»» No. 9-10 "99 »» New medical encyclopedia Experience of the St. Petersburg Geriatric Service
Ella Solomonovna Pushkova, chief geriatrician Health Committee of the Administration of St. Petersburg, Chief Physician of the Geriatric Medical and Social Center, Ph.D. honey. Sci.
There is still no clear definition of the concept of “quality of life” either in Russia or in the West. However, ideas have developed about some of its components. For older people, this is, first of all, the availability of medical and social care. Today, most professionals define such assistance as a complex of medical and social services that are provided to elderly patients in medical institutions or at home, by teams consisting of doctors, nurses, social workers, psychologists, occupational therapists and nursing staff.
The main task facing organizations providing medical and social assistance to the elderly is, first of all, to support a satisfactory quality of life for patients who have partially or completely lost the ability to self-care, and to protect the rights guaranteed by the state to medical and social services.
Due to the high rate of aging of the population of our country, a complete solution to this problem neither in Russia nor in our city can be achieved even in the next decade. This is due to the constantly increasing proportion of elderly patients and natural increase demand for high-quality, and therefore expensive, medical and social services.
In accordance with the WHO classification, the age of 60-74 years is considered elderly, 75 and older - senile, and over 90 years - a period of longevity.
Over the past 11 years in St. Petersburg, the proportion of the elderly population has increased by 100 thousand people, or 3%. According to demographic forecasts, in the next 10 years the number of elderly people will increase by another 100 thousand and will be equal to 27% of the city’s total population in 2011.
The number of people over 90 years old is growing especially rapidly in the northern capital: there are currently 2 times more of them than 20 years ago.
In St. Petersburg, earlier than in other regions of Russia, a tendency towards “aging” of the population appeared. Apparently, this is why the first scientific society of gerontologists was founded in our city in 1957, and the creation of elements of a geriatric service began. In the early 80s, the chief therapist of the city I.P. Bukhalovsky began the first geriatric appointment; in 1982, a geriatric department was organized in clinic N43, and in 1986, the Department of Geriatrics of MAPO was organized. In 1994, the first City Geriatric Medical and Social Center in Russia was created in St. Petersburg, which is financed from the city budget.
Today in St. Petersburg, medical and social services for elderly patients are provided in institutions subordinate to the Committee for Labor and Social Protection of the Population and the Committee for Health Care. Their work is coordinated by the municipal law “On the city targeted medical and social program “Geriatric care for the population of St. Petersburg””, adopted in 1998.
The modern structure of providing medical and social services to the elderly in St. Petersburg is significantly ahead of many regions of Russia and Eastern Europe. The main principles of its creation are:
- integration of health and social services;
- organization and development of services most in demand by the elderly;
- training of professionally competent personnel.
To date, geriatric institutions and departments have been deployed and operate in several districts of the city. However, they should be recognized as only the first seeds from which in the near future a unified system of providing geriatric care to elderly patients will be born (see diagram).
| Inpatient care | Outpatient care | |
| City Geriatric Center | ||
| Hospital of the City Geriatric Center - 215 beds | Clinic of the City Geriatric Center | |
| Departments of hospitals and clinics in city districts | ||
| Nursing department GB N28 (75 beds) Nursing department of City Hospital N32 (25 beds) Nursing department of City Hospital N1 (10 beds) Day hospital (20 beds) Nursing department GB N14 (75 beds) Day hospital (12 beds) Day hospital (12 beds) Nursing department GB N29 (25 beds) Day hospital (15 beds) Day hospital (25 beds) Nursing department of City Hospital N46 (10 beds) | Admiralteysky district Vasileostrovsky district Vyborg district Kalininsky district Kirovsky district Kolpinsky district Krasnogvardeisky district Moscow district Petrogradsky district Primorsky district Pushkin Central district Frunzensky district | Geriatrician's office at home social purpose Admiralteysky district Offices of geriatricians in polyclinics of the Vyborg region Geriatrician's office Offices of geriatricians in polyclinics Krasnogvardeisky district Geriatrician's office Geriatrician's office |
The issue is being resolved not only about opening geriatric departments in district clinics, but also about opening specialized inpatient departments, the need for which today is 1200 beds. Currently, there are 215 geriatric beds, 150 Hospice beds, and 180 nursing care beds in St. Petersburg.
- Geriatric beds mainly provide diagnostic, therapeutic and rehabilitation care to chronically ill elderly patients;
- Nursing beds provide supportive, symptomatic, sanitary and hygienic care,
- Hospice provides palliative care to dying patients with cancer.
Particular attention is paid to social homes in which geriatric offices have already been deployed or will be deployed, where a geriatrician will provide medical support not only to those living in this house, but also to patients of the center day stay. Such an office has already been created in the Admiralteysky district. This made it possible to make geriatric care more accessible to the population of the region and raise it to a qualitatively new level: the need for hospitalization among the elderly population has noticeably decreased.
The heterogeneity of the elements of the geriatric service in St. Petersburg is explained by the fact that the service was simultaneously created on the basis of inpatient and outpatient facilities.
In the organization of medical and social assistance to the elderly there is also a large number of unresolved problems. Particularly acute is the issue of drug provision for benefit categories of citizens, which include elderly patients. Despite the efforts made by the city, especially the Health Committee, to provide medications free of charge to chronically ill elderly people, this issue has still not been resolved.
The problem of hearing aid is no less important: age-related hearing loss poses additional obstacles to obtaining vital information and reduces the level of socialization of older people. Therefore, it is necessary to provide older people with reliable and comfortable hearing aids.
The issue of creating a local industry for wheelchair equipment and care for patients suffering from urinary incontinence has not even begun to be resolved - one of the most pressing problems of keeping elderly patients in a family or hospital setting, which, of course, negatively affects the quality of life of a large number of the city's population. Among the undoubted advantages of St. Petersburg in solving the medical and social problems of the elderly, we include the possibility of international contacts, especially with our Scandinavian neighbors. The project, diverse and extensive both in duration and in representativeness, financed by the state Swedish foundation SIDA, certainly had a positive impact on the creation of a network of geriatric institutions, especially in terms of training the staff of these institutions.
Quality of life of older people and factors influencing it
Quality of life for older people is the maintenance of a condition that provides older people with optimal physical, psychological and social comfort.
In the lives of older people, as in the lives of people of other ages, income level and health status are the two most significant variables that are the most important components of quality of life. Therefore, in order to understand the full picture of the lives of older people, it is necessary to understand what material wealth and health mean to them and how they interact with other areas of life.
It is believed that financial situation is the most important of the non-biological factors affecting health status. Medical and social problems become of great importance for the elderly. Although old people may be active and alert, as they age their need for medical care increases. Due to the natural aging of the body, a number of chronic diseases appear; the number of elderly people in need of constant care is increasing. medical supervision, with the help of gerontologists, neurologists, cardiologists, etc.
Therefore, when studying the quality of life, scientists often limit themselves only to the factors of material wealth and health. But subjective indicators are no less important, because Life satisfaction is closely related to socioeconomic factors and health.
According to the findings of foreign experts, since the 1960s, subjective indicators such as life satisfaction, self-esteem and a sense of control over life have gained great importance not only in assessing the quality of life, but also in assessing the adaptation of older people. This is confirmed by data from a number of studies that have shown that in older people, ideas about the situation and its assessment determine well-being and satisfaction with the quality of life to a greater extent than the objective situation. Therefore, quality of life cannot be measured based on externally assessed health or environmental conditions without taking into account individuals' own assessments of their health and well-being.
As can be seen from the figure, the quality of life of older people has many dimensions and can be defined as a certain matrix of interconnected elements, whose integration, in turn, determines the quality of life of each individual. Therefore, the task of researchers comes down to determining the level of quality of life of a particular individual and then comparing it with other individuals in similar conditions.
At the same time, you need to pay attention to the fact that quality of life includes such concepts as living conditions and life experience. The former relate to objective elements, such as living conditions, and the latter to subjective elements. Thus, many researchers are faced with two “spaces” and hence their disagreement in assessing the importance of each space. For example, if we talk about life experience people with mental problems, which are not uncommon in later life, then some authors believe that quality of life for them is an “individual subjective concept.”
A schematic assessment of the quality of life can be presented in Figure 1.1.
Figure 1.1 — Quality of life factors
Note - Source:
Thus, measuring quality of life must include identifying people's needs, the subjective importance of those needs, and the extent to which a person feels the need to satisfy them. Some authors include health and financial sources as objective elements, and subjective elements - ideas about well-being, the basic level of satisfaction, ideas about one’s worth, self-esteem, etc. Thus, the subjective measurement of quality of life consists of studying indicators such as life satisfaction, well-being and self-esteem and related important events in the life of an individual. It is important for social workers to understand the interactions between these components.
