The PolSenior2 project was implemented in the years 2017-2020. The pilot scheme took place in 2017, whereas the field study was conducted in the years 2018-2019. Altogether, a representative group of 5987 Polish residents aged 60 to 106 was examined.
In January 2017 the Minister of Health, acting pursuant to Art. 14 sec. 1 in connection with Art. 13 point 1 of the Act dated 11th September 2015 on public health (Journal of Laws, item 1916 and of 2006, item 2003) and the regulation of the Council of Ministers dated 4th August 2016 on the National Health Programme for 2016-2020 (Journal of Laws, item 1492), announced a competitive tender for the implementation of a task from the field of public health: Research on specific areas of the ageing adults’ health condition, including health-related quality of life under Measure 4 of Operational Objective 5: Promotion of healthy and active ageing.
The aim of the task was to assess the general health condition of the older Poles, define its related needs and indicate recommendations for the operation of healthcare entities. The study was to cover medical, psychological, sociological and economic aspects relevant to the assessment of the ageing adults’ health condition. The Competition Commission chose the offer of the Medical University of Gdańsk and Agreement No. 6/5 / 4.2 / NPZ / 2017/1203/1257 specifying in detail the obligations of the Executor regarding the conduct of Research on specific areas of the ageing adults’ health condition, including health-related quality of life was concluded on 7th November 2017. Prof. Tomasz Zdrojewski became the project manager, whereas, the Department of Preventive Medicine & Education at the MUG was responsible for coordination. Both experienced research workers affiliated with the MUG, including geriatrics specialists, as well as the best experts in the field of geriatrics and gerontology from other research centres in Poland, most of whom were involved in the implementation of the PolSenior1 project, participated in the implementation of PolSenior2.
The following report is a preliminary description of the project and obtained results, and an attempt to interpret them. It should also constitute introduction to further in-depth scientific analyses and be a source of knowledge for many stakeholders.
The introduction presents the current situation of senior citizens in Poland, their health condition based on publicly available data, as well as the organisation of health care for the ageing adults. The review of Polish gerontological research was carried out, which served as a background for presenting the origin of the PolSenior1 and PolSenior2 studies. The first one was implemented in the years 2006-2011 under the supervision of Prof. Piotr Błędowski who coordinated the International Institute of Molecular and Cell Biology in Warsaw.
The research sample collection scheme was similar to that during the PolSenior1 study and carried out along with the final of selection of individual respondents by the Ministry of Digital Affairs on the basis of their PESEL number. The research was planned in seven equal age groups: 60-64, 65-69, 70-74, 75-79, 80-84 , 85-89 and 90+ years) with an equal number of women and men. The number of randomly selected respondents in a given voivodship was proportional to the total number of inhabitants from 60 in a given voivodeship Five categories of the size of the place of residence were also taken into account.
The study was preceded by a pilot programme conducted in 2017, covering 30 people over 60 years of age. In 2018 the Elżbieta Wołkiewicz – Realizacja Badań Marketingowych i Społecznych company was selected to conduct field work, whereas the Laboratorium Medyczne Bruss Alab Group Sp. z o.o. was hired for laboratory tests. The field research lasted from 2018 to 2019 for 10 months and covered only the respondents living in households. After obtaining informed consent, medical and social questionnaires were completed during the first and third visit. During the second visit, biological material was collected.
All data acquired from the questionnaires and lab tests were gathered in one data base which, after being thoroughly verified, constituted the basis for the analyses presented in the report. So far as the numbers are concerned, the PolSenior2 project can be presented in the following way:
30 million – the number of cells in the data base
86914 – the number of attempts made by the interviewers to contact the respondents
5987 – the number of respondents examined by the PolSenior2 interviewers
1499 – the number of columns in the database. Each column corresponds to one answer to a question.
860 – the number of people cooperating in the project’s implementation, including:
507 – nurses conducting research in the homes of the selected respondents
500 PLN – the value of the medical examination package offered to the respondents free of charge
89 – the number of experts participated in the developing the following Report
16 – the number of voivodships covered by the study, including 76 territorial layers and almost 500 smaller territorial groups.
