Iceland’s elder care debate blurs health and social services

The meaning of “services for older people” is unclear in Iceland’s political debate, leaving important health care needs on the margins, argues Pálmi V. Jónsson in a contributed article published by mbl.is.

The term originally grew out of geriatric medicine, which developed during the 20th century as it became clear that older people can experience illness differently from younger people. It first referred mainly to health care guided by principles including comprehensive assessment, multidisciplinary teamwork, rehabilitation, maintaining abilities and individual care planning.

Over time, the term expanded to cover a wide range of support, including hospital and outpatient geriatric care, nursing homes, home nursing, dementia services, palliative care, support for relatives, housing assistance and community services. This reflected the reality that older people’s medical needs are often connected to their social circumstances. A person with heart failure, for example, may also face loneliness, transport difficulties, financial problems, cognitive impairment, malnutrition and caregiver burnout.

But the broad use of the term can cause confusion, Jónsson writes. Researchers, health systems and policymakers may use it to mean different things, from hospital-based assessments to community support, social work or help adapting a home. There is growing recognition of a distinction between health care and social services for older people, alongside calls to integrate them.

Health care for older people includes diagnosis, treatment, prevention and rehabilitation. Their needs can be complex because age-related changes, multiple illnesses, medication use and reduced ability to function may overlap. Effective care requires coordination among family doctors, specialists, nurses and other professionals, both in health centres and in home nursing.

Jónsson says this challenge is particularly visible in the capital region, where home nursing is centralised while primary health care is decentralised.