Malta Medical Students Association's
Policy Paper on Healthy Ageing March 2017
Healthy Ageing Malta Medical Students’ Association Policy Statement
Place:
University of Malta
Date of adoption: 28th March 2017 Date of expiry:
March 2020
Introduction The World Health Organisation defines healthy ageing as the process of optimising opportunities for health, participation, and security in order to enhance quality of life as people age, applying to both individuals and population groups. To ensure that adults live both longer and healthier, a comprehensive Global Strategy and Action Plan on Ageing and Health and a related resolution were adopted in May 2016 by the World Health Assembly. This strategy aims for every country to commit to action on healthy ageing. It advocates for the development of age-friendly environments and to orient health systems to the needs of the older population. The aim of the strategy is for every country to commit to action on healthy ageing. It calls for the development of agefriendly environments and the alignment of health systems to the needs of older populations. It highlights equity and human rights, drawing attention to the vital role of involving older adults in all decisions that concern them. It has been shown that with old age, there is a high risk of social isolation and poverty with limited access to affordable, high-quality health and social services. Hence, the need for strong public policies to ensure the sustainability of positive trends and to ensure that benefits of longer living is opened to everyone regardless of the locality in which they live or their socioeconomic group. “Healthy Ageing: A Challenge for Europe� highlights that the process of ageing is not necessarily equivalent to diminishing abilities and increasing burden, but rather an opportunity for continued healthy living and contribution to society. The European Union
goes to lengths to ascertain that basic human rights must be respected in all age groups, including the elderly. The National Statistics Officer of Malta revealed that as of 2015, 25.6% of the Maltese population was aged 60 and over, and amounted to 111,281. This is an increase of 2.8% from year 2014 and international data projects a continued increase in the proportion of elderly within Western nations. It is for this reason that there is a growing realisation that inadequate health and social practices with regards to elderly need to be addressed, and concepts and principles of healthy ageing must be applied within our society, now more than e er efore hilst recogni ing that nu erous agencies such as entru er i An an, as well as various governmental departments have already contributed much to improving the health care and social protection of the elderly, there is still much room for improvement. Acute care facilities, such as Mater Dei Hospital, find themselves strained to breaking point due to increased influx of elderly patients, many of whom require complex and long- term management. There remains an inadequate number of facilities dedicated to the long-term care of the elderly, even though the total bed capacity has been steadily increasing over recent years. Improvement in long-term care remains one of the best solutions available to ease the burden on acute facilities. Maltese law continues to stipulate that the responsibility of care rests with spouses and the system is geared towards the care of widowers or unmarried elderly, leaving a potentially large group of individuals without mainstream care facilities. Although Church and private homes continue to provide a significant portion of the beds required, specific niches seem to be catered for above others, and the state systems remain either inaccessible due to bureaucratic delays or hampered by co-financing mechanisms. Many elderly with more intensive requirements continue to suffer from a chronic low nurse to patient ratio in many of the facilities that should be dedicated to closer care of stricken elderly patients. Furthermore, communication between professionals remains informal and standards are not assured. Unfortunately, the system is further overloaded by a continued influx of elderly from the community. A significant portion of elderly patients moving into long-term care remain physically and mentally capable of living independent and fulfilling lives in the community. Such individuals are forced into long-term care due to issues including lack of health literacy necessary to make appropriate decisions about their lifestyle and
health care. Others find themselves unable to deal with the financial pressures of living within the community. Others simply do not have a safe home that allows them to lead a healthy life. In 2013, a survey was done by the NSO to measure income and living conditions in the elderly (aged 65 and over). These conditions were measured using 3 different indices:
At-risk-of-poverty: -
This was calculated at 14.9%. Of these, 71.4% owned their home.
Material deprivation: -
10.7% were living in households that could not afford to eat a meal with meat, chicken, fish, or a vegetarian equivalent every other day.
-
Additionally, 21.3% were living in households that could not afford unexpected financial expenses.
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Another aterial depri ation indicator is the a ility to keep one’s ho e adequately warm in winter. 23.5% of elderly persons were living in households that faced difficulties in affording such It also emerged that 7.1 per cent where living in severely materially deprived households,
At-risk-of-poverty or social exclusion: -
This showed a 20.8% at-risk-of-poverty or social exclusion for those aged 65 and over
Principles of healthy ageing are at face value easy measures to employ. Even though they require immense political will from all those involved, it will ultimately reap rewards for the elderly who will be able to live healthy and fulfilling lives, both within the community and in long-term care. This will also benefit the national economy due to greater job creation and money saved from adequate care of the elderly.
