Geriatric Medicine - Section of UEMS

Demography
Switzerland has a population of 7.6 million inhabitants (2007). German, French, Italian, and Rhaeto-Romanic are the four official Swiss languages. The Swiss population has more than doubled since the start of the 20th century. Population growth was highest between 1950 and 1970 when annual growth rates were approximately 1.4% of the total population. 20.3% of the population are foreign nationals, 87% of whom are of European origin. The largest group of these citizens is Italian, followed by nationals of Serbia and Montenegro, Portugal and Germany. In 2003, 15.7% of the total resident population were aged 65 years and older, 22.7% were aged 19 years or younger. Life expectancy at birth was 84.2 years for women and 79.4 years for men in 2007, and is expected to increase to 89.5, and 85.0 years, respectively, by 2050. In comparison with life expectancy rates with those of other countries, Switzerland’s inhabitants rank among the top ten in the world.

Retirement and labor force
Retirement is at age 65 years for men, and 63 years for women, with 15% of 65 to 70 year-old men and 9% of 63 to 70 year-old women continuing to work after retirement. Actual mean age of retirement was 64.7 years for men and 62.4 years for women, according to a recent 10-country European survey. According to this 2003 survey, in Switzerland the percentage of 55 to 59 year-old persons in the labor force was 86.7% for men, and 54.7% for women. These proportions are among the highest in Europe. For example, in Italy only 46.2% of 55 to 59 year-old men remained in the labor force.

Health care
Switzerland has the second most expensive health care system worldwide with 10.3% of gross domestic product spent on health care in 2007. Switzerland has a consumer-driven health care system with universal insurance coverage. In addition, a social insurance system ensures an adequate financial situation for more than 95% of the 1.2 million older inhabitants.
Decentralization of political power is marked in Switzerland, with the 26 cantons (comparable to states/provinces) being responsible for organizing health care in their geographical areas. The municipalities also play an important role related to care for elderly persons, primarily related to social and home care.
This principle of federalism has both advantages and disadvantages. On the one hand, this system increases the difficulties and complexities for coordinating acute hospital care or specialized health care in Switzerland, resulting in a lack of efficiency. On the other hand, regional authorities have the potential to respond to the specific needs and preferences of the local population. Decisions related to nursing home care or hospital beds (e.g. financing of a new hospital building) are often made in cantonal or municipal referendums, resulting in a high level of involvement of voters in health care planning issues.

Ethical guidelines
Key concerns related to the care of older persons are topics such as increasing health care costs, growing public awareness of patient autonomy, and challenges related to assisted suicide. The Swiss Academy of Medical Sciences issued guidelines for the care of disabled older persons (www.samw.ch, including English language versions of most recent guidelines).

Geriatrics
Since 2000, geriatrics is a board certified discipline with a three-year training program in addition to five years of training in internal or family medicine. Currently there are about 125 certified geriatricians in Switzerland, working primarily in Geriatric Centers in urban areas. Four of the five medical faculties in Switzerland (Basel, Bern, Geneva, Lausanne) have a chair in geriatric medicine.

Research in geriatrics
Clinical research has been shown to contribute to the development of better care for older persons. For example, models of preventive home visits and health risk appraisal that have been tested in the context of research projects are currently being evaluated for practice implementation in Switzerland. There are multiple other examples of Swiss-based research projects covering the range from basic science to technological innovation and clinical care.

Reference
This text is an updated extract of Schoenenberger A, Stuck AE. Health care for older persons in Switzerland: a country profile. J Am Geriatr Soc 2006;54:986-990.

Prof. Dr.

Andreas Stuck

Prof. med.

Christophe Graf