Home care (ADI) for frail elderly people is growing, albeit slightly, but it is essential to strengthen local care in order not to be affected by demographic pressure. In the next 20 years, it is estimated that approximately 6 million people over 65 will be alone and at risk of isolation. Today, 64% of people with dementia, one of the main causes of loss of autonomy in the elderly, are not taken care of in a social health facility, with a huge burden for millions of families. It should also be considered that, where there is less home care, visits to the emergency room and inappropriate hospitalizations increase and, therefore, the expenditure borne by the health service. This is what emerges from the 2024 Survey by Italia Longeva which, starting from data from the Ministry of Health’s information system, photographs the trend of Long-term care in our country, that is, the local care offered to frail citizens in response to the different levels of intensity of their needs.
The report was presented today at the Ministry of Health during the ninth edition of the ‘Stati generali dell’assistenza a lungo termine – Long-Term Care Nine’, the annual event of Italia Longeva that brings together the actors who, at various levels, deal with planning and managing assistance to the elderly. The survey shows that the need for home care for the elderly is enormous – a note reports – despite the growth trend of over 65s who benefit from home care, which has gone from 252 thousand (1.95% of the total) in 2014 to almost 550 thousand (3.89%) in 2023. According to the data provided by the Regions to the Ministry of Health, there would be over 80 thousand more elderly people who were assisted at home in the last year compared to 2022, a positive figure, but which does not seem to find confirmation in the ‘real world’. Then there is another 2.88% of over 65s (404,235 people) who have received residential care (Rsa) in the last year. An acceleration of the offer of Adi and Rsa services is more than ever a priority to prevent the failure to manage aging from becoming the real disease of the country, increasingly called to deal with the consequences of demographic pressure: increased burden of chronicity, disability and non-self-sufficiency that amplify health needs, moreover in a context of thinning of family networks.
“We read with cautious optimism the numbers on the ADI provided by the Regions – comments Roberto Bernabei, president of Italia Longeva – The aging of the population and the increase in related diseases (diabetes, cardiovascular diseases, dementia) require us to step on the gas to strengthen and make assistance in the territory more homogeneous. We continue to focus on the ADI because we are convinced that it is the only possible response of a health service capable of dealing with and not suffering the assistance of the elderly. We think about the visits to the emergency room and inappropriate hospitalizations, but also about the need to guarantee the safety of fragile patients who are discharged from the hospital, especially those who are without family support”.
In this regard – the note continues – 600 thousand inappropriate days of hospitalization per year have been calculated for the over 70s (source Agenas on Sdo 2019 data), only for the management of chronic conditions such as diabetes and hypertension, which contribute to overcrowding in hospitals and the increase in waiting lists, as well as to the phenomenon of late discharges due to the lack of availability of care in the territory. “Strengthening long-term care services, especially home care – adds Bernabei – means building a bridge between hospital and home, and finally providing appropriate assistance to our elderly”.
The urgency of strengthening the Long-term care offer – for Italia Longeva – must also be read in light of the growing burden of neurodegenerative diseases in a country with 14.3 million elderly people, of which over 4.5 million are 80 years old, and forecasts that estimate a 34% share of over 65s in the next 20 years, with over 80s exceeding 6 million. The 2024 Survey has opened a window on dementia, a condition that affects 1.5 million people in Italy, of which over 600 thousand are affected by Alzheimer’s disease, in addition to another 900 thousand Italians diagnosed with pre-dementia. These numbers, combined with the economic impact of the management and treatment of patients with dementia – 23.6 billion euros, of which over 60% are entirely borne by families – give the measure of the massive demand for specific care and support that are necessary and will be increasingly necessary in the near future.
“This year too, Italia Longeva has offered a snapshot of the state of the art of Long-term care throughout the country, adding a specific focus on the neurodegenerative diseases that accompany the aging of the population – says Davide Vetrano, geriatrician and epidemiologist, scientific consultant of Italia Longeva – Italy is making progress in the organization and provision of Adi and Rsa services, which represent the two crucial components of a coherent healthcare response to the needs of the most fragile elderly. The geographical panorama of home care remains extremely varied: Molise, Abruzzo, Basilicata, Tuscany and Umbria are those that do best, with Adi coverage rates above 4.5%. As for residential care, just over 400 thousand over-65s have benefited from it in the last year, once again with a patchy distribution: higher residential rates are recorded in the Northern regions – autonomous province of Trento (9.9%), Veneto (5.9%), Piedmont (5.4%), Lombardy (4.6%) and the province of Bolzano (4.3%) – and are mostly related to the peculiar characteristics of the social fabric”.
To effectively address the frailty of the elderly, “it is necessary – Bernabei lists – to have specific care settings, knowledge and skills, and the system’s ability to ensure continuity of care between different levels and places of care. First of all, by taking care of the elderly in their home environment for as long as possible, providing adequate medical, nursing and rehabilitation care and support to maintain a good quality of life”.
“But the guiding principle of this assistance network – concludes the president of Italia Longeva – is to find the best assistance solution for the patient in the territory, depending on the complexity of his needs: Adi services, access to RSA, long-term care facilities or hospices, in which each actor, professional, caregiver, plays his part to provide coherent answers to the needs of the elderly”.
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