Medical care and social support for the elderly in Switzerland: Imbalance and mix

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 sociocultural 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 10 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 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 independent life for the aged.