This presentation will focus upon the organization of mental health services for the elderly in Sweden, where the population above 65 years has doubled to 1.5 million during the last 50 years and will rise to about 25% of the population in 30 years. During the last decade the population above 90 years has increased by 65%. Epidemiological studies in different parts of Sweden are telling us about the changing panorama of mental health problems in the elderly.
The legislation and the financial control of care of the elderly in Sweden rest with the state. Health care is mainly a responsibility of the county councils. These are, however, sharing this responsibility with the municipalities when it comes to health care and medical services in the special forms of housing accommodations for the elderly. The national policy aims at enabling older people to live an active life in their own homes as long as this is possible. 92% live in an ordinary home, alone or with a spouse, and only a few percent live with their children.
Inventories of organization and resources of Old Age Psychiatry have shown unexpected differences within Sweden, probably explained by the local traditions, demographic differences and economic factors. Old Age Psychiatry is not recognized as a speciality or subspeciality of its own in Sweden. Out-patient clinics for dementia care are available in all but one of 21 counties, while 50% of all counties are lacking organized and specialized non-institutional care for elderly suffering from other types of mental diseases. The majority of personal and diagnostic resources of Old Age Psychiatry, such as neuroimaging are found at the university hospitals.
The responsibility and structure of long-term care in nursing homes and hospitals changed radically when the Ädelreform came into force in 1992. 40,000 beds were transferred from county councils to municipalities with the purpose to create clear lines of responsibilities. The number of beds for older people with mental illnesses was reduced, to some extent compensated for by increase of services at home, day time activities, temporary housing and special housing accommodations etc. The Swedish Psychiatric Association and the Swedish Institute for Health Services Development have published guidelines for Old Age Psychiatry and at present several Scandinavian countries seem to have the ambition to achieve a subspeciality of Old Age Psychiatry based on the curriculum developed by the European Association of Geriatric Psychiatry (EAGP) in collaboration with WHO, WPA, IPA, AEP, UEMDP, ADI and other international associations.
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