent of elderly women.

* Egyptian fellowship of family medicine & Egyptian fellowship of

* Government Medical Insurance healthcare:

*The MOHP started from 2001 to develop health programs

from Ain Shams university and Helwan university.

for older people that include the following: 1) Short term training program for family physicians by experts
2) The family doctor also know much about health of the
spouse and about health of the spouse and about the local services and environment .

3) Short term training program for community nurses with

collaborations of experts from Ain Shams University.

4) Clinical diagnostic service to the dementia patients (memory

clinic in the hospitals).

5) Geriatric center for rehabilitation: This unit has outpatients

assessment service, recreational activity units, long stay unit as well as rehabilitation units.

B.Teaching hospitals and institutes organizations (THIO) Serve only small proportion of population. 9 general teaching hospitals and 10 research institutes located mostly in Cairo. C. Health insurance organization (HIO). * Provides insurance to workers in the formal sector. D. University hospitals * Provides high quality care mostly in Cairo area and generates significant resources through user fees. * Primary, secondary and tertiary treatment. * University hospitals are used predominantly by the non-poor population E. Other Ministries * Ministry of interior provides free health and medical care for police and prisoners. * Ministry of transport provides services for railway employees. * Ministry of defence provides services for the armed forces as well as local civilians.

*
* Provide primary health care medicine and raise public
awareness and public health care. activities.

* Religious organization have the capacity to carry out such * Primary health care activities are mainly through grants and
donations from international NGOs.

* In

Egypt only 106 organizations out of 17,000 NGOS provide services to elderly which revealed that care of elderly had low priority in NGOS preference.
106 organizations are mainly located in Cairo and Alexandria, also it is noted nearly all of them are located in urban areas .

* These

*Foreign donors *
* Foreign
* Bilateral donors: mainly

International aid paid to government and government employees as population and capital investments. It falls under the authority of the ministry of international cooperation

donors multilateral donors: mainly WHO, world bank, African development bank, social fund for development.
Finland, Holland, and European union.

Private insurance * Private or involuntary health insurance is small. * Many companies make their own arrangements to provide medical care to their employees. Occupational syndicates * Several groups of professional and workers organized into occupational association (syndicate). * Major syndicates are medical, commercial, agricultural and engineering. * All members of associations and family are eligible to use services provided by relevant syndicate. * Membership is voluntary and is increasing very quickly. Private hospitals and pharmacies * Owned by individual and are operating in the private sector. * All citizens are eligible to use services. * Costs of drugs are expensive compared to public pharmacies. * All citizens (100%) can access these services offered provided they can afford to meet the costs. * Operates: 1202 private hospitals.

*Private based geriatrics services

* Ain
Shams University specialised hospital has a Geriatrics outpatient clinic. * Geriatric Medical Center at Downtown, Cairo * Palastine hospital established a long term care unit in 1994.] * American Hospital in Tanta Has a Geriatrics department. * Wadi El-Nile hospital has a geriatrics outpatient clinic. * Italian Hospital in Cairo has a Geriatrics department. * Abdel Kader Fahmy hospital has a geriatrics clinic. * Hasabo Hospital has a Geriatrics outpatient clinic. * Arab Contractors Medical Center has a Geriatrics consultation Service. * El-Gouna Hospital at Hurgada has a Geriatric Rehabilitation service.

* Geriatric

Medicine department at The International Medical centre at Cairo-Ismalia road. * Police Hospital of Alexandria

*Most

of Psychiatry departments in Egyptian Universities have or are establishing its psychogeriatrics section and also other non-governmental private services exist. unit at Ain Shams University has a geriatric psychiatry unit with a dementia and memory clinic (twice weekly since 1996). private Psychogeriatrics Units are available in Egypt.

*Psychiatric *Several

*Psychogeriatrics Clinic at Maadi Military Hospital. *Gamal Mady Aboul Azayem Hospital has a Psychogeriatrics
clinic.

Physicians in Egypt

*Geriatric care

* categorized into 3 Categories:

* Geriatricians :Postgraduate * Family
studies certificate/degree in Geriatric Medicine Carrying a valid Medicine and Internal Medicine Practitioners: Carrying a Continuous medical education (CME) credit in Geriatrics.

* General Practitioners

*Geriatrics

societies

* The * The

Egyptian society of Geriatric medicine was established in the 1982, First President was Prof Mohammed Sabbour, but is frozen now. Egypt Alzhiemer association is active in the field of Dementia and also in geriatric care, it was established in 1998 by Professor Abdel Moneim Ashour. It a member of the Alzheimer's Disease International Associations

*Conferences and

workshops

* Many conferences about geriatric medicine were held in Egypt. * 1st conference Ain Shams Faculty of medicine conference of Geriatrics
& Gerontology in 1988 Ain Shams University During the 1990s

