[The healthcare system and the complexity of social work]

Due to ageing of populations, the number of persons older than 65 years will increase by 70% by 2050. At the same time the octogenarian group will grow by 170%. About half of people above 70 years develop a physical handicap of varied degree. Among the elderly, about 1.5 million have diminished mobility with the number of persons permanently bedridden and in need of an on-site care exceeds 120,000. The most important problems of old age include loneliness, disease, handicap, poverty and perceived lack usefulness. The situation of the elderly is complex and influenced by such factors as worse health, decay of intergenerational traditions, cultural change, bad living conditions and worsening of social status. Among the studied elderly, almost 30% suffer from an often unrecognised and untreated depression, and similar percentage from cognitive impairment which often implies constant care. Almost half of the elderly have poorly corrected visual problems. The apalling 1.3% of them had lost hearing. The basic citeria of effectiveness of a health care system are its availability, complexity of coverage, continuity of care, efficacy and quality, opportunity of adaptation of both caregiver and the client and the flexibility and adaptiveness of the system itself. Due to the peculiarities of ageing, older persons have special care-related needs. In the efect the system should be adapded to their needs and not vice-versa. The health care system in Poland has long-since been criticised for its inefficacy especially towards its elderly clients. It offers disintegrated, dispersed and incoherent services. The system does not fulfill the standards of geriatric approach such as universality, quality, availability and complexity of coverage of complex needs of the elderly person.