geriatrics in Iceland

Geriatrics and Elderly Care in Iceland Pálmi V. Jónsson, M.D., FACP
Chief of Geriatrics
Landspitali University Hospital
Associate Professor of Geriatrics
University of Iceland, School of Medicine

Average life expectancy at birth -2001

Highest both sexes: Iceland
Lowes both sexes: Denmark – difference 3 years for women, 4 years for men

The Elderly in Iceland
Total population of 290.570 with 11.5% older than 65
Life expectancy at birth 82.6 years for females and 78.4 years for men in 2001-2
Life expectancy at age 65 was 20.7 years for females and 17.5 years for males in 2001-2 and at the age of 80, 9.2 years for women and 7.7 years for men.
Infant mortality per 1000 live births 5.5
9.4% of the Gross Domestic Production is spent on health care in 2001
Health care expenditure was 3015 Euros per inhabitant/yr in 2001
The Icelandic Health Care System; A Nationalised System
One insurance carrier, equal access
Financed by taxes.Co-payment 25-30%
Index family spends 2.8% out of pocket
The elderly pay 1/3 compared to the young
No co-payment for hospitalisation or rehabilitation
85-90 % satisfaction with the system
The Elderly and Icelandic Law
First set in 1982. Revised in 1989 and 1999
The autonomy shall be respected
Entitlement to services that are needed
Needs met at a level that is relevant and economic
Supported to live at home as long as possible
Access to a nursing home when such a need arises
The Organisation of the Elderly Care
Co-ordinated from the community health centre
Home nursing care and home help
Meals on wheels
Respite care, day care
Access to geriatric assessment units
Pre-admission assessment for a nursing home placement
  Training in Geriatrics
First basic training in Internal Medicine for 4 years
First 3 years in Iceland
Geriatrics a subspecialty, two years of training
Can be provided in Iceland at the University Hospital, but trainees encouraged to train abroad, at least in part
Icelandic authorities accept training from USA and Europe and grant specialty status based on that
Being considered to provide Geriatrics as a subspecialty of Family Medicine after two years of training
Georpsychiatric training not available in Iceland

The University Hospital Reykjavik
Department of Geriatrics –
serving a population of 170.000
Beds are 120 – 14 geriatricians trained in US, Britain and Sweden
One acute care unit for the elderly and a consultation service
Two dementia units
One 7 day rehab unit, two 5 day rehab units
Palliative care unit
Day hospital
Memory Clinic and Falls Clinic and General Clinic
Problem: Bed blockers! ? If RUG´S payment system will solve this issue
Geriatric Medicine
Most of ambulatory geriatric medicine provided at the University Hospital Geriatric Clinic
Two geriatricians in part-time ambulatory practice
Geriatricians and GP´s provide Nursing Home service, 50:50
CME is on voluntary basis, but two weeks of pay and daily allowances, airfare and meeting fees are provided for
Weekly Journal Club for geriatricians at the University Hospital – well attended
Gerontological Research Institute
Established in 1999, a bridge between the University Hospital and Faculty of Medicine
An umbrella for multidiciplinary research
AGES-RS (Aging, Genes/Environment Suseptibility-Reykjavik Study), collaborative study with NIA on aging: 30 years of data and in current pahse 7000 participants, studied on 3 half day visits
Decode Genetics, genetics of longevity and Alzheimer´s disease
Various smaller studies
Professional developement
Geriatric medicine is taught at the medical school
1 out of 10 weeks in clinical internal medicine, 4th year (out of 6)
Lectures in fourth and fifth year
Participation in preclinical training
Icelandic Geriatrics Society established in 1989
Icelandic Gerontological Society established in the 70´s
Assessment in Icelandic Geriatric Care
The PNHA is one type of geriatric assessment
There is one acute geriatric asssessment unit (24 beds) and 120 postacute/dementia hospitals beds
The MDS-NH (RAI) system is now mandatory in all Nursing homes and they are being paid for based on MDS-RUGS
The MDS-HC is being implemented in Home Care
The MDS-Post Acute Care and Mental Health instruments implemented in early 2006 at the University Hospital
The MDS-Acute Care instrument is being evaluated
The road to successful high quality cost-effective care is through assessment.
Applications of MDS Data

Icelandic Nursing Homes
9.3% of the elderly live in nursing/residential homes- 65% are NH beds
Half of all NH beds are in Reykjavík, but greater part of the elderly population – thus still relative shortage there
Pension fund income goes toward the cost, but not equity.
Maximum fee of 2500$/month
The elderly keeps 250$/month for personal expenditure
More About the Icelandic System
Good in theory, but less than perfect
Imperfect co-ordination between nursing and home help – but now active plans to unite the service
Part of the problem has been that social service is financed by the county council but home nursing service, community health, nursing home and hospital care by the state
GP´s do not make regular house calls to the elderly in home care
Home health care less developed than nursing home care
Maldistribution of nursing home beds – least number in Reykjavik
Patients from hospitals are not prioritised to nursing homes
The Ministry of Health does not manage and synchronize the system
Important Issues in the Care of the Elderly in Reykjavik
Need for a hospital based home care – already agreed on professionally to combine the hospital and community service to deliver advanced home care – avaits financing.
Attention to quality of care
Financing of the system needs to be reassessed. The University hospital is moving towards DRG´s but that system does not fit well for geriatrics, rehabilitation or psychiatric care.

contacts in Iceland

Prof., Chief of Geriatrics

Pálmi V. Jónsson
+354 543 9891

Anna Björg Jónsdóttir