When elders choose: Which factors could influence the decision-making among elderly in the selection of health tourism services?

BACKGROUND: Elderly beneficiaries (age 65+) exhibit specific characteristics that influence the distribution of health tourism market. High incidence of multiple morbidities and functional disability are hallmarks in this age group. For these reasons, elderly population requires different elements and diverse spectrum of services within health tourism, in comparison to younger beneficiaries. Thus, differences would occur within heterogeneous elderly population itself. A preliminary study that we conducted showed that the level of functional independence was one of the significant factors that guided decision-making among elderly beneficiaries when it came to their health tourism-related choices. Results suggested that beneficiaries recognized and appreciated the effect of the natural remedies and attractions available at the given destination. HYPOTHESIS: Maritime and continental health tourism are two different entities commonly selected by elderly beneficiaries for therapeutic purposes. We propose that the climate conditions, geographical location and availability of regional natural remedies are the key factors to why different services were elected by different groups of elderly. The model of Croatia, an established country in the field of health tourism was utilized for this purpose. Differences in the diagnostic categories of beneficiaries are expected due to effects of marine (sea, Mediterranean climate) and continental (thermal water, healing mud) health tourism. In addition, multitudes of mutually intertwined factors affect decision-making process among elderly regarding their health tourism choices. Such factors include the scale of preferences (with special emphasis on well-being and health), leisure opportunities, marketing influences, cost (price) and the availability/diversity of health tourism services within the particular region. Moreover, individual psychosocial and physical characteristics, disabilities and other debilitating conditions, examined in our preliminary study, significantly contributed to the decision-making scheme. We shouldn't disregard sociodemographic and cultural preferences among elderly as potential factors. CONCLUSIONS: Confirmation of our hypothesis could change the usual approach towards the group of elderly beneficiaries (65+) in the health tourism domain. This approach is often largely based on chronological age criteria exclusively. The contents of this manuscript could serve as a blueprint for the development of comprehensive and sustainable health tourism strategies worldwide.

[Family practice and health care of the aged]. / Aktualnost obiteljske medicine u zastiti zdravlja starijih ljudi.

The characteristics of health status of the elderly as well as the assumptions about their future tendencies indicate that primary health care for the elderly is becoming a prominent part of the overall health care. By developing the family practice, elderly people should be provided with different obligatory forms of primary health care--obligatory preventive minimum: health education and guidance, systematic medical examinations, maintenance and development of the existing functional abilities of patients such as treatment, nursing and rehabilitation in patients homes and homes for the elderly, as well as delivery of urgent medical care. The basic principle in health care for the elderly within the primary health care is an active and epidemiologic approach in a certain field, which includes the choice of family physician whose team could provide an integrated comprehensive primary health care which would be at the same time appropriate to the population health needs and also efficient and rational.

[Methods of monitoring health care needs of the aged]. / Metoda pracenja zdravstvenih potreba starijih ljudi.

The Monitoring of Healthcare Needs (MHN) of the elderly was begun in the Republic of Croatia in 1989, with all healthcare data linked to the patients identity card numbers. Such an approach is the usual basis of healthcare planning in developed countries. Another innovation in MHN is that, as well as information about healthcare, records are compiled on the functional states of the elderly, which is a precondition for the efficient provision of healthcare services appropriate to the needs of the patients. Among the people (3709 in total) covered by the MHN scheme at the end of 1989, 2760 people of average age 77 years were living in long-term care institutions in Zagreb. It is found that this people become ill more frequently than people who are covered by the general healthcare programme and do not live in long-term care institutions. Because of a change in functional state, one third of elderly people require specific permanent in-patient healthcare, while from time to time almost one quarter of people covered by the scheme and living in long-term care institutions need such treatment. On the basis of the MHN scheme, it is possible to appropriately promote and organise primary healthcare for the elderly.

[The importance of primary health care of elderly people in Zagreb]. / Znacenje primarne zdravstvene zastite u zastiti zdravlja starijih osoba u Zagrebu.

A survey was conducted on a representative sample of 2400 users of primary health care in the city of Zagreb. A sampling procedure was used with stratification by age, (1) the younger age population (18 to 64 years) including early maturity, middle age and late maturity; (2) elderly (65 to 74 years); and (3) the extremely elderly population (74 to 94 years). The analysis of the data collected showed that the number of patients suffering from 2-3 diseases in the 18-64 year age group was 44.36%, 52.23% in the 65-74 age group, and 47.03% in the 74-94 age group. In the course of treatment, general practitioner referred 81.88% of those in the 18-64 year age group, only 11.03% of those aged 65-74 and 7.09% of those in the extremely elderly population to various specialists. Apart from the fact that younger population more often suffers from acute diseases and unclear conditions leading to higher demand for treatment by specialists, one has to accept that elderly people entrust their health protection mainly to general practitioners, and here is a great chance for primary health care to develop, through its institutions, programmes aiming at the health promotion and health protection.