It must be remembered that a decent quality of life for an elderly person is impossible without motivation for active longevity. Propaganda needed physical activity, rational nutrition, mental training, overcoming a sedentary lifestyle. Psychological support is required, which can reorient interests and life values. What is important is a favorable microclimate in the family, a feeling of being in demand in society, taking into account life and professional experience.
Rating of countries in the world according to the quality of life of older people
The Global AgeWath Index is a global study and accompanying ranking of countries around the world in terms of the quality of life and well-being of older people. Calculated according to the methodology of the international non-governmental organization HelpAge International based on statistical data obtained from national institutions and international organizations, which are accumulated in the United Nations Population Fund (UNFPA).
These groups of indicators were chosen because they have been identified by older people and policy makers as key components of the well-being of older people. For each group, countries are given a score from 1 to 100 (using tenths). The higher the score, the more highly a country ranks in a given area. The overall Index is calculated as the geometric average of the four regions and thus shows how close a country is to the ideal value. For example, an overall Index score of 35.0 points means that the well-being of older people in the country is only 35.0% of the ideal (100).
This page contains a current (periodically updated) list of countries and territories around the world ranked by the Older People's Quality of Life Index. In 2015, the study covers 96 countries.
Quality of life index for older people in countries around the world
HelpAge International. Global AgeWath Index 2015
125171, Moscow, Leningradskoe shosse, building 18, office 815
Quality of life for older people
This paragraph examines the main characteristics of the quality of life of older people: place of residence, financial situation, nutritional habits, health status, safety, social well-being, leisure and recreation. Having analyzed the monitoring results, we can come to the conclusion that the most characteristic social risks of older people are: poverty and material disadvantage; deterioration of health and risk of premature death; risk of social isolation (uselessness to society); loss of family ties; deformation of norms of behavior; risk of fraudulent activities. Their presence threatens the normal life of the elderly population of Russia.
On October 25, 2010, at a meeting of the Presidium of the State Council for social policy regarding elderly citizens and improving their quality of life, President Russian Federation Medvedev D.A. indicated that “caring for the older generation is an unconditional state priority” and “recently something has been done to improve the quality of life of older people.” Today in Russia “there are no longer pensioners whose incomes are below the subsistence level.” But, “this is only the first step in development pension system" Other steps will be taken in the near future.
One of these “steps”, in the light of the ongoing reforms, is to study the opinions of older Russians themselves about the changes that have taken place, assessing their lives in various aspects: in terms of place of residence, financial situation, dietary habits, health, safety, social well-being, life leisure and recreation. To implement this area of work, a quantitative study was conducted using a survey method. When setting goals and objectives for monitoring, the emphasis was on studying life situation elderly Russians to develop management decisions on issues of system development social protection population. By interpreting the results of Comprehensive Monitoring of the level and quality of life of older people, one can come to a determination of the social risks characteristic of the cohort of older people.
Participated in the survey different types elderly people: “young” pensioners and older people; employed and those who have completed their working career; singles and families, those receiving home care, and others. The sample population of the study consisted of 5,000 respondents who had reached retirement age, of which 4,100 were women (82%) and 900 men (18%). The average age of female respondents was 69 years, male respondents - 72 years. Every fifth old man- is lonely, and every fourth person continues to work.
The scope of activity of older people who continue to work is varied. Among the interviewed respondents were those working in almost all areas of employment characteristic of Russia (industry, state and municipal administration, education, trade organizations and public catering establishments). At the same time, a significant proportion of respondents are elderly people employed in social services and housing and communal services. This is explained, firstly, by the possibility of employment in this area for persons with highly specialized professional characteristics, and secondly, by the continued benefits of the social protection system for older people when continuing to work after reaching retirement age.
Issues of financial situation seriously affect the social well-being of older people and their level of satisfaction with their lives. Material security is assessed, first of all, through the level of income, indicators of the purchasing capabilities of older people, as well as the availability of durable goods, etc.
Almost half of the respondents (42%) have enough money for food; another 40%, in addition to food costs, can afford to buy clothes and shoes. The share of those who experience difficulties even when purchasing food is 5%. And, only 12% of respondents are satisfied with the quality of their food and can afford to buy a TV, refrigerator, washing machine and other durable goods. The share of elderly people who can easily afford the purchase of durable goods, as well as cars and real estate, is less than 1%.
Almost everyone has a refrigerator, a gas or electric stove, a vacuum cleaner, carpets, a color TV, and a washing machine at home. At the same time, TV and washing machine were purchased relatively recently (no more than 10 years ago), the remaining products have a significant experience of use (more than 10 years). A third of respondents have a food processor in their household, sewing machine, music center, video and photographic equipment, personal vehicles. Most of these products were purchased more than 5-10 years ago. About 20% have a dacha (summer garden house) or a garden plot, less than 10% have a garage. Such acquisitions were made during the pre-retirement period of life.
The average cost of the respondent is about 12 thousand rubles. At the same time, the most significant expense items (in descending order) are the purchase of food (4,500 rubles); payment of utility bills and communication services, electricity, Internet (2,800 rubles); purchase of medicines (2,500 rubles).
Savings for a “rainy day” are on average insignificant - 700 rubles per month. It is characteristic that these funds are considered not as potential investments, possible investments in some promising project, but rather as possible insurance in a situation when things get really bad. The small size of such contributions indicates the low financial stability of the lives of older people.
Since the most expensive type of expenditure for older people is the purchase of food (which is typical for the consumption structure of poor households), respondents were asked about the availability of basic food products for them.
However, availability could be limited either by considerations healthy eating, or lack of funds. Based on the results of the study, we can conclude that the vast majority of respondents have access to bread, cereals, pasta, potatoes, vegetables and melons, vegetable oil, milk, sour cream, cottage cheese, eggs and tea.
The undisputed “leaders” among products that are rejected for reasons of healthy eating are canned meat (65%) and fish (62%), as well as alcoholic beverages (66%) and tobacco products (49%), traditionally classified as food products. Almost half (47%) also reject offal (kidneys, liver, etc.) and butter (41%). However, for every fifth respondent, these by-products are inaccessible due to financial difficulties, and 11% find it difficult to buy butter not for dietary reasons, but for financial reasons.
For financial reasons, 40% of respondents limit themselves to purchasing meat, 36% - fruits and berries, 38% - alcoholic beverages and 44% - tobacco products. Every fourth person finds it difficult to purchase meat products (sausage, frankfurters), as well as to purchase fish.
Thus, the typical “food basket” of a pensioner still has a pronounced carbohydrate character. The source of protein is mainly milk and dairy products, eggs, and poultry. There is a shortage of fruits and fish that are very useful in old age.
At the same time, 1% of older people each chose polar assessments of nutrition quality (“very bad” and “very good”). The number of those who chose the “pretty good” option is almost four times the number of those who chose the “bad” option. In other words, bad ratings total less than 10% of the responses. This indicates that if there is a large choice in the consumer market and with minimal security allowing this choice to be realized, older people are generally tolerant of restrictions in some product sectors if they have the opportunity to freely purchase a familiar set of products.
Despite extreme weather conditions (abnormal heat in summer, severe frosts in winter) and, as a consequence, an increase in the cost of certain food products demanded by older people, three-quarters of those surveyed felt that their food quality remained at the same level, only one in five reported that this quality worsened. For the remaining share of respondents it rather improved.
One of the most important aspects of any person’s life is the assessment of living conditions. Two-thirds of respondents live in two-room apartments, a quarter of respondents each live in three- and one-room apartments, respectively. Housing, as a rule, is owned; only 50% of respondents live in an apartment under a social tenancy agreement.
The majority of older people surveyed are satisfied with the size of their living space, and only a quarter of the total number feel constrained. More than a third of respondents even consider their homes to be spacious or very spacious.
The most pressing problems associated with the operation of residential premises are power outages, lack of hot water, water leaks, the presence of insects or rodents (cockroaches, bedbugs, mice), as well as deterioration of heating and water pipes, malfunction of air ducts, fungus damage to walls .
However, these problems were noted by less than one third of the respondents. The majority of older citizens surveyed do not experience these difficulties.
Health status is one of the most important indicators characterizing the quality of life of the population, especially older people.
44% of respondents rate their health average (between bad and good), which is generally understandable for older people age groups.