Main Text In view of the above, the Malta Medical Students Association:
1. Acknowledges that an excessive amount of space in Mater Dei Hospital and other acute facilities is being taken up by elderly patients who rather than acute care, require access to long-term rehabilitation or residence facilities, and thus: 
 a. Calls upon the government and health authorities to investigate fully the bureaucratic practices which currently limit the access of elderly to these facilities and delay necessary transfers to long-term facilities, with the hope that transferring and referral processes are optimized; b. Demands that the referral systems be thoroughly investigated and improved upon to ensure that elderly patients are provided a smooth and easy transition between different levels of care, and that such referral systems are rigorously checked with appropriate sanctions taken on individuals who refer patients improperly or with negligently incorrect or missing data; c. Insists that bed capacity must be increased further in these long-term facilities to further decrease the burden on acute care facilities and improve the efficiency at all stages of the national health system; 
 d. Also urges that acute care facilities should have specially designed geriatric wards which are appropriately staffed, in order to deal with complex geriatric cases which may present for acute management, before being stabilized for safe discharge back into the community or adequate and timely transfer to long-term care. 

2. Insists that whilst a large portion of resources must continue to be invested in acute care facilities, even more attention must be paid to rehabilitation and longterm facilities, and thus:
a. Calls for continued renewal and modernization of long-term facilities such as Karen Grech Hospital and the Saint Vincent de Paule Residence, to fulfil the standards set out by the European Union for such facilities; b. Calls for more funds to be made available by the government for invest in equipment specifically designed for geriatric rehabilitation throughout state residences and hospitals for the elderly; c. Calls for more equity in allocation of resources and funds between different medical and health specialties in order to respect the changing needs of our increasingly elderly population.
3. Congratulates the efforts being made to move care for the elderly into the community and urges the health authorities to continue moving in this direction, yet also: a. Urges the government to perform a wide consultation with all relevant stakeholder to assess how state-provided community services for the elderly, can be better optimized or improved upon to match the particular needs of our current elderly population, as well as the needs of their carers; b. Calls on the government to issue more centralized and accessible information as to the facilities and community-based interventions which are available for elderly patients with the view to improve awareness and reduce inappropriate admissions to acute care facilities; c. Insists that common standards, in-line with stipulations of the European Union, should be in place and that health authorities should inspect elderly care facilities regularly and hold them to the same high standard that other health facilities are held to; d. Further insists that similar standards must be imposed on all carers, both state-employed and opportunistic, to ensure an optimum quality of care within the community, facilitating admission to mid-term and long-term care when regular checks identify such quality to be lacking and harmful to the elderly patient.
4. Notes, with satisfaction, that massive strides are being made in making pharmaceuticals and community-based intervention more readily accessible for the growing elderly population, yet: a. Calls on the government to consult medical and pharmaceutical experts in order to review current medications on offer through the Schedule V, in order to bring these in-line with superior options being identified through international evidence-based research; b. Also notes that local research into optimal pharmaceutical and communitybased interventions for the elderly remains vastly lacking and thus calls on health authorities to incentivize more local studies with the aim of updating guidelines to ensure the best therapeutic benefit for our increasing geriatric population. 5. Strongly believes that healthy ageing is only achievable through the creation of an empowered elderly population, and to this end: a. Congratulates the drive by health authorities to increase the uptake by elderly of the Influenza vaccine, but calls also for campaigns to improve knowledge on essential pharmaceuticals such as antibiotics by the elderly population, with the hope that this improves appropriate self-administration and reduces erroneous demands being placed on pharmacists and medical physicians; b. Recognizes the good work being done by the Health Promotion Department in educating elderly about essential issues such as diabetes, but also calls on this department to more crucially educate this population about basic medical rights as patients, encouraging all elderly to take a more active role in their own health management; c. Insists that health promotion should specifically target the problem of falls in the elderly population, a factor that greatly increases morbidity and mortality in this population, and to this end, educating the elderly about appropriate falls prevention and management.
6. Aware that certain disease in the elderly is not always brought to the attention of the health care authorities in a timely manner allowing appropriate management, and thus: a. Calls for more universal screening for mental illness to be undertaken by General Practitioners in all of their professional contacts with elderly, and to institute appropriate primary care treatment with referral to secondary care and social workers when the severity of issues identified would require such a referral; b. Calls for elderly-appropriate lifestyle advice to be on offer in all primary care facilities and measures put in place to ensure such information can reach all elderly in the community, whether by means of written information or health professional house visits.