* First Annual Egyptian Conference on Aging, Ain Shams University, Cairo,

Egypt, January 1993. * Fifth International Geriatrics Congress: The Egyptian Twenty-First Century, Cairo, Egypt, February, 1998 * 1st Ain Shams University conference and condensed gerontology course July 2009 * 2nd Ain Shams University conference and condensed gerontology course for Physicians March 2010 * 2nd Ain Shams University conference and condensed gerontology course for Non-Physicians March 2010
Elderly in the geriatrics and

geriatrics and
geriatrics and

Suez Canal University

* Conference on Geriatrics and Gerontology, Suez University School of

Nursing, Port Said, Egypt, February, 1998 * First annual national meeting of rheumatology "Geriatric Rheumatology", In Ismailia Mercure hotel.67 July 2006

Helwan University during 1990s (6 conferences 1990 - 2005)

* First Regional Conference for Elderly Care. The Center of Elderly

Care-Helwan University April 2000

Al-Azhar University

* Faculty of medicine conference 2006

Alexandria university:

* Faculty of medicine conference 2006 * Geriatric Unit Conference April 2010

Cairo University aging conference 2009
Tanta University

* Faculty of Medicine Annual Conference Geriatrics health &

Prevention conference 2009

*Health expenditures
* Investments
implemented in the program of health services during 2002-2004 showed about L.E 5 billions, including L.E 3.3 billions accounting for 66% by the government sector and the rest by the private sector. implemented in 2004-2005 hit L.E 2.4 billions including L.E 1.7 billions implemented by the government and economic agencies, accounting for 70.8% of total investment

* Investments

*Education
I - Geriatric education: Started in 1988, at the post graduate level as master degree in geriatric medicine and a doctorate degree in geriatric medicine. Moreover, the study of the geriatrics is introduced at the undergraduate level. II - Geriatric nursing education: In many universities, there is a module in geriatrics nursing both at the undergraduate level as well as postgraduate. III -The Higher Institute for Public Health Alexandria University: This is a postgraduate institute for public health. There are 9 academic departments from which one is especially for the department of health at old age. This department offers postgraduate training in geriatric health at the diploma level, master degree level and Ph.D. degree level in public health.

IV. Geriatric Physical therapy education:

* Physical therapy education is available in three universities, for

undergraduate.

* Higher degree studies are available in geriatric Internal

medicine and geriatrics.
V Faculty of Social service and faculty of Art (department of psychology): Their curriculums contain Some lectures about elderly.

*Clinical services for older people:

I.
Geriatric department Ain Shams University

* This

clinical service started as the geriatric unit in Ain Shams University in 1990. This academic department is the only academic department in the Egyptian universities.

* The geriatric unit has change to be academic unit in 1996. * Clinical unit:The clinical unit has around 23 acute assessment
bed which accept patients from the out-patients departments. service for the seriously ill elderly patients.

* Geriatric ICU unit:This unit has 8 beds and is offering a clinical

* Osteoporosis unit

Alexandria University

* Faculty of medicine contain a Geriatrics Unit since the 1970s. * A biweekly geriatrics Outpatient clinic is also available * The department have a cooperation with the Geriatric Nursing
department of the Faculty of Nursing.

* Elder

health section of the family health department of the High Institute of Public Health of Alexandria University.

* Postgraduate Program in Geriatric Nursing in the Faculty of Nursing.

Mansoura University

* Has established its own Geriatrics Unit. * Inpatient department consists of 2

Endocrinology Unit.

beds affiliated to the

* Geriatric

Medicine Residency Program has started since 2006 in Mansura University in Cooperation with the Ain Shams Geriatrics & Gerontology department. Three residents has joined the program until 2009.

* The department has started a weekly geriatrics outpatient clinic.

Cairo University * Faculty of Medicine has the geriatrics speciality included in the public health department, but geriatrics is not a separate entity. It is included in the family medicine curriculum & Family medicine M.Sc. * Psychogeriatrics Unit is being established in the Psychiatry department. Assuit University * Faculty of Medicine is currently establishing a Geriatric Medicine department. Tanta University * A Psychogeriatrics Unit was established in 2008. * The Tanta Faculty of Medicine has organised a conference on Geriatric Medicine in 2009. * The Faculty of Nursing has a Post-Graduate Program for Geriatric Nursing. Suez Canal University * Faculty of Medicine has a family medicine department that teaches geriatric medicine course in the undergraduate curse of the first year. * Also the Geriatrics module is taught in the postgraduate course of the master degree and the Doctorate degree in family medicine. Sohag University * Has a Geriatric Health Curriculum taught in the Faculty of Nursing, in the Program of Geriatric

Center of Elderly Care, Helwan University (CEC): * The center of elderly care has been established in 1996. This center is a self-financed unit for community development in Helwan University. * The main objective of the center is to provide both the clinical service as well as trying to develop a geriatric care. * Out-patients service: * In which the center runs out patient clinics. Also, there is an outpatient clinic which is held twice monthly in one of day care centers for older people. Core team runs this service which includes a geriatric specialist and a nurse. * Dementia service in the CEC: * The center also runs a special dementia memory clinic for dementia patients in collaboration with MOHP. * Home care service: * This service is delivered to the frail older patients who are house bound. * Long-term unit in CEC: * This is mainly for frail older people who are functionally dependent on other for their ADLs and IADLs. * The center provides long term facilities for both the physical dependent (post stroke physical disabilities, severe Parkinson's disease) and cognitively impaired (dementia). * Respite care is also provided for such group of patients.