At the same time, the updated assessments given by respondents indicate a clear shift towards impaired health. Thus, the answer option “rather bad than good” was chosen by 27% of respondents, and the option “rather good than bad” - only 9%. The number of people who consider their health to be absolutely good is 2%, within the strategic error. However, those who believe that their health is unconditionally poor account for 18%. In other words, the share of people with good health(absolute and with reservations) equals 11%. The proportion of people with poor health (absolute and qualified) is 45%.
Even more indicative are the data obtained by identifying the dynamics of the respondents’ well-being.
1% of respondents assessed their health as having significantly improved compared to the previous year, and as slightly better by 6%. Two out of five elderly respondents believe that the dynamics of changes in their health have stabilized, that is, their health is the same as a year ago. These are decent indicators that positively indicate both the level of social services for the population and the performance of the healthcare system.
At the same time, however, more than half of the respondents note a negative trend in changes: their health is somewhat worse (35%) or much worse (16%) than a year ago. Self-rated health provides subjective indicators that can be influenced by certain random variables, but a large proportion of those who consider their health to have deteriorated indicates a potential increase in the need for medical and social services, and in the long term, for ongoing care.
This is also evidenced by the answers to the question “Do you have difficulty moving”?
Exactly one third of respondents do not experience any difficulties. However, the rest experience some difficulties (47%) or serious difficulties (20%). Thus, we can conclude that almost every fifth elderly person is already classified as having limited mobility, which has significant consequences in the form of the need for additional measures of social services, adaptation of the transport system, urban environment, etc.
To identify the degree of mobility of older people, they were asked what types of daily life activities cause them difficulties.
It turned out that, on average, older citizens find it easy to perform activities such as daily hygiene procedures(rather easy and not difficult at all, with a total of more than 90%); putting on clothes (in total about 90%); moving around the apartment (about 90%). At the same time, cooking already causes some difficulties: 39% have no difficulties, 46% find it rather easy than difficult to do it, 11% find it rather difficult, and finally, 4% of respondents experience absolute difficulties.
Thus, cooking is already an activity with which more and more older people find it difficult. Elderly citizens find it difficult to move outside the home, climb stairs, carry bags, and clean the apartment. These manifestations of limited mobility determine the need of people of older age groups for social services.
The health of respondents is also characterized by answers to questions about the diseases they have and their duration.
The presence of cardiovascular diseases is noted by 83% of respondents, 56% of respondents suffer from diseases of the musculoskeletal system, which causes difficulties in movement and poor mobility. Diseases of the gastrointestinal tract are noted by 58% of respondents, which is the result of deviations from healthy image life. Unfortunately, the Russian population has not yet sufficiently developed the skills of self-preservation behavior that would allow them to approach old age with a smaller range of diseases.
The study was unable to accurately determine the duration of the diseases. More than half of respondents indicate that the disease was diagnosed in them more than 10 years ago. However, 28% could not answer this question.
There is a point of view that older people are prone to suspiciousness and exaggeration of the severity of their illnesses. In order to clarify this problem and identify the “level of suspiciousness,” respondents were asked how exactly they assessed their health in comparison with the health of other people.
It can be stated that about a third of those surveyed already belong to the number of depressed individuals who consider themselves more painful than others and expect additional adversity.
The overall indicator characterizing the quality of life of the elderly population is life satisfaction.
Thus, a total of 46% of respondents are satisfied with their personal life, while 23% are not satisfied. About a third cannot assess their personal life neither in a positive nor in a negative aspect. Older people are much less satisfied with their health status, and this coincides with the above answers to questions about physical well-being. A total of 13% give a positive assessment, while 51% give a negative assessment. The number of those satisfied with the fulfillment of cultural and spiritual needs is a minority of respondents. This means that leisure activities with older people need to be improved.
One of the elements that determines general dissatisfaction with life is the socio-psychological phenomenon of depreciation, the victim of which was the elderly population in our country with the beginning of radical socio-economic reforms in the 90s of the twentieth century. Veterans and honored people felt the belittlement of their merits, the aimlessness of their lives, which had an extremely negative impact on their well-being and self-esteem. This is due both to the general stress of life in large cities and to the age-related difficulties of older people.
The presence of unpleasant and even tragic events, which can be a source of fear for an elderly person, also negatively affects their well-being and self-esteem. Thoughts about their own death worry 22% of respondents, but the possible loss of loved ones worries 48% of respondents.
Lack of demand in the profession is another source of decline in people’s vital activity: the majority of respondents’ professional careers have already ended, but some (18%) continue to worry about this factor.
Perhaps the most alarming changes are perceived as loneliness, inability to self-care, and memory loss, which are the main attributes of old age. More than half of respondents perceive loneliness painfully. Elderly people are also afraid of possible changes associated with health problems (memory deterioration, inability to self-care), which can make them more vulnerable, dependent, and in need of outside help.
The life of older people, unfortunately, includes losses - this may be due to demographic processes that are natural for a given age, accidents, or some negative social processes of our time. Half of the respondents experienced the loss of a life partner: most often it was a spouse, since the life expectancy of men in our country is much lower than the life expectancy of women. According to Rosstat, the average life expectancy for men in Russia is 69.5 years. For women, this figure is 77.7 years. If we take into account that men more often die in accidents, incidents or extreme situations during working age, it is not surprising that in older age groups the number of women significantly exceeds the number of men. 15% of respondents experienced the death of children.
Adverse events related to the health of loved ones are widespread (46%) and own health(52%). 8% experienced property loss. Unfortunately, professional crime has developed in Russia, which aims to seize the property of older people, primarily apartments. Measures taken by executive authorities and law enforcement agencies cannot guarantee the personal and property safety of older people.
It is interesting that only 28% of respondents noted the loss of savings, although all of them lost their savings in 1992, with the beginning of radical socio-economic reforms, and, possibly, in 1998, during the period of default. Perhaps the shock of losing your savings has already passed, or in comparison with the loss of loved ones, the loss of money is perceived as unimportant.
Assessing their level of security on a 10-point scale, 87% of respondents feel completely unprotected or rather unprotected. Elderly people feel deep discomfort in their lives due to the presence of many dangers or disturbing factors and in their complete, in their opinion, vulnerability in the face of existing dangers.
Accordingly, the feeling of uncertainty about the future is high.
In order to find out what fears destroy older people's confidence in the future, older citizens were asked the question “To what extent are you afraid or not afraid of getting into dangerous situations”?
Unfortunately, all of the listed options for dangerous events can happen to older people in life, and all of them cause anxiety among those surveyed.
The danger of becoming a victim of an assault, robbery, or murder worries 77% of respondents. 73% of older people are afraid of becoming a victim of an accident. Becoming a victim of a terrorist attack - 76%, being poisoned by food or water - 72%, being surrounded by aggressive, drunken hooligans - 79%.
Fears of being subject to blackmail, extortion, and being forced to give a bribe worry our respondents relatively less (57%), since they may be exposed mainly to petty bribery (for example, in healthcare institutions and housing and communal services). There is very significant concern about the risk of losing their livelihood (77%) - here you can see an echo of price liberalization and default, which have already deprived older people of all their savings. Elderly people are also afraid of becoming victims of scammers (75%) and losing their housing - 73% in total, but the most high level absolute anxiety 56%.
Anxiety factors include the fear of being unwanted by relatives (60% in total). It is possible that the relatively low indicators for this item are due to the fact that some respondents have already lost contact with relatives for various reasons and are actually lonely.
Having summarized the results of the Comprehensive Monitoring of the level and quality of life of the elderly population, the most characteristic social risks were identified, the presence of which jeopardizes the normal functioning of older citizens. These are the so-called internal risks associated with the peculiarities of the life situation of representatives of the study group. social group(showing its vulnerability and social insecurity compared to other groups):
2. Deterioration of health, risk of premature death. Human aging is accompanied by a steady increase in the risk of death, reflecting a decrease in the vitality of the body and its adaptive capabilities, which are lost compared to previous years of life. The general health status of older citizens in Russia is not only significantly worse than that of the population as a whole, but is generally in an extremely deplorable state.
According to the Comprehensive Monitoring of the Level and Quality of Life of Elderly Citizens, only 2% of older people rate their health as good. The rest, having chronic diseases heart (83%), lungs (39%), gastrointestinal tract (58%), musculoskeletal system (56%), are more pessimistic in their assessments. Moreover, according to the Russian Economic Health Monitoring, conducted by the Institute of Sociology of the Russian Academy of Sciences, almost half of older people (44%) simultaneously suffer from several diseases.
