dear colleague, I am really interested in geriatric topics - anyway - we do not have any mobile clinics in our country focused on elderly. I will be very happy if I could follow your research. Andrea Pokorná form Czech Republic

Dear friend

This issue is very important. We tested an intervention based on geriatrics service at hospital, and the results were very positive but we do not have experience in research in priamry or community care. I believe that, talking about primary care, the alternative is to train family physicians or general practitioners, I do not think that have a geriatrician would be cost effective, but, yes, we have to prove it. I attach one of our papers and also, we wrote a book titled Geriatrics for the family physician, unfortunately it is in spanis. Also we will start a project in emergencies rooms, evaluation an intervention based on geritricians as consultants.

In New Mexico (USA) where there are many elders living in rural areas, I noticed the importance of home health and hospice care. These multidisciplinary teams visit the older adult in their home, train family in some of the care, and the services are covered under the Medicare insurance program. I mention this as I see this as a mobile team, despite the fact that the team members are not there at the same time.

My research has been around elder abuse forensic teams (resolving situations/protecting elders). The Elder Justice Act (included in the Obama Care legislation-Affordable Care Act) highlights the value of these teams and suggests they also be done as mobile teams, responding to various geographic areas with the full interdisciplinary team. Glad you are interested in this growing need!

I believe that it would significantly improve QoL and health status. Sooner diagnose of most disease increase probability of minimazing its effect. And some elderly people are unable to reach doctor by themselves.

When we have provided scientific research on centenarians it happened that geriatrician called an ambulance to pneumonia patient. She was all alone at home, unable to go out from bed and her chances to stay alive would be really low if doctor wouldn't came there.

Health status depends on many factors. However, accessability to health care systems is one of theses factors. Rural and urban regions are vary regarding accessability even in developed countries. Most of the people living in rural areas can not afford many of health care services. Particularly, services for chronic problems (all levels of prevention) which are frequent in seniors are costly and expensive because of high level professioncies, especial devices and materials.

One of the differences between rural and urban areas is the distance and availability of the services. Mobile clinics can help to solve this issue, but the question is how they should pay for these services? What is the differences between the cost of mobile and usual health services? In other words, availability is part of accessibility. People should be able to pay the costs and expenses of the services, otherwise they are not accessible, although the services are available.

The other issue is the training and education required in order to use these sort of services in rural areas. I think we can focus on health aging which considers all aspects of health incluing physical, mental, and social.

Mobile clinics may affect the HRQOL of seniors, but the cost efficiency should be evaluated.

It's wonderful that these services are providing at homes. I can assume that these services improve HRQOL of the seniors receiving these services.

On the other hand, the problem with the governmental services is sustainability of the services. The changes in the policies and budgetting may impact the services.

In some countries, geriatricians and their orders are not adopted and admited by the other specialities. I do not know about your country, but this would be another challenge with this method. However, I inseast that these sorts of services are perfectly impacting HRQOL of seniors.

Thanks for all the researchers,

I would like to add my note about the current situation in India. The geriatric population size of India is much bigger than size of the total population of many countries. The geriatric population in India are really facing alot of discrimination from the society and family. The financial and medical support is very minimal and I observed it practically with my comparative study of health status in Geriatrics living in slum and non slums.

While collecting the data and discussing with the elderly population went so emotional and every elder person has their own odd story to share. The situation is so worst in slums. Many elders have per capita income of 3-4 US$/month, 85% of the patients have min. of 1 complaint and 30% of the elders in slums are confined to bed and 56% elders are living alone without any support and most horrible that 65% of the elders left in the parks and bus stations by their children due to burden in the family.

My paper is under peer-review process and wish to share the results what the actual situation and problems in India and I hope this conditions may be similar or different with the geography.

But Geriatric Life is really Vulnerable in India.

Use this link to know my recent paper on improving adherence in Geriatrics.

https://www.researchgate.net/publication/227348627_Geriatric_Care_Improving_adherence_through_Pharmacy_Practice

Article Geriatric Care: Improving adherence through Pharmacy Practice

Dear colleague

Your question is very interesting and relevant because, in my opinion, one of the problems experienced in the elderly population is the decreased ability and motivation to move.

The fact that, especially in regions with a dispersed or rural demographics, will make even more sense.

my interest is in building a model for this type of service that also includes prevention (health education).

Dear colleagues!

Interesting question! I truly believe that good attention to our patients depends on primary care, proximity care, home care and so on. I recently revised some of the international guidelines that points out the need of geriatric and palliative care population for this kind of policy and organization.

Although all the conferences and scientific investigation, I think we are far away from this in Europe.

I recently knew that in Africa (yes, in Africa!) there are a great empowerment of teams on community to care of their population. They just can´t go to the great hospitals as we do in the cities, so they have support near population. Even with minimal conditions (is true), but their vision of care is on the right way, I believe.

We should think of this proximity care to our rural environments but also to all the population that could have attention at primary care or at home. There also evidence that that kind of care includes reduce of costs and is effective: a change on health systems is needed everywhere and this can take part of the solution.

I am writing this from a state called Kerala which is in India. In India though we claim to have a strong family network, just like in any developed county, the relationships are weakening. As such, Government has taken this initiative of Paliative clinics with support from the local public with the following objectives: 1. Getting people from a region together

2. Discussing the problems of the patients and their family 3. Enlisting the support of those willing to spend a minimum of two hours per week 4. Structured training

5. Encouraging the group to plan and organize locally relevant services 5. Defying action plan in association with the health care professionals 6. Mobilizing fund for the project locally through Governmental support. These clinics operate mainly in rural areas. I have personally visited such clinics and have found the particiants looking forward to the next meeting, which shows that their QOL is definitely improving.

A proper demographic study and its associated rapid changes may soon create a flat graph to all accredited praise for communal or locally organised care systems. Since the feminisation of the nursing and care industry, especially older people´s care is fast losing its stance, as more women, than ever before tend to now pursue same and equal career as their male counterpart. This tend to pose a danger for locally organised group, where women seem to be the major contributors to paid or voluntary services.

The task should not be left for the women alone. Therefore, more doors for male carers should be opened, so that the gap be covered.

It starts with encouraging fathers embark on paternity leave.

It sounds as if I have totally digressed? No, not at all.

I am taking Africa, if not in general, but some part of it where the word geriatric centre or nursing homes seem to be nearly not in existence, because of the so to say "strong family ties" as an example. Here you see, almost only the women showing interest and it may not be long that it reaches the stage of lack of personnel. Although, the strong family network is hopefully, presently playing a great role, but may not continue to be if the whole topic is not brought out to sensitise the locality, government and family.

I am wondering if some of the issues for the elderly in some of the newly industrialized [last hundred years] are akin to what happened England and the US when the elderly went from being central to families, economy [they owned he farm or the small business] to when adults were the main workers, workers often moved to where the jobs were and the old no longer had a major role to play...and they were looked upon as simply persons in need of care etc.

For myself I find that this new situation has, at least in the United States, created a culture in which the old are looked upon as 'those in need of care' ....while adults, who also need care eg, food, transportation, health care etc are viewed as the 'doer' of society and not as those in need of care. [in part because in the US there are already many structures in place to meet the needs of adults eg. transportation,

take out food, ATM machines, stores open til 10PM

Kate Lindemann

Senior Scholar Institute of Aging and Policy.