Sot. SC;. Hed.Vol. 23.So. I?. pp. 1327-1332. 1956 PnntedinGrearBriram. Allnghrs reser-..ed zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA 027'.9536 86 5300 +O.OO Copright t 1986 Pcrgamon Journ& Ltd MEDICAL CARE AND SOCIAL SUPPORT FOR THE ELDERLY IN SWITZERLAND: IMBALANCE AND MIX ALFREDO MORABIA,' FRAXCOIS LOEW: and HILKE TAKLA' ‘University Medical Policlinic, Cantonal Hospital and ‘University Geriatric Hospital, Geneva, Switzerland Abstract-Medicalization refers to the current practice of providing medical solutions to broad social problems facing the old. This approach is destined to bring about serious economic and socioculturai dilemmas in the coming decades due to the aging trends in Switzerland. On the one hand, additional bed requirements will double, really jeopardizing the present federal savings policy on health and welfare. On the other side, ignoring the specific needs of nearly 20% of the population (as the 65 and over age group are expected to reach in the year 2010), will provoke unwielding social/political tensions. Assigning medical answers to social needs is both expensive and inadequate. This proposition is illustrated by two aspects of Geneva’s medical care system for the aged: (a) At the University Geriatric Hospital a large proportion of the patients are admitted for purely social reasons (‘home maintenance impossible’). The long term bed stays, medically unjustified, constrains the optimal functioning of this acute care and rehabilitation hospital. The prolonged length of institutionalization reduces the capacity of the elderly out-patients to carry on autonomously. This observation is confirmed by many Swiss medical and sociological surveys which reveal that institutionalization is rarely necessary or desirable in the IO to 20 first years of post-retirement provided there is an adequate system of social and primary care services available. (b) The drug prescription to those 65 and over consulting at the out-patient department of the Geneva University Medical Policlinic typically amounts to excessive prescription for women and especially of psychoactive drugs. In many cases, the prescribed care appears as an unsatisfactory substitute for loneliness and the lack of regular mental or social activity. Medicalization thus often means negation of existing social problems and marginalization in nursing homes and hospitals. Social support to the elderly zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHG by a well-balanced system of health and social welfare emphasizing their autonomy and dignity is an alternative to medicalization. Its goals should include reducing inequalities, lowering financial burdens, rationalizing medico-social support and creating the conditions indispensable to an active independant life for the aged. Key words-medical care, social support, welfare state, aged WHAT IS OLD AGE? Why is old age generally synonymous with retirement age? From a biological point of view, such a definition is entirely erroneous. There is no caesura in the human life-cycle that would define a given chro- nological age as the turning point between adulthood and old age. From a social point of view, retirement as termination of a wage or salaried activity does not apply to the vast majority of women who nevertheless make up the bulk of the elderly. It is only from an economical point of view that old age and retirement age are linked. Old people heavily rely on State benefits and, as a group, they tend to become more and more important in number. In Switzerland retire- ment age is at present 62 for women and 65 for men. Most households are financed by the man’s income and age 65 may thus be considered the beginning of a greater economic dependence to social welfare. In 1941 the Swiss population older than 65 was 8.5% as compared to 13.4% in 1978 and an estimated 20% in the year 2010 [l]. The percentage of people older than 80 is expected to rise from 2.56% in 1980 to 4.3 1% in 2010 [I]. A period of economic recession enhances the consequences of this population shift: early retirement, unemployment, loss of professional qualification as new technologies evolve. These fac- tors increase the number of prematurely old people dependent on the welfare state. Linking old age and retirement thus defines an important social entity with its own specific claims. It is a group that lives on savings acquired during active life but also heavily depends on social security benefits. In this context, three fundamental aspects of social life stand out: previous occupational experi- ence, livelihood, and the peculiar situation of women. (a) Living conditions of the retired person or the retired couple are closely related to their previous economic status. Aging is not a general phenomenon, there are various ways of growing old. The type of previous work is an important factor with respect to morbidity, mortality and life expectancy [2]. It also conditions exposure to various risk factors such as tobacco 131, alcohol [4] and inappropriate eating habits [5]. Social security benefits are in relation to previous income. From a cultural point of \iew, the inner life of the old will be more or less fulfilling according to the satisfaction achieved in more than 50 years work experience. (b) The precariousness of financial revenues affects the majority of the old [6]. Old age is a time of poverty “In Switzerland, the retired person’s income is on the average 30% lower than that of an active person” [7, p. 341. This applies mostly to formerly salaried persons and to a lesser extent to top profes- sionals and liberal professions [8, p. 901. Even in as rich a country as Switzerland, old age often accen- 1321 SSM 23 11-1