These so-called diseases of old age are the main causes of mortality - almost 60% of deaths in 2010 in Russia.
3. Risk of isolation (not needed by society). An elderly person runs the risk of becoming unnecessary and socially isolated. The problem of the lack of participation of older people is very acute. Often, many of them have solid professional and work experience that they could pass on to younger generations. However, retirement also ends work activity"new" pensioners. Their rich professional experience remains unclaimed; employers give preference to younger specialists, even with less work experience. Thus, 18% of participants in the Comprehensive Monitoring of the Level and Quality of Life of Older People pointed to lack of demand in the profession as one of the sources of anxiety and decreased vital activity.
4. Loss of family ties. Senior citizens suffer from many chronic diseases and health problems, often becoming a burden to their children and relatives. According to the Comprehensive Monitoring of the Level and Quality of Life of Elderly Citizens, 60% of elderly respondents expressed fears of being unwanted by relatives.
6. Risk of fraudulent activities. The risk of fraudulent activity is most likely in relation to older citizens, since they are more gullible and less literate compared to young people and middle-aged people. Perhaps this is the only social risk that is typical specifically for residents of megacities, where the cost of housing many times exceeds both the level of income of the population and the cost of similar housing in the regions. The fact of the presence of living space, which can become the object of persecution during the life of the elderly owner, as well as the level of anxiety associated with this, is confirmed by the results of the Comprehensive Monitoring of the Level and Quality of Life. The fears of senior citizens about possible fraudulent actions with housing are confirmed by their fears: 56% of respondents noted that they are very afraid of losing their housing, and 75% of seniors are to one degree or another afraid of becoming victims of scammers.
Thus, we can conclude that, given relatively acceptable living conditions, the level of anxiety in older people is very high. Feelings of fear, danger and vulnerability have a very negative impact on the quality of life of older citizens. Moreover, their fears and anxiety are caused both by the presence of specific facts and events of an objectively dangerous reality, and by personal losses and experiences. To reduce the level of anxiety, not only psychological and socio-cultural work with older people is necessary, but also strengthening law and order in Russia.
Assessing the standard of living of an elderly person in modern Russia
The article examines the main aspects of the life of older people in Russia in the context of pension, medical and social security.
Elderly people today are a category of the population that requires increased attention from both relatives (if older people have them) and society and the state as a whole. IN last years“elderly people have become a separate demographic, social and medical-biological category, requiring a special approach to solving their problems.”
Since the second half of the 1990s, work has been carried out in Russia aimed at improving the level and quality of life of the elderly population. However, research shows that this work is not systematic, comprehensive and systematic.
One of the significant shortcomings in the formation and implementation of state policy towards older people is the primary focus not on stimulating the development and use of the own potential of older people, but on their social protection through various mechanisms, including through the organization of social services.
In the context of an aging population and a projected increase in the number of people over working age, their share in the country’s population, an increase in the demographic burden and gender imbalances, maintaining existing approaches and stereotypes in relation to the elderly population is associated with serious political, financial and social risks.
Rosstat data indicate a steady growth in the number of elderly population (population over working age) in the Russian Federation in 2010-2015, outpacing the growth of the entire population of the country: if the total number of residents of Russia during this period increased by 2.5%, then the elderly population - by 10.5% (Table 1).
Introduction. In recent years, geriatric research has attracted much attention from researchers around the world, which is due, firstly, to the increase in the number of elderly and senile people in the population, secondly, to the trend towards an increase in the average human life expectancy, and thirdly, to the strengthening of the geriatric focus of medicine. The humanization of Russian society largely determines the new direction of social attitudes towards people of the older generation. Creating optimal conditions for them to conduct successful social life, adaptation, social security, and integration into society are today priority tasks in all developed countries of the world. The content of the concept “quality of life” is fundamental, since it largely determines the subject and methods of research, as well as the possibility of interpreting the results. Discussions about the content of this concept continue to this day. The most specific and accurate is the following: “Quality of life is an integral characteristic of a person’s physical, psychological, emotional and social functioning, based on his subjective perception.” As follows from the definition, quality of life is always related to health, since it is essentially an assessment of health based on the subjective opinion of the individual.
Relevance. Older people are a rapidly growing socio-demographic group, making up one fifth of the country's population. In the Russian Federation there are more than 30 million people over working age. The number of people of retirement age in Veliky Novgorod is 70547 according to Pension Fund Novgorod region and this share of the population will grow, as in the country as a whole. On this moment There is insufficient government work to improve the quality of life of older people. Social programs and projects in this area do not produce the desired results. To develop effective and adequate programs, it is necessary to have more detailed information about the state of the quality of life of the population, and the problems that older people themselves highlight in different areas life of Veliky Novgorod.
Target. Explore the quality of life of older people in Veliky Novgorod
Tasks: Determine the quality of life based on the subjective assessment of people, identify the connection between the quality of life and living conditions.
Research methodology. In our study, we surveyed older people: women over 55 years old, men over 60 years old. The minimum sample size was calculated using the formula: n=N x σ 2 x t 2 / N x Δ 2 +σ 2 x t 2 , (3) where n is the required sample size; N is the size of the population; σ - standard deviation; t - reliability coefficient equal to 1.96; Δ – maximum sampling error; when the values of σ and Δ were not determined in advance, but their maximum values were taken (σ=0.5, Δ=0.05). n=70547*0.5 2 *1.96 2 /70547*0.05 2 *0.5 2 *1.96 2 =400.
The sample size should be 400 respondents. The 503 people selected for our study can be considered a representative sample.
The survey was conducted over two weeks in the following points of the city: shopping center "Phoenix" (Schucheva St.), shopping center "Magnit" (Derzhavina St.), shopping center "Lenta" (Pskovskaya St.), shopping center "Lenta" (Velikaya St.) , shopping center "Marmalade" st. Lomonosova, shopping center "Bark" (Svobody St.), shopping center "Magnit" (Kochetov St.).
For statistical processing of the obtained quantitative data and plotting graphs, the SPSS Sigma Stat 3.0 program was used. Traditional descriptive statistics were used as statistical criteria. For pairwise comparisons between groups, the Student-Newman-Keuls test was used. To assess the fit of the distributions random variables Gaussian, the Kolmogorov–Smirnov normality test was used. Differences were considered statistically significant at p value< 0,05. Для представления полученных данных использовали такие показатели описательной статистики, как среднеарифметическое значение и ошибка среднего (О.С.).
Results of own research and their discussion. The number of people of retirement age in Veliky Novgorod is 70,547 according to the Pension Fund of the Novgorod Region, and this proportion of the population will grow, as in the country as a whole. There is no complete unanimity in determining what age to call elderly. For the purposes of our study, we consider reaching retirement age to be the beginning of old age (i.e., women over 55 years of age, men over 60 years of age). In the reference, scientific and special literature devoted to this issue, there is no clear, unambiguous concept of “elderly person”. Active discussions on this matter continue. . Mudrik A.V. the period of old age is considered from 50 to 60 years.. Khukhlaeva O. The lower limit of late age applies the time of retirement. According to the pension legislation of the Russian Federation retirement age occurs at age 55 for women and at age 60 for men.
The situation of the elderly population in the Russian Federation is complicated by reforms in the sphere of economics and political ideology. Unprepared the legislative framework to new demographic conditions. According to a study carried out in 2000 by T.Z. Kozlova, 40% of Moscow and 60% of Russian pensioners report the level of their quality of life as unsatisfactory. In 1997, 91% Russian pensioners The attitude remained that the state had to provide everyone with a living wage and work. . Such facts correspond to the results of the study, which claim that the paradigm "dominates in the public consciousness of Russian society today" survival", and the elderly population of Russia is considered only as an object of assistance who lives out the remaining years.
The works of L.A. are devoted to studying the quality of life of older people in Russia. Belyaeva, N.N. Kozlova, T.Z. Kozlova, N.I. Lapin and other researchers, but this is not enough to draw full conclusions. Researchers' data on the quality of life of the elderly population in the Novgorod region provide brief information. Before starting to develop recommendations and effective programs to improve the quality of life of older people in Veliky Novgorod, there is a need for a more detailed study of their quality of life in order to identify problems in various areas that may have a direct or indirect effect on the state of life and its satisfaction.
The study involved 503 people, average age was 64.2±0.6 years. Among the respondents, there were 248 non-working elderly people (49%), while 255 (51%) were working respondents. Gender characteristics of men - 117 people (23%) and women surveyed - 386 (77%).