II.

*SERVICES PROVIDED BY
MINISTRY OF SOCIAL SOLIDARITY

a.

Provides support to the meeting of the higher committee of the elderly welfare (established by ministerial decree in 1997).

Ministry of Social Solidarity programs and services are wide ranging:

1. Elderly homes:

* An increasing trend for new homes can be observed over the last four
decades. in 1978 was 28, in 2006 was 84 (serve 4000 elderly)BUT the number of geriatric homes cannot be called sufficient. 2. Elderly clubs:

* These are day care centers providing entertainment, social, health

and mental care services as well as encouraging older persons to invest themselves in productive activities to use older person's expertise.

* Elderly clubs are increasing so rapidly, As regards elderly club service,

it is expanding rapidly during the last few years reaching up to 170 clubs in 2007 (serve 33000) compared to 5 clubs in 1978 distributed over 26 governorates.

3. Physiotherapy unit:

* This type of service is attached to the elderly clubs and homes.

They provide sessions of physiotherapy to the elderly living in homes, clubs and to those living within their family. In 2005, their numbers reach 52 units.

4. Elderly service offices (most in elderly clubs and homes):

* It involves social care, home cooked meal, domestic help to the

5. Hosting family project:

elderly within their families. In 2005, their numbers reach 27 offices. new project has currently being tested in 5 governorates. A family hosts the older persons and provides health care, entertainment, social care and balanced meals for a monthly fee paid by the elderly according to ministry of social solidarity conditions.

*A

6-Elderly sitter program: * In the last few years, Egypt experienced socio-economic changes represented in the participation of women in labor force and change of family structure from extended to nuclear family. * Ministry of social solidarity conduct training courses to the elderly sitter via different NGOs (family support association, Egyptian red crescent association ) as well as technical and financial support for these services). * More than 900 persons are trained to provide the required services and care for 500 senior citizens in Egypt. * Unfortunately, the negative cultural concepts about the job of the sitter in our oriental society cause embarrassment to the service provider (sitter) as it is considered as a low status job. 7-Higher committee for elderly care: * It includes all the ministries and organizations (ministry of health and population, ministry of social solidarity, ministry of transport, ministry of law, ministry of media..etc.) that provide services to the elderly, 1997. * It aims at linking between different authorities in elderly care to control investment in elderly care, rendering them effective. 8. International day of older people: * In the first of October every year according to United Nations decision

*Some important services

provided by the government to the senior citizens in Egypt

1-Social security programs for the senior citizens * In 2003, the government social security budget either pensions or social aids expended from L.E 88,657,867 in 1999 to L.E 176, 000,000 millions which covers half millions families in which the senior citizens represent 11% of the beneficiaries. 2-Advance payment of pensions * In two cases stated by the law, a pensioner -not exceeding 65 years of age- may request an advance payment of a sum of money, to be deducted from his pension over a period of 10 years. 3-Home delivery of pension * If the pensioner is 70 years old or more, of if he/she is totally or partly handicapped, he/she would be entitled to request the delivery of pension to his/her home address. However, in a study, only 10.5% stated that they knew about this service. 4-Aids and loans though Nasser Bank * The bank achieves this goal by offering financial aid and by providing loans without interest, to persons who wish to set up small productive projects, and to those who encounter social an/ or economic difficulties. 5-Reduction in transportation * Pensioners are entitled to submit a request to the national organization of insurance and pension for a railway travel permit (two return trips per year to any part of the country at a reduced rate of 50%). Egypt Air issued a circular in 1983, granting pensioners a reduction in fares of 5% on international flights and 10% on domestic flights. 6- Reduction in prices of tickets for recreation * Pensioners are entitled to apply for permits to attend theatre and cinema performances at a reduced rate of 50%. The reductions are valid in theaters and cinema owned but the public sector only. Very few elderly (3.0%) knew this entitleme

*ADVERTIZING SEVICES

AVAILABLE FOR ELDERLY

TV programs:

* Rabee3 el omr Program started in 1993. It

Radio programs:

introduces different activites and specific elderly care from social, psychological and entertainment.

* program: discuss important elderly health, social

and psychological problems. Meeting with famous elderly and introduce elderly news. gives advices to youth.

* program: it connect life to religion.

caring and directing youth.

And elderly

* program: stress on the role of grandma in

* program: famous elderly introduces the

program and speak about his life long experience health, social and psychological problems.

* program: introduce some solutions for important

Radio elderly:

* It considered the main support for elderly in Egypt as it cover

most of activates related to elderly with ensuring the role of geriatric clubs. Newspaper for elderly:

* Alahram news offer specialized weekly page called

main support which started in January 2001. it introduces advices for elderly and geriatric clubs and nursing homes