Silver Opportunity Case Studies: Experiences with Building Integrated Services for Older Adults around Primary Health Care

Table of Contents

• Front Cover 1
• Contents 7
• Foreword 13
• Acknowledgments 15
• About the Editors 17
• Abbreviations 19
• Overview. Building Integrated Services for Older Adults around Primary Health Care: Challenges and Opportunities in Countries 21
• Introduction 21
• The Silver Opportunity Agenda 23
• Silver Opportunity, Volume 1, and the FIRE Framework 25
• Silver Opportunity, Volume 2: Expanding the Country-Level Evidence Base 26
• Key Findings from the Case Studies 30
• The Remainder of this Volume 34
• Notes 34
• References 34
• Chapter 1. Bangladesh: Reconfiguring Primary Health Care for an Aging Population 37
• Key Messages 37
• Background 38
• The Case Study Methodology 39
• Findings 39
• Recommendations 49
• Conclusion 51
• Note 52
• References 52
• Chapter 2. Colombia: Tackling Older-Adult Care Needs and Their Socioeconomic Determinants 55
• Key Messages 55
• Background 56
• The Landscape of Aging and Old Age in Colombia 56
• Regulation 62
• Design and Implementation of Public Policies on Aging and Old Age 63
• Challenges 65
• Recommendations 67
• Notes 67
• References 68
• Chapter 3. Mongolia: Meeting Older Adults’ Health Needs through PHC and Getting the Most from Screening Programs 71
• Key Messages 71
• Background 71
• The Case Study Methodology 73
• Case Study Findings 73
• Conclusions and Lessons 83
• Recommendations 0
• References 84
• Chapter 4. United Arab Emirates: Leveraging a Crisis to Advance Integrated Older-Adult Care 0
• Key Messages 87
• Aging Populations and the COVID-19 Pandemic 87
• Mitigating the Disruptions to Health Care Provision for Older Adults 88
• Lessons Learned 95
• Notes 100
• References 100
• Chapter 5. Long-Term Care for Aging Populations in Africa: Current Landscape, Key Challenges, and Policy Considerations 101
• Key Messages 101
• Africa’s Looming Demographic Shift 0
• The Current Landscape of Long-Term Care 104
• Policy Framework on Aging 106
• Key Challenges and Policy Considerations 109
• References 111
• Chapter 6. The Unmet Need: Assessing the Demand for and Supply of Home-Based Support for Older Adults with Disabilities in European Countries and Comparators 113
• Key Messages 113
• Introduction 114
• Study Design and Target Populations 114
• Key Findings 115
• Discussion 121
• Annex 6A Supplementary Tables 123
• Notes 129
• References 130
• Chapter 7 Conclusions and Policy Directions 133
• A Silver Opportunity to Strengthen Care Systems in Countries 133
• Broad Features of the Policy Environment for Older-Adult Care 134
• Policy and Implementation Experiences in the FIRE Domains 137
• The Way Forward: Strengthening Older-Adult Care on the Path to Universal Health Care 149
• Notes 151
• References 151
• Boxes 65
• Box 2.1 Model of Care in Bogotá: Implementation of the District Care System 65
• Box 4.1 Five Objectives of the Population-at-Risk Program 89
• Box 4.2 The Remote-Care Platform App 92
• Box 4.3 Estimated Cost Savings: Telemedicine Outpatient Consultations versusFace-to-Face Visits 96
• Figures 25
• Figure O.1 PHC-Centered Integrated Care for Older Adults: The FIRE Framework 25
• Figure 1.1 Percentage of the Population Age 60 and Older in Bangladesh, 2001–22 40
• Figure 1.2 Life Expectancy at Birth in Bangladesh, 1960–2020 40
• Figure 1.3 Age-Sex Pyramid in Bangladesh, 2001, 2011, 2022, and 2051 (Projected) 41
• Figure 1.4 Population Age Structure, by Sex, in Bangladesh, 1990, 2019 (Reference Scenario), and 2100 (Reference Scenario) 42
• Figure 1.5 Proportional Mortality from Noncommunicable Diseases in Bangladesh, 2011–22 43
• Figure 1.6 Proportional Mortality from Various Causes in Bangladesh, 2018 43
• Figure 2.1 Census Data for Colombia, 1985 and 2018 57