Correlation by age: presented in the diagram (Fig. 1.).
The first objective of the study was to determine the quality of life based on people's subjective assessment by asking respondents: “How would you rate the quality of your life?”
Fig.1. Age composition respondents
Fig.2. Quality of life of the population
According to the diagram (Fig. 2), we observe that the largest percentage of the elderly population rate their quality of life as satisfactory - 42%, 36% of the population rate their quality of life as good, only 9% of the population rate it as excellent, and 13% of the population rate their quality of life as less than satisfactory. According to these estimates, we divided the surveyed population into five levels of quality of life from 1 to 5. From the data presented above, we can conclude that the level of quality of life has a large percentage of low indicators as subjectively assessed by the population.
Based on this, the next task in the study was to identify the relationship between quality of life and living conditions. All indicators were studied by the objective opinion of the elderly population. Respondents were asked to rate their satisfaction with the quality of the following areas of life on a five-point scale, where 5 is the highest score, 1 is the lowest score: housing conditions, financial situation, food, medical care, social sphere. The results were obtained, the average values were calculated and presented in the form of a histogram (Fig. 3).
Rice. 3. Satisfaction with quality of life, average indicators
For all of the areas of life we randomly selected, we did not find an average rating higher than “satisfactory (3).” The financial situation of older people and medical care received a lower rating. The indicators are 3.28 and 3.1, respectively.
For a more in-depth analysis, averages for all indicators of living conditions were calculated for individuals divided into groups according to their standard of living. The obtained data are presented in table form (Fig. 4).
In this case, mixed results were obtained and are statistically confirmed.
|
Quality of life level |
Housing conditions (F) |
Financial situation (MT) |
Power (P) |
Medicine |
Social sphere (C) |
Fig.4. Satisfaction with the quality of areas of life among people with at different levels quality of life, average indicators, *p≤0.05, **p≤0.01
Indicators of average values for groups provide more informative data. Of all the groups presented, there is no average rating higher than “satisfactory (3).” A relationship was identified between quality of life and the following areas of life: housing conditions, financial situation, medicine, social sphere (p≤0.05). No statistical relationship was found between nutrition and the level of quality of life according to subjective assessments of older people.
For clarity, the data is presented in the form of a histogram (Fig. 5).
Fig.5. Satisfaction with the quality of areas of life among persons with different levels of quality of life, average indicators, *p≤0.05, **p≤0.01
The presented diagram clearly shows that with an increase in indicators of living conditions, the quality of life also increases. It is necessary to pay attention, first of all, to the financial situation of older people and the quality of medical care provided to them. It is these criteria that have low indicators that correlate with the level of quality of life. Therefore, it is necessary to direct programs to improve the quality of life of older people to these areas first. With all this, 51% of respondents are working pensioners, which again reflects low material conditions and the impossibility of living only on pension benefits.
Conclusions. Having studied the quality of life of older people in Veliky Novgorod, we come to the conclusion that it is insufficient for the full physical, psychological, emotional and social functioning of a person. Of the areas of life we have studied, it is first necessary to pay attention to the area of medical care and material support for older people. The average population assessment of their financial situation is 3.28; the assessment of the scope of medical care is 3.1. A statistical relationship was identified between the level of satisfaction with the quality of life and the data in the sphere. Consequently, having low satisfaction with the quality of their financial situation and the scope of medical care, satisfaction with the quality of life of older people will have a low indicator.
Based on this, systems of measures aimed at improving the quality of life of older people in the region should be subject to organizational changes. It is necessary to constantly support the created projects to achieve their goals, and in our case, to improve the quality of life of older people.
Bibliography:
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- Mudrik A.V. Introduction to social pedagogy. Textbook for students. - M.: Institute of Practical Psychology, 1997.-365s
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1.1 Level and quality of life of pensioners
Recently, throughout the world there has been an increase in interest in the problem of the level and quality of life of people; it is attracting more and more attention from both researchers and practitioners involved in the development and implementation of social policy. Indicators of the level and quality of life are becoming indispensable and extremely important components of assessing the results of social policy.
In this regard, the main concepts with which we operate are “pensioner” and “pension”. Since little research has been conducted on this topic over the years, there are relatively few definitions. The first definition is given by V. Dahl, who says that “a pension or pension (French) is a salary in excess of salary, for distinction or length of service; salary upon retirement for service. Pensioner is a citizen receiving a pension.”
A pensioner is a person who receives a pension from public funds for old age (men over the age of 60 and women over the age of 55), disability or breadwinner, for long service.
“A working pensioner is a person who is on an old-age or disability pension; engaged in professional activities while maintaining a pension (in cases provided for by law).”
“Pension - regular (usually monthly) cash benefit, which is paid to individuals who:
Have reached retirement age (old age pension),
Due to disability they cannot work (disability pensions),
Lost a breadwinner (survivor pension).”
The labor market is the most important element of the national economic market. This determines the importance of a more detailed study of the basic laws of its formation and functioning. The labor market determines the degree of efficiency in the use of labor of hired workers, who supply the bulk of the labor force to production.
There are many definitions of the labor market. According to Doctor of Economic Sciences A. Kotlyar, “the labor market represents the aggregate demand and supply of labor, which, through the interaction of these two components, ensures the placement of the economically active population in areas of economic activity in industry, territorial, demographic and professional qualifications. In labor markets, relationships develop between employers and employees that contribute to the connection of labor with the means of production. This satisfies the need of the former for labor, and of the latter for wages».
Standard of living is a socio-economic category that expresses the degree of satisfaction of the material and cultural needs of people in the sense of the provision of consumer goods, which are characterized primarily by quantitative indicators abstracted from their qualitative meaning (amount of wages, income, volume of consumption of goods and services, level of consumption of food and industrial goods, length of working and free time, living conditions, level of education, health care, culture, etc.).
The standard of living is one of the most important social categories. The standard of living refers to the provision of the population with necessary material goods and services, the achieved level of their consumption and the degree of satisfaction of reasonable (rational) needs. This is how well-being is understood. The monetary value of goods and services actually consumed by an average household over a certain period of time and corresponding to a certain level of satisfaction of needs is the cost of living. In a broad sense, the concept of “standard of living of the population” also includes living conditions, work and employment, life and leisure, health, education, natural habitat, etc.
An increase in the standard of living (real income, consumption, provision of certain goods) creates the opportunity to improve the “quality of life”, its material basis.
Quality of life is a sociological category that expresses the quality of satisfaction of people’s material and cultural needs (quality of food, clothing, home comfort, quality of healthcare, education, service sector, environment, leisure, degree of satisfaction of needs for meaningful communication, knowledge, creative work, etc. same level of stressful situations, settlement structure, etc.)
The conditions necessary to improve the quality of life of pensioners are not limited to the level of consumption of goods and services. Quality of life includes the results of socio-economic and political development, such as average life expectancy, morbidity rates, the ability to use medical services, labor conditions and safety, accessibility of information, and ensuring human rights.
In a market economy, the most important components of the quality of life are the degree of social security, freedom of choice of a person, the state of nature and the social environment, and cultural and religious relations.
The perception of the quality of life from the point of view of the individual is almost always subjective: some people may consider their life completely unsatisfactory due to minor everyday difficulties, while others may be quite satisfied, although objectively their life is full of problems.
WHO experts define quality of life as “the way of life resulting from the combined influence of factors affecting health, happiness, including individual well-being in environment, satisfactory work, education, social success, as well as freedom, free action, justice and the absence of any oppression.”
Over the past decade, foreign researchers have proposed a number of methods for studying the quality of life of older people. According to these studies, the concept of quality of life for people in older age groups should include such components as the individual’s subjective satisfaction with his life and its circumstances, the objective functioning of the individual in his social roles, the availability of resources (material and financial conditions, the possibility of receiving social support), somatic and psychological state, social relationships, functioning in everyday life, satisfaction with oneself.
In Russia, the problems of criteria for assessing the quality of life of older people, identifying social projects and technologies aimed at improving the quality of life of this category of the population, taking into account these indicators, adjusting the practice of providing certain social services are closely related to assessing the quality of life of the population as a whole.
Modern indicators of the levels and quality of life of the Russian population are relatively low. According to international comparisons of GDP per capita carried out under the auspices of the Organization for Economic Cooperation and Development using purchasing power parity, we are in 40th place in the world, four times behind the United States in this indicator, and the average life expectancy at birth of residents of, for example, Norway exceeds our indicators by more than 12 years.
