Care of the frail elderly in developed and developing countries: the experience and the challenges

Demographic and epidemiological changes will result in dramatic changes in the health needs of the world's populations. Everywhere there is a steep increase in the need for management of chronic diseases and for long-term care. Therefore, the search for effective policies to care for the frail elderly in general and long-term care (LTC) policies in particular, is one of the most pressing challenges facing modern society. There is no single converging paradigm and countries are experimenting with a number of different approaches. This section of the Monograph presents the experience in several developed and developing countries: Canada, United States, Italy, Germany, Sweden, Japan, Thailand and Chile. This effort is important because there is much to be learned from the experience of developed and developing countries in defining the range of policy options and in identifying successful and unsuccessful practices. In-depth understanding of the existing situations in developed and developing countries, and the nature of the variance among countries are important to provide insight for development of care policies by learning from what already exists. This article focuses on LTC, that is, on addressing the needs of the functionally disabled elderly. Our reflections are based on an international initiative to develop a decision-making framework for LTC policies launched by the World Health Organization (WHO) with the JDC-Brookdale Institute leading this effort.