• Figure 2.2 Percentage of People Age 60 and Older in Colombia, by Age Group and Sex, 2015 59
• Figure 2.3 Percentage of Colombians Age 60 and Older, by Socioeconomic Status, 2015 60
• Figure 3.1 Age Pyramid of Mongolia, 2021 72
• Figure 3.2 Mongolian Sustainable Development Concept—2030 73
• Figure 3.3 Referral Procedure in Mongolia’s Health System 77
• Figure 3.4 Electronic Referral Procedure between Health Care Facilities in Mongolia 78
• Figure 3.5 Action Areas of the United Nations Framework “A Decade of Healthy Ageing” 84
• Figure 4.1 Population-at-Risk Program in the United Arab Emirates: The Journey of a Patient 90
• Figure 4.2 Numbers and Percentages of Patients Enrolled in the Population-at-Risk Program in the United Arab Emirates 91
• Figure 4.3 Organizational Structure of the Population-at-Risk Program in the United Arab Emirates 94
• Figure 4.4 Services Rendered by the Population-at-Risk Program in the United Arab Emirates 94
• Figure 4.5 Results of Two Patient Surveys of Satisfaction with the Population-at-Risk Program in the United Arab Emirates, 2021 97
• Figure 5.1 Population Age 60 and Older in Africa and Its Subregions, 2022 and 2050 (Projected) 103
• Figure 5.2 Population Age 60 and Older in Select African Countries, 2022 and 2050 (Projected) 103
• Figure 6.1 Country-Specific Trends in the Prevalence of ADL/IADL Limitations, 2011–18 116
• Figure 6.2 Country-Specific Trends in the Mean Extent of ADL/IADL Limitations, 2011–18 117
• Figure 6.3 Percentage of Older Adults with ADL/IADL Limitations Receiving Assistance 118
• Figure 6.4 Mean Prevalence and Extent of ADL/IADL Limitations in Relation to Mean Health Expenditure per Capita 119
• Figure 6.5 Unadjusted Annual Percentage Change in ADL/IADL Limitations and Receipt of Assistance 120
• Map 58
• Map 2.1  Proportion of the Elderly Population in Colombia by Territorial Entity, 2020 58
• Tables 42
• Table 1.1 Aging Population in Bangladesh, 2019 and 2050 (Projected) 42
• Table 1.2 Prevalence of Nine Chronic Health Conditions Used in Defining Multiple Morbidity in Bangladesh, by Sex, 2011 44
• Table 2.1 Demographic Indexes of Colombia, 2018–23 57
• Table 2.2 Most Frequent Pathologies among Colombia’s Older Adults 61
• Table 3.1 Documents Regulating the Provision of Care to Older Adults at PHC Centers in Mongolia 74
• Table 3.2 Availability and Use Indicators for Family and Soum Health Centers in Mongolia, 2021 75
• Table 3.3 Services for Older Adults at PHC Facilities in Mongolia 76
• Table 3.4 Per Capita Rate for PHC Facilities in Mongolia, 2018–22 80
• Table 3.5 Case-Based Payment Rate from the Health Insurance Fund to PHC Facilities in Mongolia, 2022 81
• Table 3.6 Claims Submitted to the Health Insurance Fund for the Four Types of Services Provided at PHC Facilities and Reimbursement in Mongolia, 2021 81
• Table 3.7 Accreditation Criteria for Services for Older Adults at PHC Facilities in Mongolia 82
• Table 4.1 Distribution of High-Risk Patients in Abu Dhabi, by Sex, Insurance, and Age Group, 2019 91
• Table 4.2 Services Delivered by Two Private Providers under the Population-at-Risk Program in the United Arab Emirates 95
• Table 4.3 Patient Case Studies and Outcomes Resulting from Enrollment in the Population-at-Risk Program 97
• Table 5.1 Total Population and Population Age 60 and Older, by World Region, 2022 and 2050 (Projected) 102
• Table 5.2 Models of Integrated Care Delivery for Older Adults in Africa 107
• Table 5.3 Sub-Saharan African Countries with Health Care Legislation for Older People 108
• Table 6A.1 Descriptive Analysis of the Sample, by Age and Sex, Various Years, 2011–18 123
• Table 6A.2 Descriptive Analysis of the Prevalence and Extent of ADL/IADL Limitations and Assistance Received, Various Years, 2011–18 126
• Table 7.1 Policy and Implementation Takeaways from the Silver Opportunity Case Studies 149