10 – the number of months the field research, i.e the nurses’ visits, lasted
The response rate was 41% (52%, if you consider the lack of personal contact with the respondents despite three attempts to visit) and is comparable to the PolSenior1 study and the National Health and Nutrition Examination Survey (NHANES), a renowned American project which has been implemented for over 60 years.
A complex scheme of respondents’ sampling was taken into account in the statistical analysis. Post-stratification was applied as well to weigh the structure of the sample against the Polish population aged 60 and more. The results were presented after weighing procedures in relation to the current structure of the Polish population as percentage, mean or median values. The analysis was carried out by the means of the R statistical computing software, version 3.6.3. as well as the SAS 9.4 TS Level 1M5 programme.
The medical part of the monograph specifies 38 issues examined during the PolSenior2 study. Body ageing is a risk factor for many chronic diseases and the accumulation of deficits leading to disability and growing dependence from other people. The first chapter of the following part of the report is devoted to the assessment of the ageing adults’ fitness by the means of the Comprehensive Geriatric Assessment (CGA) scales. Initially, the screening scale VES-13 was applied, according to which over 3 million Poles should undergo the CGA. In terms of activities of daily living (ADLs), almost every tenth senior citizen showed at least one deficit, and in the scale of complex activities of everyday life – every fourth. The weakness syndrome as predicator of disability was found in 16% of seniors, and the risk of this syndrome (pre frail) in more than half of the population after 60 years of age. One of the causes of the weakness syndrome is a weakened muscle mass and strength, which was observed in every tenth senior on the basis of handshake measurements. The results of measuring the time of getting up from the chair 5 times suggest that 42% of the study population – more often women than men – have a weakened lower limb strength. One of the consequences of sarcopenia may be a fall, experienced by 16% of people aged 60 and over, with one in two falling more than once, and with 4 in 10 falls resulting in injury.
Diseases in old age are often accompanied by pain. Its occurrence was reported by 52% of women and 41% of men. Three on four people who experienced pain reported it in more than one location (3 places on average) and rated the pain intensity at an average of more than 6 points on a 10 point scale.
The efficiency and quality of life in old age are affected by visual and hearing impairment. Impaired quality of vision was found in over 40% of the studied population, including a significant degree of impairment in 1.2%. The most frequently reported ophthalmic disease was cataract (23%), with over 65% of the respondents having undergone a least a unilateral surgery. Hearing disorders are less frequent and affect less than every tenth senior citizen.
Cognitive impairment was tested with two tests. According to Mini–Mental State Examination (MMSE) dementia can be suspected in 16% of people aged 60 and over, and mild cognitive impairment in another 17%. It thus implies that in Poland the population of seniors with suspected dementia living in the home environment can be estimated at 1.5 million, including approximately 130,000 who may suffer be suffering from severe dementia. The clock-drawing test was correctly performed by only 37% of women and 48% of men, including only every tenth senior with primary education. According to the Geriatric Depression Scale (GDS), the disorder can be suspected in 26% of women and 19% of men, with more than a quarter of it being the cases of severe depression.
Sleep disorders become more frequent with age. During the PolSenior2 the phenomena was assessed using the Pittsburgh Sleep Quality Idex (PSQI). Almost half of the studied population complained about poor sleep quality; more often women than men. The most common reason for waking up was the need to use the toilet. Disorders of the lower urinary tract were reported by 60% of respondents with nocturia being the most frequently reported symptom – most dominant in men. The frequency of nocturia in women was similar to stress urinary incontinence. Faecal incontinence was reported by 4% of seniors – just as in the case of urinary incontinence, more often by women than men. On the other hand, every fifth senior complained about defecation problems.
The incidence of malnutrition was assessed by the means of the Mini Mini Nutritional Assessment (MNA). Its rate in the studied population exceeded 3%, and the risk of malnutrition was 23%. It should be emphasised that in the group of women over 90 years old it was 18 and 53%, respectively. Diet is directly affected by dental health. Only 21% of the Polish seniors retained their functional dentition, whereas 30% does not have any remaining teeth.
