Электронный научный журнал

Introduction. Population aging is one of the most important social and economic challengesfacing European societies in the 21st century. This phenomenon will affect all the Member States and will influence almost all areas of EU action.

Currently at EU level the average age is 39.8 years, but according to the latest estimates provided by Eurostat, in 2060 the average age of citizens of the Union will be 47.2 years. The segment of the population aged 65 and over will represent in 2060 more than 29.3% of the EU population (compared to 16% in 2010).

In a few years the working age population of the EU will drop, while the number of residents aged 65 and over will continue to grow by nearly 2 million people per year. In 2060 the ratio of people of working age and older people will be 1 to 2 (currently this ratio is 1 to 4).

Moldovan population has the same characteristics of aging. Unlike European course where this process has lasted over the centuries, in Moldova pace aging process is much faster, aging coefficient reaching the critical level of 14.4%, while the critical level in most European countries is 12%.

Total population with older age exceeds the number of children, perpetuating demographic decline.

In Moldova every fourth person is aged between 60-64 years and 14.1% have more than 80 years.

Of the total number of older people two-thirds are living in rural areas and the population aging process is more advanced here, as people aged over 60 represent 15.2% of the total population, compared to 13.2% in urban areas. The maximum critic level of this indicator was exceeded in 11 districts.

According to forecast calculations of the Department of Social and Economic problems of the United Nations (UNDESA), in 2025 in Moldova people aged 60 and over will constitute 23.2%, while in 2050 their number will form 33.8 % of the entire population.

Also, the forecasts show that in 2025 the average life expectancy in our country can achieve 71.9 years (female 75.3, male 68.5 years).

For knowing and predicting the interdependencies between the influences of the demographic, social and economic factors, in terms of development, the "Study on Aging Population in the Republic of Moldova" (2011) project was completed, being financed by UN sources, with the support of UNFPA. In this project a research was conducted by evaluating the status of the elderly in several country regions and collecting objective information on the needs of the elderly, their family status, level of welfare, ensuring dwellings, and access to health and social services, employment opportunities in the labor market and social inclusion, etc.

Study results allowed evaluating basic socio-demographic status of the population aged 50 and older, the welfare aspects, issues related to job placement, health status, availability and demand for health and social services, issues on aging reflected in mass –media and others.

In the context of the International Plan of Action on Ageing adopted in Madrid in 2002, the Vienna Ministerial Declaration of 2012 - "Ensuring a society for all ages: Promoting quality of life and active aging," Moldova being a part of it, which provides integration of aging as a way to promote the rights, interests and welfare of the elderly, becoming a tool for obtaining balance and fairness for all ages of human society, Moldova has approved the Program for the integration of aging issues into policies followed by an Action Plan on the Implementation Guide map for the integration of aging issues into policies (2014-2016).

The Program for the integration aging issues into policies is intended to adapt to the inevitability of continuing aging of the population, and the purpose is to determine the basic objectives of ensuring a society for all ages and prioritizes promoting quality of life and active aging.

The Action Plan for 2014-2016 period provides measures structured for all the areas, according to the International Action Plan on Ageing objectives adopted in Madrid in 2002, the Regional Strategy for the Implementation of the Plan, which illustrates the objectives, actions and terms; allocation of responsibilities for implementation of each objective and indicators for monitoring progress on the first stage.

Taken together, the Programme for the integration of aging issues into policies and the strategic national Programme on Demographic Security of the Republic Moldova (2011-2025), are applied policies in order to overcome the demographic challenges facing Moldova, they propose an optimistic view of efficient exploitation of new opportunities, and combat stereotypes and disputes caused by aging.

To achieve these objectives the society should be sensitized on the rapid growth of the elderly population by providing a friendly environment for them and to maintain their physical and mental health.

Geriatric medical service in Moldova

The rapid demographic aging in Moldova and the demographic trends and forecasts for the 2010-2050 period, led to the creation of the geriatric medical service.

In Moldova the geriatric service is recognized at state level as a development priority of the healthcare system. Geriatric service has been included in major policy documents becoming guidelines for the Ministry of Health and National Health Policy (picture 1). In order to develop geriatric service in Moldova the National Center for Geriatrics and Gerontology (2007) was established within the Clinic Hospital of Ministry of Health. National Center for Geriatrics and Gerontology coordinates and monitors the activity of geriatric hospital and outpatient services in the country, promoting the state policy in the healthcare applied to the efficient functioning of geriatric service. Geriatric service mission is to ensure access to qualitative geriatric care in ambulatory and hospital conditions adjusted to the needs of elderly.