7. Affirms that appropriate geriatric care involves a multidisciplinary approach, and thus: a. Encourages greater cooperation and communication between members of the multidisciplinary team which are involved in the care of elderly within the community, as well as within state residences, by means of creating a secure patient information database forum for discussion and/or holding regular meetings to discuss key patients; b. Urges that current efforts to increase awareness about geriatric issues in primary care and in the community should be maintained and stepped up by devoting greater attention and dedicated teaching time in the course of studies for all health professions, coupled wherever possible with appropriate and sufficient patient exposure during training.
8. Deplores the current state of housing and community infrastructures that many elderly patients continue to make use of, identifying that in some cases these may lead to a dramatic increase in the risk of falls and hypothermia in the elderly population, and to this end:
a. Suggests that a system is set up whereby health professionals including, but not limited to Occupational Therapists visit the homes of community dwelling elderly as a form of national screening program to identify risk factors for falls and hypothermia, with the view of providing appropriate advice to elderly community residents and funds to those without the means to put in place the measures necessary to reduce mortality and chronic disability; b. Recognises that the state of pavements and roads across the Maltese islands poses a major risk factor for falls in elderly living within certain communities and thus strongly urges the government to make funds available to local councils with the aim of improving their state and increasing the safety of elderly; 
 c. Congratulates measures which are in place to keep elderly individuals mobile and active outside of their own homes by providing more agefriendly transportation but encourages local communities to incentivize elderly residents to lead healthier lives by providing easy access to exercise facilities, public parks and state buildings such as libraries; 
 d. Encourages the government to invest in building housing estates specifically designed for elderly populations in order to allow elderly residents to remain independent in the community, yet residing in safe and protected environments, by providing appropriate heat insulation, lifts and other forms of access and age friendly pavements, steps and utilities.
9. Insists that elderly abuse is a common and underestimated phenomenon and crimes against the elderly is on the rise, thus: a. Calls upon health authorities to commission further local studies on the issue of elderly abuse to further understand the nature of these crimes; 
 b. Insists that harsher penalties are put in place for violence, abuse and crimes that are committed against elderly populations, in view of their vulnerable nature; 

c. Brings the attention of this issue to the local police force and encourages the latter to be more stringent in investigating those who prey on the elderly; 
 d. Encourages local communities to sanction more events and outreaches aimed at increasing awareness about the needs of the elderly and engendering a greater respect to this population; e. Insists that elderly should be assisted in making greater efforts to protect themselves and their homes and ensure that appropriate security measures are in place and used at their residence.
10. Is fully aware that the current pension system is unsustainable and thus;
 a. Calls upon the government to review the system and commission experts to come up with alternative strategies that respect elderly needs whilst also ensuring the Maltese economy can withstand the support that should be offered; b. Encourages that more measures are made to reduce the financial burden on elderly individuals, including hidden energy and medical expenses, by encouraging more openness on the financial implications of inadequate housing and care, and offering wallet-friendly interventions which are costeffective to both the patient and the state.
References
1. Agency for Health Research and Quality. 2010. Higher nurse-patient ratios result in societal cost benefit for some hospital areas 2. Analytical Support on the Socio-Economic Impact of Social Protection Reforms. 2010. Annual National Report 2010 on Pensions, Health and Long-term care in Malta 3. Center for Health Improvement. 2009. California Health Policy Forum: Policy Brief 4. Clarke SP, Donaldson NE. 2008. Patient Safety and Quality: An Evidence-Based Handbook for Nurses 5. Commission of the European Union. 2000. Charter of Fundamental Rights of the European Union 6. European Commission DG on Employment, Social Affairs and Equal Opportunities. 2005. Long-term care in the European Union 7. Howe CL. 2009. Staffing Ratios in Nursing Homes 8. National Center for Chronic Disease Prevention and Health Promotion. 2011. Healthy Ageing: Helping people to live long and productive lives and enjoy a good quality of life 9. National Statistics Office of Malta. 2010. Social Protection: Malta and the EU 10. National Statistics Office of Malta. 2014. News Release – International Day of Older Persons 2014 11. National Statistics Office of Malta. 2015. News Release – Focus on children and the elderly 12. National Statistics Office of Malta. 2016. News Release – world population day 2015 13. Organisation for Economic Cooperation and Development. 2005. Annual Report of 2005
14. World Health Organisation. 2002. Active Ageing – A Policy Framework 15. World Health Organisation. 2012. Good Health Adds Life to Years: Global brief for World Health Day 2012 16. World Health Organisation. 2016. The Global strategy and action plan on ageing and health (2016-2020)