As a result, in terms of the human potential index - the international analogue of quality of life indicators - Russia finds itself in the sixth ten and falls into the group of developing countries. Another important integral indicator of the quality of life in the country, which also records the decline in the quality parameters of the population’s life, is the index of the intellectual potential of society, human capital per capita (the level of expenditures of the state, enterprises and citizens on education, healthcare and other industries social sphere), population vitality coefficient. This is an objective reality that cannot be ignored. But there are also subjective factors that also indicate an unsatisfactory situation with the quality of life in the country. This is confirmed by the results of a population survey conducted by the All-Russian Center for the Study of public opinion(VTsIOM).
The fact that the category “quality of life” is becoming decisive in social policy deserves attention and positive assessment. This indicates a strategic orientation and the rise of social support for the population to a higher level, implying something fundamentally different than survival. Currently, a number of scientific and government organizations and departments are developing a doctrine of state regulation of the quality of life of the Russian population based on progressive social technologies, as a coherent set of scientifically based approaches and views on the goals, objectives, methodology, content and use of administrative measures, financial resources and social technologies available to the institutions of federal and regional authorities, with the aim of changing the economic, socio-political and cultural conditions that ensure improving the quality of life of Russians.
With all the variety of interpretations of the concept of “quality of life,” it is necessary to highlight some evaluation criteria that would be applicable at the present stage to such a specific category as older people. These may include:
Ø indicators of the financial situation of older people (pension provision, changes in the structure of expenses of pensioner families in the conditions of market transformations), indicators of the prevalence of poverty and low-income among older people, and subjective assessment by older people of their financial situation;
Ø influence of the system state benefits on the financial and social situation of pensioners, medical care and drug provision;
Ø indicators of housing security and payment for utility services;
Ø development of the sphere of social services for older people and its impact on the social well-being of this category of citizens;
Ø the degree of interaction between state and public organizations in solving the problems of older people.
There are a number of factors that negatively affect the quality of problem solving for older people:
Ø limited financial and economic capabilities of the state;
Ø decreasing importance in society of such a fundamental value as “family”, which leads to a breakdown in the connection between generations of children and parents;
Ø the lack of formation of civil society leads to the fact that the role of public organizations in solving the problems of older citizens remains insignificant.
The totality of the listed problems characterizing the quality of life of an elderly person leads to the conclusion that in modern conditions pension is synonymous with poverty, which is associated with low levels of pension provision and the need for most retirees to remain in the labor market.
Dmitry Medvedev: Dear colleagues! We met in St. Petersburg, here, but the topic of the meeting, naturally, concerns the whole country, and I would like us to talk today about the problems of people of mature age.
Let me remind you that in our country almost every fifth person is an elderly person, as they say. We are talking about tens of millions of people, and the lives of these people should be a normal, decent, human life, if you like. It largely depends on us - on the state and not only on the state - how this will happen.
In recent years, we have worked to improve the quality of life of older people in our country. I mean social services and the provision of medical care, medicines, including vital drugs. Today, their prices rise slightly – about 3.5% per year. Although the situation is different, nevertheless, this is a kind of middle option: it is lower than the inflation rate. These are still important changes.
In 2012, high-tech medical care was provided to 200 thousand citizens over 56 years of age. The total number of complex operations, including joint replacement operations, has increased, and it has increased quite seriously: in 2009, 12 thousand such operations were performed, in 2012 - 31 thousand. As we all understand, these operations provide mobility to older people and, the most important thing is independence, at least some opportunity to work, to help your loved ones, children, grandchildren.
The regions of our country are implementing relevant regional programs to improve the quality of life of older citizens. Here we have representatives of the subjects, I would like you to briefly tell how successful these programs are, what is interesting about them, what is new. For example, I just visited a social home, I know that such homes are not available everywhere, not in all regions of our country, but this experience was not bad. We just spoke with the governor, and Georgy Sergeevich (G. Poltavchenko - Governor of St. Petersburg) I was told that up to 50 of these houses are going to be built, did I understand correctly?
G. Poltavchenko: Yes.
D. Medvedev: Yes, that is, naturally, in such a programmatic part this is a large construction project. Why am I talking about this? Because this is also a good experience, and yet everyone who lives there is, of course, primarily lonely people who have no relatives or relatives somewhere far away. But these elderly people live in normal conditions with normal services. I’m talking about this because this is not the case everywhere, and there are problems associated with the transfer of property to the balance sheet - the minister told me about this, there are problems with conducting all these operations, nevertheless, this is still an interesting experience.
There are also plenty of pressing problems: they write to the Government and appeal along party lines, as they say. The main problems are hospitalization, medicine and Spa treatment, and work, of course, for those who are still able to work.
It is obvious that a whole set of measures is needed that will create a modern, effective system of social support and social services for people in our country. This is precisely what the state program “Social Support for Citizens” is aimed at, which just recently, on November 29, was approved by the Government of the Russian Federation.
What are the specific tasks now? I'll name them. The first and perhaps very important one in terms of work in our country is that we have a very significant gap between regions in the level of access to medical care, this is true. In St. Petersburg there is one level, in Siberia - another, in the Far East - a third, but our people live everywhere, and these are people of mature, old age. Therefore, it is necessary to introduce different forms of medical care that are most adapted to the conditions of a particular area, of course, concerning lonely and sick people. We are talking about hospitals at home, foster care services, and mobile medical complexes. I examined a lot of them, they are especially in demand in rural areas and in the provinces, in remote areas, where medical care is, for obvious reasons, more difficult.
The second is the development of new forms social work. And I hope that this will ultimately eliminate the queue for services for older citizens. Since 2006, it has decreased by more than 7 times, but the queue remains quite significant: as far as I have data, it amounts to more than 35 thousand people for inpatient services and for home services in approximately equal proportions.
Third. Among social service institutions, only a little more than 1% are non-state institutions. Of course, the state will have to continue to largely carry out this work: for obvious reasons, there is no one to delegate it to. But on the other hand, public-private partnerships, including the use of youth volunteer movements, businesses, and charitable structures, are still a very correct form of work, and we need to be more active in this direction. By the way, we have special budget money allocated for this. There is a special program “Increasing efficiency state support socially oriented non-profit organizations." The money there is also decent and sufficient: 1.5 billion rubles for 2013.
The fourth thing I would like to say. Currently, about 10 million people over working age are employed in the economy, and more than 300 thousand pensioners are ready to work. We are talking about the upcoming shortage of labor resources - this is really such a talk of the town, but older people are, as a rule, experienced personnel who can benefit their country, their locality, and simply themselves, their loved ones, because While a person is working, he is known to live an active life. This is a personal question, everyone solves it in their own way, but in general this is correct, and you just need to try to extend your active professional longevity, including when working as mentors, in the vocational education system, and at enterprises.
Almost 15% of citizens of pre-retirement and retirement age express a desire to undergo vocational training or improve their qualifications and generally just gain some new knowledge. I just walked into this Veterans House and looked: our respected veterans were sitting, studying the computer. Good job! Georgy Sergeevich (addressing G. Poltavchenko), you nod your head correctly: we will need to help equip all the veterans’ councils in the city with appropriate computer classes, there are 18 of them. The costs are small, my colleagues told me, about 1 million rubles, in my opinion, but this will still create the opportunity for our dear veterans, our older generation joined to the values of civilization. Sometimes a computer is not a hindrance in this, and by the way, this is an opportunity to talk with loved ones through a computer, write some kind of letter - this is a good thing.
At the same time, 70% of such people who would like to improve their qualifications have at least a secondary or higher education, that is, they are quite prepared people and, of course, deserve better prospects than, say, working as a concierge or a security guard in a parking lot.
We have many examples of what in fact old age a person is able to lead an active, creative life. Tourism (as much as possible), cultural leisure should not just extend the years - they should make these years rich and fulfilling. Such examples should not be a happy exception, but a common situation. And here, of course, this is not only the task of the state: it is the task of the entire society, because it is obvious that the responsibility of each person extends not only to his children, but also to the older generation. This is how society works, this is normal. I expect that the heads of regions will be guided by precisely this wish, these principles.
Here is an approximate range of questions I have outlined. If you mention something else from among the possible proposals for improving the quality of life of older people, I will be glad. Let's listen to short speeches by our heads of ministries - the Ministry of Labor and the Ministry of Health. Maxim Anatolyevich Topilin (addressing M. Topilin - Minister of Labor and Social Protection), let's start with you.