Obesity assessed by the means of the body mass index (BMI) was reported in 42% of the older women and 33% of men, and overweight was observed in 34% and 45%, respectively. Obesity is the main cause of an improper carbohydrate metabolism. Diabetes was found in 20% of woman and 24% of men in the studies population, whereas the prediabetes in a similar percentage of ageing adults. It should be emphasised that 1.8% of women and 2.7% of men in the study population had previously undiagnosed diabetes.
Hypertension, which is the main risk factor for deaths in Poland, Europe and the world – diagnosed on the basis of measurements, history and analysis of the used drugs – was found in 75% of senior citizens. Every fifth elderly person with hypertenison is not aware of the disease, whereas every third is successfully treated. A preliminary comparison of the results of the PolSenior1 and PolSenior2 demonstrated an unexpectedly large reduction in mean arterial pressure in the elderly in Poland. The blood pressure databases of the two studies were combined for the purposes of scientific verification of that phenomena. Professional, in-depth statistical analyses confirmed very favourable changes in terms of improving the arterial hypertension monitoring – observed in the case of Polish senior citizens as well. Probably, this fact contributed to the significant reduction in the prevalence of chronic kidney disease, observed in the last decade. This initial pilot analysis indicates how important it will be to evaluate the changes with respect to the state of seniors health in the last decade by the means of combined PolSenior1 and PolSenior2 databases.
Hypercholesterolaemia affects 74% of men and 82% of women, and it is one of the few diseases which decreases with age in terms of its incidence rate. Hospitalization due to coronary heart disease or myocardial infarction was reported by 13.5% of the studied population after the age of 60, more often by men than women. Atrial fibrillation and heart failure were reported by 13% of people
The stroke-related prevalence rate was found in 8% of seniors, whereas the prevalence of epilepsy and Parkinson’s disease was 1.6% and 1.1%, respectively. Only epilepsy is more common in men.
In their lifetime 9.7% of the studied population has been diagnosed with a malignant tumour. The total estimated number of people aged 60 and over who have had or currently have cancer is approximately 750.000.
Nearly 15% of the seniors reported the presence of respiratory diseases; more often city dwellers than rural residents. Asthma was reported by 7%, and COPD by 4%. Protective vaccinations against influenza were performed rarely (18%, including 10% on regular basis), whereas pneumococcal vaccinations were practically not administered.
The liver cirrhosis incidence rate was estimated at less than 1%, whereas in the case of hepatitis B and C at 3%. Vaccinations against hepatitis B were reported by 48% of women and 41% of men. Elevated bilirubin levels were observed in 4% of seniors, while the A1AT i GGTP liver enzymes’ activity in 2% and 13%, respectively.
Vitamin deficiency was found in 45% of the studied senior population, and severe deficiency more often than in every tenth senior. The optimal level of vitamin D3 was found in 13% of the studied population. About 12% have been taking vitamin D, and the supplementation was insufficient in most case.
The prevalence of the primary hyperparathyroidism in the senior population was estimated at less than 2%, and of the secondary at 31%. Thyroid diseases were declared by every fourth woman and every twelfth man. Increased levels of thyroid stimulating hormone (TSH) were observed in 5% of women and 2% of men, and hypothyroidism was found in 19% and 6%, respectively. The prevalence of hyperthyroidism, estimated at 1.6%, was twice as high among women.
In the population of people aged 60 and over chronic kidney disease occurs in 17.3%, whereas anaemia can be observed in one in five seniors.
The above list indicates that multimorbidity is common among the ageing adults in Poland. The median of diseases was 3. The prevalence of most diseases increases with age and, in consequence, multimorbidity can be observed in 70% of the 60-64 age group and 90% of the 90-year-old group. Multimorbidity often entails polypharmacy (≥ 5 drugs a day), which occurs in more than half of seniors aged 60 and more, whereas 12% of the studied population take 10 or more drugs daily. Despite dealing with multiple diseases, nearly six out of ten seniors assess their health condition as good, and four out of ten as average, and only 3.7% as bad. A good self-assessment like this does not coincide with the Healthy ageing concept – its parameters are met by only 11% of people aged 60 and over.
