[Palliative care for the elderly with advanced cancer organizational problems].

Scientific studies have demonstrated the need for the development of palliative care to patients with malignant neoplasms in Russia; more than 2/3 of these patients are retired; more than 80% of deaths occur at home. The purpose of the work was to highlight the main organizational problems of palliative care for elderly patients with generalized forms of malignant neoplasms. The authors have studied cancer morbidity and mortality in the Nizhny Novgorod region and in Russia in the past decade and identified the need for palliative care beds. The analysis of medical records has revealed great physical symptom burden in cancer elderly patients in the last year of life. The main problems that require solutions to alleviate the suffering of incurable cancer elderly patients and support their families have been formulated and some solutions have been offered.

[On the issue of improving health care organisation for retirement age population (the Nizhny Novgorod experience)].

The article presents a detailed analysis of health care provision to both general and retirement age population (RAP) in the Nizhny Novgorod region. For the past 10 years, the organization and use of different types of health care for RAP have not changed. The availability of inpatient health care for RAP is high whereas the availability of nursing and outpatient health care is low and palliative care service is not available. In order to enhance availability and ensure quality of medical services it is necessary to implement restructuring of health care for RAP at the municipal level herewith a key attention will be paid to out-patient types of health care expansion and palliative care development. The authors formulate some proposals aimed at improving the organization of medical and social care for RAP which should be included in the health care restructuring program at the municipal level.

[Characterization of morbidity and seeking of ambulatory care among the elderly]. / Osobennosti zabolevaemosti i obrashchaemosti pozhilykh za ambulatorno-poliklinicheskoi pomoshch'iu.

Chronic diseases accumulate with age; the share of chronic diseases, particularly endocrine, circulatory, and gastrointestinal, in total morbidity structure increases. As a result of health deterioration, elderly people have to visit outpatient centers 5 times more often. Patients of advanced age consult their local therapists more and more often. A greater number of home visits (23.7 times per annum) and of registered cases (9.7) are due to patients aged 70-74 years. The share of home visits increases. Proper, timely, and adequate organization of care of elderly patients at home will essentially increase the volume of outpatient medical care and thus decrease the number of emergency calls to elderly patients and the rate of their hospitalization.

[Allocation of additional funds for development of public health]. / O privlechenii dopolnitel'nykh sredtstv na razvitie zdravookhraneniia.

The Gorky N. A. Semashko Regional Clinical Hospital has the long-term experience in drawing additional means into patients' treatment at the expense of enterprises and collective farms on the strength of the agreement on cooperation. In order to expand cost accounting in public health it is necessary to determine cost indices in the work of curative and preventive facilities. Total cost of the provision of various types of medical services and that per patient have been calculated in the Gorky Regional Hospital. Besides current expenditure they involve the main funds, estimated by annual indices. Complete cost of 306 diagnostic and treatment procedures have been determined. Proceeding from the data obtained complete actual costs of diagnostic and treatment procedures per patient on 105 nosologic forms have been identified along with the expenditure on these nosologic forms that is necessary for modern diagnostic and treatment care.