M. Topilin: I will briefly dwell on the problems that the Ministry of Labor is solving together with relevant public organizations. And I'd like to start by emphasizing the demographic situation we're in. The fact that today we have 32 million people - people aged 60 years and older - only emphasizes the importance of the problem and the need to increase attention to older people, said Dmitry Anatolyevich. But at the same time, we must understand that in 10 years the cohort of such citizens of the Russian Federation will increase, according to our estimates, by 7–8 million people and there will be almost 40 million elderly people. Therefore, today we can just say that the development of infrastructure and attention to these categories of our fellow citizens is very important. At the same time, the tasks that have been set - increasing life expectancy - also require increased attention to this problem.
According to our forecasts, if today life expectancy is 70.3 years, then by 2018 this figure should be 74 years. At the same time, we have huge reserves. Compared to developed Western countries, life expectancy is, of course, not yet so high. If we take Switzerland, it is 82 years old, Italy is also 82 years old, France and Sweden are 81 years old, that is, we have something to work on and where to strive.
I would like to briefly say what we are doing in terms of issues related to financial support for older people. Firstly, this is, of course, the fact that constant work is being done to improve pension legislation. We are constantly indexing labor pensions, and according to the documents prepared by the Government, we have... If today the ratio of the average pension to the living wage of a pensioner is 180%, slightly lower - 179%, to be precise, then in the draft Strategy pension reform, which has been prepared, the ratio of the average pension to the living wage of a pensioner by 2030 will be 2.5–3 times. At the same time, the annual indexation of pensions allows us to ensure a real increase in pensions, and here we must consistently continue this policy.
I would like to note that it was prepared by the Government and literally recently signed by the President new law on the consumer basket, in accordance with which the approaches to the consumer basket have been revised. It is very important here that in our calculations and justifications we paid the most important attention to providing for the group of pensioners. Living wage for this category of citizens will increase only due to the structure of the consumer basket by 8–9%. At the same time, the most significant attention was paid to the set of food products that are included in the consumer basket (previously this set was quite seriously underestimated), and due to this, we will have indexation not next year, but in 2014 social pensions by 15%. Due to the structure alone, there will be an increase by exactly this figure, as well as by the consumer price index.
In your speech, Dmitry Anatolyevich, you focused on employment problems. In pursuance of the decisions that were made at the State Council, which met on these issues, we have prepared special amendments to the employment law and the Administrative Code. It so happened that just yesterday the ministry introduced them to the Government - amendments agreed upon with all ministries and departments. What is the essence of these proposals? Firstly, today, according to current legislation, a person can only be recognized as unemployed up to 60 and up to 55 years of age... That is, when one is already of retirement age, a citizen cannot be recognized as unemployed, and in this regard we give the right to regions and employment services in principle, engage in retraining of citizens after the age of 60. Now, in principle, there is no such right, and even if the regions want to do this, there is no opportunity to spend money for these purposes, therefore this law gives the subjects (and in our country employment powers have been transferred to the subjects) the right to provide such support and organize retraining and vocational training citizens of retirement age.
Also, we all know how negative society is and it has already become the talk of the town when job advertisements contain age restrictions. That is, citizens under 45 years of age are required, and this is perceived negatively, so the bill provides for a ban on employers announcing such restrictions. Of course, we believe that this will not completely solve the problem with employment, but at least it seems to me that such a restriction, such a ban will still contribute to a greater extent to the usual, I would say, normal attitude towards the fact that people over 45 years of age is, first of all, normal labor potential.
D. Medvedev: Yes, this is correct, because this kind of instructions, at least in moral terms, looks absolutely unworthy. This does not mean that we will bend the employer and say: you need a young, completely healthy person, and we oblige you to hire a pensioner. But at least it doesn’t look like endless pressure.
M. Topilin: Yes, we understand that this will happen in practice, but we still believe that it will be correct. And the publication of such information will be subject to appropriate sanctions in the Code of Administrative Offences.
We also continue to support programs in the regions related to the critical situation on the labor market, which provide mentoring, which you also mentioned. I hope that this bill will be quickly considered and adopted by the State Duma. We will make efforts to achieve this.
As for strengthening the material and technical base, I would focus on the fact that we, within the framework of regional programs and within the framework of supporting the constituent entities of the Russian Federation (every year 1 billion rubles are allocated for these programs), are continuing to develop both stationary types of service provision and regional provision , regional social transport services. Over the past year, such services were equipped with 600 vehicles, and we will continue this program. At the same time, a decision was made to allocate 350 million rubles from the Reserve Fund of the President of the Russian Federation, and just the other day such an order was signed. 38 regions will receive additional funding in the amount, as I said, of 350 million rubles for 80 inpatient social service institutions.
I would like to briefly mention that we continue to implement the “Accessible Environment” program and, Dmitry Anatolyevich, we consider this very important not only for citizens with disabilities, people with disabilities. What is being implemented within the framework of the “Accessible Environment” program is fundamentally positive for older citizens. This is simply convenience, this is a special transport that is convenient for use, these are handrails, these are ramps - the infrastructure that is convenient for everyone. Therefore, we believe that this is also a very serious area of work for older citizens.
And I would like to dwell very briefly on two points. You spoke about involving NPOs primarily in working with public organizations in the provision of services. We are now working very closely with the Ministry of Finance on the transition to normative per capita financing. There are such instructions, and I think we will be able to finally resolve this issue in the near future. Now we have practically agreed to submit to the Government a draft law on the fundamentals of social services. It went through a fairly detailed and lengthy discussion with public organizations, and I believe that in this bill we will be able to lay the foundations for the regions to legitimately make such decisions. Regulatory per capita financing (we have such experience) is when our money already goes to the person, and then this is the infrastructure and private nursing homes that we have, and what we can provide at home, attracting these structures to help social workers, this should receive very serious development.
If possible, the last one. We have already begun to prepare for the celebration of the 70th anniversary of Victory in the Great Patriotic War. I think that during this preparation we should probably think about the social support measures that will be provided in two years. I would ask that this also be noted in the draft protocol decision, so that the Ministry of Finance and I can begin to consider this topic. I mean that, of course, we treat this issue very carefully, but the amount of assistance that we provided before was only 5 thousand rubles. It seems to me that, after all, for the 70th anniversary of the Victory, in two years, we could provide more significant material assistance to those who took part in these events. Thank you.
D. Medvedev: Thanks a lot. Veronica Igorevna (addressing V. Skvortsova - Minister of Health), now you have the floor on medical care for older citizens.
V. Skvortsova: Thanks a lot. Dear Dmitry Anatolyevich! Dear meeting participants! Taking into account the increase in life expectancy throughout the world and in Russia and taking into account the tasks that we set for ourselves for the future, naturally, the trend towards increasing the number of our population in older age groups is becoming stable. But at the same time, an additional parallel trend appears to increase among this population the number of active individuals with high potential and vital energy and strength, experience, and skills, which makes these people one of the main engines of the country’s socio-economic development. In this regard, medicine sets itself two main tasks. The first is medical maintenance of active longevity. And secondly, it is slowing down and, if possible, overcoming certain age-associated diseases, which primarily include a wide range of cardiovascular diseases and diseases of the musculoskeletal system, and senile diabetes, and neurodegenerative diseases, and a number of others.
Of course, in the entire system of our measures Special attention We focus on early detection of diseases and, if possible, their correction. And I would like to draw your attention to the fact that since 2013 we have been resuming total medical examinations of the entire adult population - from 21 years of age to the most respected age. This medical examination will take place every three years and will include the entire necessary list of specialists, including a neurologist, ophthalmologist, gynecologist, urologist, other specialists, a wide range laboratory research, as well as instrumental and functional studies. In 2013, a total of about 30 million adults will undergo medical examination, including more than 6 million people over 60 years of age. Based on the results of clinical examination, risk groups are identified: today, 72% of people over 60 years of age have one or another chronic disease and more than 17 million people are under constant medical supervision.
Undoubtedly, special meaning for older people, they have the quality and accessibility of primary health care, assistance within walking distance, so special attention is paid to it. In cities, this is the development of a network of polyclinic care. As for rural areas, this is the development of the network and the non-reduction of its wide variety of medical organizations.
In the last two years, during which regional healthcare modernization programs were implemented, a large number of FAPs were recreated and updated (medical and midwifery station), today there are 39,810 of them, general medical practices - 3,741.
