Geriatric Medicine in the land of mountains and fjords

Marit Apeland Alfsvåg is leader of the Geriatric Department at Stavanger University Hospital and Prof Annette Hylen Ranhoff is Professor of Geriatric Medicine at the University of Bergen.

Norway has a long coast, fjords and huge mountain areas. The population is small with only 5 million people, and 4 million live in cities.

Norway has become part of the wave of ageing. The percentage of people who are 65 years or older is about 14% and is estimated to reach 23% in 2030. The care of the older people has been declared to be a national priority.

The health care system is strongly based on primary care, both as first line medical management and as a gatekeeper to secondary care.

Norway has a national health service with universal coverage for medical care in hospitals.  It also covers other necessary health services when the yearly cost per patient is over a certain limit (about Kr250 in 2013). Home care nursing is mostly covered by the municipalities. Long term care in nursing homes is covered for the first three months. For longer stays the patient has to pay 75-85% of their income up to a certain limit. Overall, 20% of persons over 65 years’ age are receiving home care services, 5% are living in sheltered housing with care services, and 6% are living in nursing homes.

The hospitals are run by the government. Home care, rehabilitation and nursing homes are mainly community based, and the two economies are divided. Since 2011 there has been a strong shift of economic responsibility for older patients from the hospitals to the communities called “Samhandlingsreformen” (The Cooperation-reform).

Care in the community

Among over-80s, more than half receive some kind of home-nursing, home-help and assistance in activities of daily living. To allocate services many municipalities are using an “order-and –supply” model, assessing needs on an individual basis. Families generally still take a big responsibility for the care and safety of their older relatives and support them to stay in their own homes as long as it is practicable.

Nursing homes are part of community care. GPs and an increasing number of specialized nursing home physicians are responsible for the medical services. The average age of the residents is 83 years, and about 80% suffer from dementia and many of them have psychological and behavioural symptoms.


Geriatric medicine and hospital services

Figures show that 35% – 45% of patients in medical departments are 75+ years old. About 11% of those have the common geriatric syndromes. Geriatric units with an interdisciplinary approach have been the preferred way to organize acute hospital care for older people, and there are units in all big and most middle-sized hospitals. All stroke patients regardless of age are recommended to be treated in acute stroke units.

As a curiosity, one could mention that Norway has the highest incidence of hip fractures in the world; surprisingly this is not related to snow and ice and outdoor falls. Some hospitals have organized orthogeriatric units with comprehensive geriatric, interdisciplinary assessment.

Geriatric outpatient clinics in the hospitals are often responsible for assessment of cognitive impairment and dementia, falls, urinary incontinence and functional impairment. In our hospital there is an organized cooperation between psychiatrists, neurologists and geriatric medicine in the assessment of dementia.


The Norwegian Geriatric Society

The Norwegian Geriatric Society was founded in 1973. Geriatric medicine became a subspeciality of internal medicine in 1975. All medical university departments have geriatric medicine on their curriculum, and geriatric medicine is increasingly popular among young doctors.

The society will host the congress of European geriatric medicine, EUGMS, in Oslo 2015: “Geriatric Medicine for Future Europeans”.


Staying healthy

Ingrid Espelid, the lady who taught Norway about nutrition and cooking on national TV for thirty years, has successfully reached the age of 89 and is still sharing her secrets: eating healthy, balanced and nice-looking food, being physically active and enjoying the company of good friends. Let’s do that!

More information on geriatric medicine in Norway can be found in Hazzard’s Geriatric Medicine and Gerontology 2009, pp. 79-80, written by Prof. Anette Hylen Ranhoff.