geriatrics in Malta

Geriatric medicine in Malta
Notes on the health care system and the specialty of geriatric medicine

The Maltese Islands (archipelago of 3 main islands: Malta, Gozo, Comino)
 

Background information
Total land area: 315 km²
Total population: 404,000 (census of 2005); 50.3% females
Population density: 1,282 km² (most densely populated EU member state; Netherlands 2nd at 480 residents/km²)
Life expectancy: 80.4 yrs (females); 76.4 yrs (males)
% pop elderly: 13.7% 65 yrs+ (10.8% 65 - 79 yrs, 2.9% 80 yrs+)
Projected to increase to 27% by 2050.



Health Care system
Mixture of state-run and private-run services
 

Public Health Service
  • 5 hospitals:
 General acute (St Luke's) 900 beds
  Oncology, neurorehab, skin (Boffa) 50 beds
  Psychiatry (Mount Carmel) 500 beds
  For elderly (Zammit Clapp) 60 beds
  Gozo general 250 beds

 

  • 8 Community Health Centres provide primary health services Mainly family practitioner service Some specialized clinics eg for diabetic patients


Some general statements about the public health service

  • Services are all free
  • Funded from general taxation
  • At present 7.4% of GDP spent on health
  • Patients have to pay for medication unless inpatients or if cannot afford (means tested) or if suffer from specified 'chronic diseases'.
  • List of chronic diseases includes IHD, hypertension, glaucoma, disabling Parkinson's disease etc. Of relevance to elderly: at present dementia not included; medication for hyperlipidaemia only free till age 75 yrs.
  • Have to pay for aids and equipment (unless cannot afford if means tested)
  • Regarding human resources:

All health care professional groups catered for by local undergraduate courses (except dietetics/nutritionists).

For postgraduate training/qualifications doctors and other staff usually go abroad.

Enough human resources to cater for local need (present problems: new therapy graduates unemployed; brain drain of doctors).

Private Health Service

  • 3 hospitals provide inpatient and outpatient services.
    Their bed capacity accounts for 12.5% of total number of acute hospital beds for Malta.
  • Several clinics.
  • Many family practitioners (usually work single handed; very few group practices).
  • Government employed specialists/consultants can and do work privately.
  • 25% of population has some kind of private health insurance.


Some landmarks which helped the development of geriatric medicine in Malta
(Before 1987, care of the elderly associated solely with long-stay institutions which were either state-run or church-run)

1987 Creation of the post of Parliamentary Secretary for the Care of the Elderly within the Ministry of Social Policy/Ministry of Health. Served as a political catalyst to concentrate on a spectrum of needed services for the elderly.
From 1987 - 1992

  • Appointment of first consultant geriatrician within public health service.
  • Opening of an assessment and rehabilitation hospital specifically for the elderly with an emphasis on enabling them to return back into the community.
  • Introduction of community services (home helpers, meals on wheels, day centres etc).
  • Introduction of module on geriatric medicine for medical students.
  • Opening of Institute of Gerontology (University of Malta) to organise postgraduate courses targeted at a multidisciplinary audience.
  • Opening of United Nations International Institute on Ageing (INIA) to organize training programmes for developing countries.

Where has geriatric medicine arrived in Malta

  • Recognised as a separate specialty
  • 5 consultant geriatricians Work mainly at Zammit Clapp Hospital - assessment and rehabilitation unit
    60 beds + outpatients + day hospital services
    Interdisciplinary practice; try and concentrate on frail elderly (mean age 80 years).
    Specialty clinics - memory, falls, movement disorders, continence.
    Teaching and research
    Hospital activity data for 2005: 965 admissions; length of stay 22 days;
    973 OP/DH new referrals; 872 patients assessed at other hospitals
    Consultants also work at St Vincent de Paule Residence (SVPR) -
    long-stay complex of 1100 beds which provides hospital/nursing/residential/respite facilities. Each consultant responsible for 220 beds.
  • The Geriatric Medicine Society of Malta officially launched in 2005.


Some present problems/pending issues

  • Not based on the main acute hospital site (but in 2007 new general hospital to open with a 25 bedded ward for geriatric medicine!).
  • No official department of geriatric medicine with clinical chairman (always imminent!).
  • No state-run community services to provide more intensive care for the elderly in their own homes (deemed too expensive and no future plans formulated!).
  • Although geriatricians look after residents at SVPR, they are not involved in the process of deciding who gets admitted by an admissions board - 'social criteria considered more essential than clinical criteria'.


Some bombshells for 2006:

First bombshell:
New 'step-down' wards open in the grounds of the local psychiatric hospital to take 'social cases' from the main acute hospital awaiting transfer to SVPR. Geriatricians 'encouraged' to look after patients there.

Second bombshell:
Geriatric unit to move out of ZCH and move into a new 280 'rehabilitation hospital for all age groups' still to be built in the grounds of SVPR.

Third bombshell:
Government committed to create 100 new long-stay beds per year.

The following data shows that there already has been a lot of emphasis on long-stay institutions:
 

Places in longstay institutions 1992 2003  
Private homes 88 804  
State-run residential homes 194 538  
Church-run homes 567 643  
SVPR 1007 1100  
Total 1856 3085 (+ 1229)
Recipients of Home Help service
'to prevent entry into an institution' 2006 3446 (+1380)


Rough estimate % population of elderly in long-stay
institutions based on 2005 census:

If residents, 65 years + 5.6% (3100 places/55,000 pop)
If residents all 75 years + 14.2% (3100/21,800 pop)

Contacts in Malta

Dr., MD FRCPE DGM MA

Mark Vasallo

mark-anthony.vassallo@gov.mt
+35622081822
Dr.

John Cordina

john.j.cordina@gov.mt