OPTIMISATION OF GERONTOLOGICAL CARE IN THE HEALTHCARE SYSTEM OF THE CITY OF ASTANA

Abstract

The accelerating ageing of Kazakhstan's population is leading to an increase in the proportion of elderly and senile citizens, which requires improvements to the gerontological care system. Astana has high rates of chronic non-communicable diseases, cognitive impairment, sarcopenia and social risks associated with loneliness and a decline in the quality of life of the elderly. The existing model of medical care does not sufficiently integrate an interdisciplinary approach, preventive strategies, and monitoring of functional status. Optimisation of gerontological services is considered a necessary condition for increasing active life expectancy and reducing the burden on the healthcare system.

Materials and methods: An analysis was conducted of regulatory documents, the organisational structure of primary health care (PHC) and specialised units of Astana's urban health care system. Statistical data from the Public Health Centre and urban polyclinics for the last 5 years were studied. Methods used included situational analysis, the SWOT approach, and expert interviews with geriatricians, social workers, and PHC managers. Existing geriatric programmes were evaluated in terms of population coverage, accessibility, interagency cooperation, and compliance with the WHO Integrated Care for Older People (ICOPE) international standards.

Results: The following key issues were identified:

1. Insufficient integration of geriatric services into primary health care;
2. Low availability of comprehensive geriatric assessment (CGA);
3. Limited use of digital tools and telemedicine for monitoring functional status;
4. fragmentation of social and medical services;
5. low public awareness of preventive programmes.

The analysis showed that the introduction of CGA, multidisciplinary teams, day care centres, schools for elderly patients and fall prevention programmes contributes to a reduction in hospitalisations, improved quality of life and increased independence for older people.

Discussion: Optimisation of geriatric care should be aimed at developing an integrated model combining medical, rehabilitation and social components. The introduction of digital platforms for monitoring cognitive status, physical activity and biomarkers of ageing is strategically important. There is a need to improve the geriatric competencies of primary healthcare specialists, develop telemedicine consultations, improve patient routing, and create a city network of preventive care clinics for older people. The experience of the international ICOPE and Age-friendly Health Systems programmes demonstrates the effectiveness of a multidisciplinary approach.

Conclusion. To improve the effectiveness of geriatric care in Astana, it is necessary to introduce an integrated model of care for older people, expand access to CGA, strengthen interdepartmental cooperation, develop telemedicine, train personnel and actively involve older people themselves in preventive programmes. The implementation of these measures will reduce the burden of chronic diseases, improve quality of life, and prolong the period of active longevity of the city's population.