The quality of care of the elderly.

During this century, the number of people over 65 years of age increased 4-fold, and that of 85 year olds, 7-fold in England. In Sweden, 80% of those over 85 live alone, and those over 65 use 60% of the health care resources. One hospital bed is required for 28 nonagenarians, of whom 20% live in institutions in America and 50% in Sweden. Of institutional residents, 90% need help dressing, bathing, and/or moving, and 69% have difficulty seeing. Of octagenarians, 20% are senile, and every fourth woman over 65 has suffered fractures caused by osteopenia, the incidence of which increases by 6% per year. The Swedish staff of nurses aids employed for the care of the elderly was 95,000 in 1984 and 123,000 in 1988. An increase of between 40,000 and 70,000 is going to be needed in the future. In addition, the annual staff turnover of 25% has to be replaced, and replacements have to be found for the annual sick absenteeism of 45 days per employee. The cost for absenteeism and turnover in this category of staff alone amounts to 3% of the total Swedish health care budget. Even though the present quality of the care for the elderly is frequently considered unsatisfactory in Sweden, both in institutions and at home, the task to improve or even only to maintain this quality is monumental.