Health-seeking behaviours of the older generation leave much to be desired. Older adults rarely participate in physical activity. More than half of them used to smoke cigarettes, and 14% are still active smokers. What is more, many have bad eating habits and drink insufficient amounts of fluids. It should be mentioned that a low level of education, along with age and sometimes gender, constitutes one of the major risk for developing many diseases and geriatric syndromes. However, the differences between urban and rural inhabitants are much less frequent. In terms of regional differences, it is the eastern and then central regions which usually fare the worst. They are followed by western regions and Mazowieckie Voivodship.
The elderly population is not only becoming more numerous, but also more diverse in terms of social and demographic situation. Diversification of both health and social situation indicate that is difficult to define a typical course of the ageing process and old age itself. This is confirmed by the so-called cohort effect as a factor affecting education, professional activity, health or housing conditions. Successive cohorts of the elderly, with slightly different experiences and living in different conditions, are becoming more educated, with the nature of their professional work or the scope of previously acquired skills used in old age changing as well. This affects the quality of life in their advancing years.
The seniors’ family situation is quite diverse. About 80% of men and 50% of women are married, but it worth noting that 40% of women are widows. This entails not only the lack of support from the closest person, but also a greater financial burden for the household. The percentage of married women decreases with age (from 64.7% at the age of 60-64 to just 7% at the age of 90 and over), and the pace of this change is much faster than in case of married men. Over 90% of seniors have at least one adult child. The number of children in the families of the elderly living in rural areas is averagely higher – 27,3% of the elderly living in rural areas have four or more kids, which is true of only 3,8% of those living in big cities The family plays an important role as both a recipient and giver of aid. Seniors, especially the younger ones, support their families by providing financial assistance (33%), helping to run a household (33%) and psychological support (45%). The support network in which seniors play the role of potential and actual recipients is very small and has a family, mainly two-generation character. In The respondents count primarily on children and their spouses. In the event of problems with computer and Internet, older people count primarily on the help of their children, and clearly less often – on spouses and grandchildren.
The financial situation of the elderly is difficult to assess because only half of the respondents answered the question about the amount of their income. Therefore, it is significantly more difficult to answer the question of the sufficiency of the Polish seniors’ current income in satisfying their basic needs and participating in life of local communities. The interpretation of the obtained answers is not easy also due to the internal diversity of the seniors population. When answering the question about the assessment of their financial situation, more than half of the respondents (52.8% of women and 55.6% of men) stated that they lived frugally and therefore, had enough financial resources to satisfy all their basic needs. Every seventh woman and every fifth older man stated that they had enough to meet their every need without meticulous saving Although these data sound very optimistic, they should be approached with great caution. It cannot be ruled out that seniors, unable to satisfy some of their needs, simply displace them from awareness.
Negative assessments of their financial situation are more often formulated by women. This is due to the fact that their incomes are lower than those of men, which is primarily a consequence of previous differences in wages to the disadvantage of women The fact that every tenth respondent did not have enough money to buy medications in the last 12 months is indeed a very disturbing signal.
The housing situation of the elderly is generally a consequence of their financial situation. The housing conditions and equipment of the seniors’ apartments are worse than average. The highest percentage of people living in the oldest (and worst-off) housing infrastructure is constituted by people over 80. Every tenth person aged 60-64 years old, every fifth person aged 75-79, every fourth person aged 80-84 complained about the presence of architectural barriers in the living environment, and in the age group of 85-89, the percentage amounted to almost 38%.
The seniors’ leisure time activity, along with trips outside their place of residence, were also analysed. People aged 60 and over usually devoted their free time to watching TV or DVDs, and the least frequently to social activities. Women participated in religious pilgrimages significantly more often than men, whereas man visited their recreational plots significantly more often than women. The frequency of those trips clearly decreased with age. The rural residents participated in multi-day trips, recreational and spa stays less frequently than the city residents. The same applies to the recreational plots trips.
In conclusion, the Polish seniors prefer passive ways of spending their leisure time. It is thus recommended to further develop the Universities of the Third Age’s programmes, along with the systemic support for social activation of the elderly. Particular attention should be paid to lonely people in advanced old age, struggling with a with a worse material status and living in smaller towns. One should bear in mind that any form of activation prevents social exclusion, depression and has a positive effect on the quality of life.