Since 2009 in all district and municipal hospitals short term (14 days) geriatric beds were introduced. To improve care and promote effective policies, encourage the geriatric services, a Ministry of Health order (07.09.2010) was issued: "Geriatric service activity in Moldova" which approved 10 regulatory acts of the geriatric service in the country:

1. Regulation on geriatric care organization, indications and contraindications for admission of the elderly patients in hospital geriatric wards.
2. Rules of procedure of the National Center for Geriatrics and Gerontology.
3. Rules of procedure of the geriatric consultative office from the outpatient department.
4. Job description papers of the Geriatric ward staff: geriatrician.
5. Job description papers of the Geriatric ward staff: geriatric medical assistant.
6. Job description papers of the Geriatric ward staff: geriatric nurse.
7. Job description papers of the Geriatric ward staff: consultants.
8. Job description papers of the Geriatric ward staff caregivers.
9. Geriatric patient assessment standard.
10. Geriatric Evaluation Form.

In the Teaching program of the Faculty of Medicine Year 6 students, starting with the year 2009-2010, the Geriatrics discipline was implemented. In 2009-2011 over 1500 students from this faculty were trained.

Geriatric doctors' training was performed through 2-year clinical internship after graduating residency in Internal Medicine specialty. Starting 2014 the Geriatrics specialty residency was introduced. So far 18 geriatric doctors have been trained.

With the aim of permanent training of doctors of different specializations in the field of geriatrics, Geriatric and Gerontology Course approved the programs for 3 new training cycles: gerontopulmonology, gerontocardiology and gerontorheumatology.

To improve the training process in geriatrics and gerontology of the students, residents and physicians, the Geriatric and Gerontology Course staff published some scientific works:

1. The methodical indication on ”Community-acquired pneumonia in the elderly” (2011).
2. The manual "Compendium of Geriatrics and Gerontology" (2012). In this manual practical geriatrics and gerontology, social gerontology, geriatric nursing and geriatric recovery problems are reflected.
3. The methodical indication on “Complex geriatric assessment principles” (2013).

The main scientific directions of the Gerontology Scientific Laboratory are:

• Determining risk factors of early senescence

• Development of new methods of diagnosis, treatment and prevention of diseases with high incidence in the elderly

• Peculiarities of cardiovascular diseases in the elderly in correlation with main geriatric syndromes

• Isolated systolic hypertension

• Mild cognitive impairment in the elderly

The research results led to the approval by the Ministry of Health of 10 regulative acts of geriatric service activity in Moldova.

Conclusion. In conclusion we find that the implementation of geriatric medical hospital andoutpatient services in the national health system, foundation of the geriatric physician specialty in academic and practical plan, starting scientific research in the field of gerontology is a good practice for state policy response to the demographic aging process in the country.

Perspectives.

• Opening of geriatric wards with 30-40 beds with average length of stay (1-4 months) for elderly patients with chronic multimorbidity, dependent, fragile, solitary, requiring geriatric care.

• Organizing a national geriatric network of home nursing.

The creation of multidisciplinary medical geriatric teams: the geriatrician, geriatric nurse and social worker being the core, and some involvement of the pharmacologist, physical therapist, nutritionist, psychiatrist, etc. 

References.

1. Negara A., Blaja-Lisnic N., Lupascu-Volentir F., Soric G., Cosciug E. Principiile evaluarii geriatrice complexe (Comprehensive geriatrics assessment). Moldova, 2013. 100 p.

2. Negara A., Parasca V. Arta Medica. 2012, Vol. 2, no. 49, pp. 5 – 8.

3. Negara A. Compendium de Geriatrie (Compendium of Geriatrics). Moldova, CEP “Medicina”, 2012. 360 p.

4. Bogdan C., Capisizu A., Stoianovici S., Elemente de nursing geriatric (Geriatrics nursing principles). Moldova, 2012. 264 p.

5. Health System Development Strategy for 2008 - 2017, the Government of Moldova no.1471/24.12.2007.

6. National Health Policy of the Republic of Moldova for the years 2007 - 2021, the Government of Moldova no.886/06.08.2007.

7. The Green Card of Moldova’s Population, National Commission for Population and Development. UNFPA, 2009. 56 p.

8. Ministry of Health of Moldova order no. 469/25.12.2007. The foundation of the National Center for Geriatrics and Gerontology, 2007.