D. Medvedev: How many FAPs do we have?
V. Skvortsova: 39 810.
D. Medvedev: What was it some time ago? That is, is their number growing or decreasing?
V. Skvortsova: Growing by more than 200. We are increasing the number of FAPs...
D. Medvedev: Per year, right?
V. Skvortsova: Over the past two years, in the process of modernization. Moreover, not only is the number increasing, but currently several regions have presented us with standard designs of new modular first-aid stations, very convenient and modern, and we are currently replicating these first-aid stations in all regions of the country. Where possible, there is an active replacement of FAPs with general medical practices. Today there are 3741 of them, and 4441 rural outpatient clinics.
I would like to note that at the same time we are organizing in-patient clinics and home beds. To date, 232,414 beds have been provided and 7,044 first aid households have been established with training in basic first aid approaches.
Mobile forms of work are actively used. In 2012, 6.6 thousand mobile teams of specialists were formed, and more than 700 units of special mobile medical equipment were organized - these are mobile health centers, medical outpatient clinics, first aid stations, fluorographs, mammographs and some other options. In 2013, the constituent entities of the Russian Federation will additionally purchase 235 mobile medical complexes for the maximum possible medical examination coverage of the entire population. There is positive experience from a number of entities in organizing hospital buses to transport elderly people living in rural areas to medical institutions and, accordingly, back. The overall incidence in adults over 60 years of age was more than 66 million cases per year. This is 208 thousand diseases per 100 thousand population over 60 years of age. Accordingly, among all hospitalized patients, 28.7% were people from older age groups. Basically, assistance is provided in the general inpatient network, but I would like to draw attention to the fact that an additional 1.39 thousand gerontological beds have been deployed, the need for which is obvious, since both age-related and physiological characteristics, as well as the characteristics of the course of diseases, are becoming increasingly apparent , including features of pharmacokinetics and pharmacodynamics, the need to adjust drug therapy as the population ages. In fact, gerontology is a methodological basis that allows us to take into account the characteristics of sick older age groups in different profiles of medical care.
I would like to note that, as Dmitry Anatolyevich said in his opening speech, the volume of high-tech medical care provided to people in older age groups has increased significantly: in this one year - by 44.4%. This is due, firstly, to improving the quality of high-tech medical services themselves and reducing the risk of adverse outcomes, and on the other hand, to an increase in the volume of high-tech medical care provided by the constituent entities of the Russian Federation. In one year, the volume increased 3.2 times, and in 2012, only 62.1 thousand patients over 60 years of age received medical care in the constituent entities of the Russian Federation, and not in federal institutions.
I would also like to note that the volume of high-tech medical care has increased significantly in the main popular medical profiles: 2 times in the field of ophthalmology (mainly cataracts and glaucoma), 1.5 times in various cardiovascular diseases. In addition, for diseases of the musculoskeletal system, including those operations that Dmitry Anatolyevich spoke about: the number of endoprosthetics has increased by 34%.
I would like to note that the number of operations for people over 81 years of age has doubled. This is a very good indicator that characterizes two blocks of the system: on the one hand, the high professionalism of doctors, including anesthesiologists, who allow people of respectable age to undergo such complex operations. On the other hand, the availability of high-tech assistance is significantly increasing.
Particular attention is paid to veterans of the Great Patriotic War. Today we have 63 veterans’ hospitals in 56 constituent entities of the Russian Federation with a total capacity of 16.8 thousand beds. In 2011, 314.6 thousand people received treatment in these beds. And I would like to emphasize that we support a network of hospitals for veterans of the Great Patriotic War: for the holiday of the 65th anniversary of the Victory, they were overhauled and equipped modern equipment, the issue of drug provision for these hospitals is under special control.
A special point is the development of palliative care, nursing care and assistance to those patients who cannot be provided with more radical treatment. For the first time, at the end of 2011, we included the very concept of palliative care in the law on the fundamentals of protecting citizens’ health and included the care provided in medical organizations in the program of state guarantees of free care. Currently we have about 2 thousand - 1952 palliative beds, but in the coming years we will have to increase the number almost 10 times.
I would also like to note that in parallel, a network of nursing care beds is developing and today we have more than 21 thousand such beds deployed. To provide assistance to older people, of course, special medical education is needed, which allows doctors of different profiles to effectively treat people of older age groups. And the special direction - gerontology, we hope, will receive additional development in the near future. We have three mechanisms for training geriatricians, or gerontologists: through a two-year residency, through professional retraining for four months, and advanced training.
In 2012 alone, more than 1 thousand doctors from all 83 regions of the country underwent advanced training in the areas of gerontology. At the same time, special attention is paid to the training of methodologists themselves, gerontologists, or geriatricians. Currently, we have only 147 of them in the country. These are the specialists who allow doctors of various profiles to improve their qualifications in gerontology, so the ministry will now pay special attention to this. We have already updated the program for training specialists in gerontology, and I would like to say that a decision has been made to introduce the position of a chief freelance specialist in geriatrics - this will be a specialist who will actually coordinate this work in the country with his expert group.
Literally very briefly about drug provision. Dmitry Anatolyevich, I would just like to note that 55% of federal beneficiaries for free drug provision are people over 60 years of age, and in 2012 alone we allocated almost 19 billion rubles for the purchase medicines for federal beneficiaries. The average cost of an annual prescription was about 600 rubles. Along with this, the number of regional beneficiaries is 15 million, and of these, 4.6 million are people over 60 years of age. An additional 23.5 billion rubles were allocated from regional budgets for drug provision; the average cost of a prescription in the regions was 750 rubles. In addition, within the framework of high-cost nosologies, the number of provisions for people over 60 years of age is increasing - this is 27 thousand people (30% of the total), 7.3 billion rubles were spent in 2012, while the average cost per person per year is 75.6 thousand rubles. Thus, the work continues and plans for 2013 are expanding.
A special, whole range of measures was implemented to increase the availability of drug care. For this purpose, 3,599 FAPs are equipped with special pharmacy points; they are allowed to dispense medications at retail to persons living in rural areas. In addition, a three-month prescription period has been introduced, which reduces the number of visits to the doctor for prescriptions. I would like to note that we have introduced orders for medicines by telephone and by email, we have introduced social pharmacies, and we have provided discounts to senior citizens on medicines. In addition, together with the social service, a system for home delivery of medications has been specially developed. We have developed a whole system for identifying people in need of such delivery of medicines: this includes door-to-door visits, and identification during the provision of patronage services, and during the work of mobile medical teams, and when interviewing older people, including those living in special social homes and in houses veterans.
Separate work is underway to inform citizens about the possibilities of providing medications.
In addition to our routine everyday work, an entire subprogram within the framework of the state program “Health Development” is aimed at developing medical science, including scientific gerontology. And I would just like to end with the fact that three serious, comprehensive scientific programs will be implemented starting in 2013: development comprehensive programs active longevity, the development of early genetic screening, in fact, genetic certification for age-associated diseases, and the third is regenerative medicine, cellular and tissue, for the possibility of restoring functions impaired due to diseases. And we really hope that such a personalized approach, a predictive approach, will allow us to make a scientific contribution to active longevity. Thank you.
D. Medvedev: Thank you.
Closing remarks by D. Medvedev:
Thanks a lot. In my opening remarks, I specifically spoke about the exceptional importance of creating public-private partnerships to solve the problems of mature people or older people. Everything, of course, is good, we just don’t want to get too caught up in the kind of hyper-political correctness that some of our friendly states like to play at. It is not so important what we call the corresponding age category. But in fact, now, judging by the data that I have listed here, only 1% of social service institutions are non-state. Judging by our discussion, due to representation, the situation is exactly different, because in our country the most active representatives were representatives of the non-governmental sphere, volunteer movements, and non-profit organizations. This is good, it means that we are gradually starting to change this system, because anyway, for obvious reasons, it will never again be as state-owned as it was during the Soviet period.
To be honest, it wasn’t very good during the Soviet period. But those older - middle-aged and older people - know what it was, and we all visited such places when we visited our relatives or someone we knew. Therefore, we need to think about the future. Of course, I will give instructions: here I already have a whole set of proposals. It seems to me that the idea that one of the speakers voiced—to create a group to assess the state of legislation in this area—is absolutely correct. We need to create such a group, and clean up the legislation, and, of course, think about new ways and measures to support new movements and, of course, the state system as a whole, because it will bear the main burden for a very considerable time, a very significant period.
And so I would like to thank you all for your participation and express the hope that you will continue to be as caring as you are today. And many thanks to our veterans who received us today at the Veterans House, for everything you do, for your work and for your energy. Looking at you, you understand how to live. Goodbye!
Before the meeting, the head of the Government visited the Veterans House, where, in particular, he inspected the computer class.