The availability and level of satisfaction among the seniors with health services leave much to be desired. The elderly, especially men, consult a primary care physician relatively rarely. Only 7.5% of women and 11.7% of men admitted that they had visited a doctor at least six months earlier, which indicates no systematic health monitoring. This is particularly important in the case of the oldest group of respondents for whom reaching a physician poses a growing problem. Seven out of ten seniors indicated a rather difficult or definitely difficult access to free specialist care
The percentage of people expressing the opinion that due to their health and fitness they definitely need help from other people increases from 3.5 in the 60-64 age group to 57.7 in the 90-year-old and older group. The demand for such support can be treated as close to the scale of the demand for long-term care services. There is a relatively significant risk of seniors being digitally excluded – 57%, while nearly 40% declare interest in the possibility of contacting a doctor remotely, and about 46% – of monitoring their health in such a manner. The elderly, with a lower level of education, living in smaller towns, use the Internet less frequently
It is worth emphasising that at the time of the study 33.0% of people aged 60-64 who are already retired, 25.7% of respondents aged 65-69 and 16.2% aged 70-74 expressed their willingness to resume work. The most frequently mentioned condition was obtaining a higher salary.
Assessing their life’s quality during the last two weeks on the basis of the WHOQOL-Age questionnaire, 60% of the respondents assessed it as good, and 14% as very good. Only a few respondents (3.3%) assessed their quality of life as bad or very bad The factors which affected this very positive assessment include, among others, satisfaction with the ability to independently perform daily activities and with the housing situation. The latter example indicates that, when formulating their opinions, older people may be guided by the fact that they have adapted to not always the best living conditions and accept them.
It should be noted that violence – experienced in various forms by 3,6% of the respondents – may also be an accompanying phenomenon of old age. Considering that almost every fifth respondent refused to answer the questions about violence, one may express a concern that the scale of the problem is actually greater.
On the basis of data obtained during the PolSenior2 project, inequalities in certain health aspects, such as the prevalence of dementia and depression symptoms, the percentage of people with disabilities (ADL and IADL scales) or the prevalence of severe diseases, were also analysed depending on the level of education and the household’s financial status. It has been established that there are major health inequities among people aged 60 and more due to their socio-economic status. Low socio-economic status in selected health indicators turned out to be a very strong determinant of the occurrence of dementia, symptoms of depression, disability and poor health.
The authors of the report hope that the recently completed PolSenior2 project entitled Research on specific areas of the ageing adults’ health condition, including health-related quality of life, along with a comprehensive presentation of its main results in the following monograph, will start another important stage in shaping a modern, evidence-based, senior policy in Poland.
It is for the second time in Polish geriatrics and gerontology that a comprehensive cross-sectional study allowed for obtaining essential information about the health condition and social factors in the assessment of ageing and old age. Although the project itself has come to an end, in-depth analyses and a very important interdisciplinary interpretation of the results will continue for some time. It is of prime importance that the knowledge obtained on the basis of 30 million individual-record database is properly used by the Government of the Republic of Poland, its Parliament, all marshal offices, districts and boroughs in Poland, and by many organisations and entities dealing with the broadly understood senior policy.
Considering the essential determinants of the PolSenior2 project – as a cross-sectional field study completed two months before the start of the COVID-19 pandemic – the authors of the project would like to emphasise that the actual and optimal use of its results requires the following actions:
– developing strategic recommendations for the senior policy in the country by the PolSenior2 Scientific Committee (task planned for the first half of 2021),
– conducting a telephone survey in 2021 among the project’s respondents in order to assess the social and health effects of restrictions caused by the COVID-19 pandemic in Poland,
– merging the databases of the PolSenior1 and PolSenior2 projects and conducting detailed statistical analyses on the basis of a single, conjoined database of both projects to assess the scope of changes in the health and social situation of seniors in Poland in the last decade (the task should be implemented no later than in the years 2021-2022),
֪– comparing the health status of people who agreed to participate in the PolSenior2 study and those who refused, by analysing the incidence and prevalence in both groups in the database of the National Health Fund, e.g. in 2015-2020,
– repeating the PolSenior2 study in 2024-2025 among the respondents surveyed in 2018-2019 in order to commence modelling the health and social situation in Poland, including precise forecasting of the health, social and economic burden of the healthcare system resulting from ageing society.