Juan Humberto Medina-Chávez
Coordinación Técnica de Excelencia Clínica, Coordinación de Unidades Médicas de Alta Especialidad, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Distrito Federal, México.
Correspondence: Juan Humberto Medina-Chávez
In recent decades, the world has gone through the phenomenon called "global graying".
With the improvement in quality of life, health, and services –added to falling birth rates and mortality and increased life expectancy – there is a trend towards a demographic transition in which the population pyramids are inverted.
Developing countries are no exception to this phenomenon, which means that they face the consequences of aging in a more complex context, in which multiple health, social, functional, and economic problems are mixed.1,2 In this regard, Mexico ranks as the eleventh most populous country and seventh among those with accelerated aging: it will only take 19 years for its population of older adults to double, while Australia, Sweden, USA, and France all took 70 years or more. This phenomenon will imply a profound transformation in the spectrum of social demands and the reorganization of many institutions, which must respond to the needs of employment, housing, education, and health related to an age structure that ceases to be predominantly young, moving quickly to stages of full aging.
In 2000, 6.9 million people over 60 were living in Mexico; in 2030 it will be 22.2 million, and it is expected by the middle of this century to reach 36.2 million.3 Notably, 72% of this increase will occur starting in 2020, giving the country and the Instituto Mexicano del Seguro Social just a decade to prepare the conditions to adequately address this process.
In fact, the rapid growth of the elderly population in Mexico is accompanied by an increase in chronic diseases and individuals with greater physiological vulnerability, which makes their management more complex and which requires increased consumption of resources due to high demand for care, so it is necessary to have tools to identify needs, detect risks, and provide specialized care to older adults in order to develop a treatment and follow-up plan for the problems presented by older adults.
The Instituto Mexicano del Seguro Social (IMSS) does not escape from this situation, because the insured population is now 20 years older than the general population (IMSS, DATAMARTs. Estadísticas Médicas, 2012). However, not only is it more aged, but the growth rate of the elderly is higher than in any other group: in 1990, the proportion of adults over age 60 was 9.2%, in 2000 it was 12.3%, and in 2010 it was 16.1%; that is, this age group has doubled in the last 20 years and is estimated to reach 28% by 2050, which will means that one out of four beneficiaries will be an older adult. In fact, 30-50%4 of the hospitalized population is older adults, forcing workers of all categories to be trained and sensitized in dealing with this age group.
Therefore, one of the major challenges of demographic aging is its impact on health systems. Because of their condition, older adults require comprehensive, interdisciplinary assessment and care, involving special considerations based on biological aspects proper to the aging organism, those related to the activities of daily living and functionality, and others associated with psychological, social, and family concepts inherent to this age, with more care models aimed at "taking care" rather than "healing", at maintaining health, controlling risk factors, and promoting autonomy, functional independence, and integration into the family and community. Definitely if older adults’ care is not planned and a culture of good aging is not developed, this will leave us in a collapse, because the old people of tomorrow is us.
IMSS has developed the Plan Geriátrico Institucional GeriatrIMSS, an organized response to the aging of the insured population, which seeks to promote healthy aging, implementation of geriatric care in medical units, and the development of clinical research in this area.
However, the complexity of care of the older adult requires a level of knowledge, attitudes, and specialized skills that are not covered in the basic university education. Promoting, developing, and disseminating knowledge about it seems urgent, which is why this issue of Revista de Enfermería del IMSS is dedicated to the older adult, since clinical care that does not take into account the peculiarities of aging will give bad results, will be unable to prevent complications and disability, and economic, social and moral costs will be high.
It is definitely necessary to address the older adult in an interdisciplinary way with staff trained or specialized in detecting physiological vulnerability and preventing risks and complications during and at discharge from hospitalization, in order to limit unwanted consequences and disease, and to improve the functionality and quality of life, including that of the family. In this multiple intervention model, effective communication and respect take on a key role; equally important is the medicine prescribed by the doctor, the health mobilization and education carried out by the nurse, or the socio-familiar intervention for the caregiver done by the social worker. In addition, the family or caregiver are part of the team, they are integrated into decision-making and trained in the different techniques to continue management and prevention interventions at home. Without a comprehensive and interdisciplinary management, therapeutic or rehabilitative goals may not be achieved.
The philosophy of GeriatrIMSS is to meet the needs and problems of aging with flexible and versatile health staff, with solid knowledge of the affairs of the aging process, who in their everyday professional activity generates a culture towards good aging. The aim is to develop skills that enable comprehensive care in which psychosocial and functional aspects are as familiar as the technical-clinical, with a humanistic vision of geriatric medicine, a high sense of bioethics, and social willingness for help and participation.
We all are or will be in contact with older adults; especially we health professionals will increasingly see difficulties related to aging in our activities, so it is necessary to break paradigms and move towards a new perspective where interdisciplinarity and communication are the basis of health care.
Finally, the process of demographic aging of Mexico is not reversible, since tomorrow's seniors have already been born,4 and it is better to prepare the ground for when we get to that age.
Bloom DE, Canning D, Fink G. The graying of global population and its macroeconomic consequences. PGDA Working Paper No. 47. Cambridge, MA, US; Harvard University; 2009. [Cited 2014 Nov 27]. Available from: http://www.hsph.harvard.edu/program-on-the-global-demography-of-aging/WorkingPapers/2009/PGDA_WP_47.pdf
Miró-G CA. Transición sdemográfica y envejecimiento demográfico. En: Papeles de Población. 2003;9(35):9-28.
Secretaría de Gobernación (SEGOB), Consejo Nacional de Población. Envejecimiento. Índices demográficos para adultos mayores. [Cited 2014 Nov 27]. Available from: http://www.conapo.gob.mx/en/CONAPO/Envejecimiento
Instituto Nacional de Estadística y Geografía (INEGI). Cuadro Resumen. Indicadores de demografía y población. México: INEGI; 2014. [Cited 2014 Nov 27]. Available from: http://www3.inegi.org.mx/Sistemas/temas/Default.aspx?s=est&c=17484
The author declares that there is no personal or institutional conflict of interest of a professional, financial, or commercial nature, during the planning, execution, writing of this article.