BİRİNCİ BASAMAK SAĞLIK KURUMLARINDA YAŞLI SAĞLIĞI HİZMETLERİ VE HEMŞİRELİK YAKLAŞIMI

Öz

Tüm dünyada yaşlı nüfus oranı her geçen gün artmaktadır. Türkiye’de 2024 yılı verilerine göre, yaşlı nüfus oranı %10.6’ya ulaşmış ve nüfus projeksiyonlarına göre 2040 yılında %17,9 olacağı öngörülmektedir. Yaşlanmayla birlikte görülen sağlık sorunları genellikle ciddi olan ve öldürücülük düzeyi yüksek olan hastalıklardır. Bu nedenle yaşlıların sağlığının korunması ve geliştirilmesi için birinci basamak sağlık kurumlarında verilen yaşlı bakımı son derece önemlidir. Türkiye’de birinci basamak sağlık hizmetleri aile hekimliği sistemi ile yürütülmektedir. Aile Sağlığı Merkezlerinde yaşlı izlem modülü kullanılarak yaşlı birey tüm yönleriyle değerlendirilmektedir. Yaşlının kapsamlı şekilde değerlendirilebilmesi bir ekip hizmetidir. Yaşlı bakımını hedef alan hemşire bu ekibin aktif ve önemli üyelerinden biridir. Sunulan hemşirelik hizmetleri ile hastalıklar erken tanınır, hastalıkların neden olabileceği yetersizlikler önlenir ve yaşlılarda var olan bağımlılıklar azaltılır. Bu kapsamda hemşire yaşlı bireylerin ihtiyaçlarını değerlendirerek önceliklerini belirler, bireyi değerlendirirken fiziksel, duygusal, sosyal, entelektüel ve manevi boyutlara göre tanılama yapar, uygun girişimleri planlar, uygular ve sonuçları değerlendirir. Yaşlı nüfusun artması koruyucu hizmetlerin planlanmasını zorunlu kılmaktadır. Aşılama, kazalardan koruma, eğitim, taramalar, komplikasyonları önleme yaşlılara sunulan en önemli koruyucu sağlık hizmetlerindendir. Bu derlemede birinci basamak sağlık kurumlarında yaşlılara sunulan sağlık hizmetlerinin kapsamı, koruyucu sağlık yaklaşımı ve hemşirelik hizmetleri ele alınmaya çalışılmıştır

Anahtar Kelimeler

• koruyucu sağlık
• hemşire
• yaşlı

Elderly Health Services in Primary Health Care Institutions and Nursing Approach

Öz

The proportion of elderly population is increasing day by day all over the world. According to 2024 data in Turkey, the elderly population rate reached 10.6% and is expected to be 17.9% in 2040 according to population projections. Health problems associated with aging are generally serious and highly lethal diseases. For this reason, elderly care provided in primary health care institutions is extremely important for the protection and improvement of the health of the elderly. Primary health care services in Turkey are provided through the family medicine system. Elderly individuals are evaluated in all aspects using the elderly monitoring module in Family Health Centers. Comprehensive assessment of the elderly is a team service. The nurse targeting elderly care is one of the active and important members of this team. With the nursing services provided, diseases are diagnosed early, disabilities that may be caused by diseases are prevented, and dependencies in the elderly are reduced. In this context, the nurse assesses the needs of elderly individuals and determines their priorities, diagnoses the individual according to physical, emotional, social, intellectual and spiritual dimensions, plans and implements appropriate interventions and evaluates the results. The increase in the elderly population necessitates the planning of preventive services. Vaccination, protection from accidents, education, screening, and prevention of complications are among the most important preventive health services offered to the elderly. In this review, the scope of health services provided to the elderly in primary health care institutions, preventive health approaches and nursing services were discussed.

Anahtar Kelimeler

• Elderly
• nurse
• preventive health

Kaynakça

1. Turkish Statistical Institute. Elderly People with Statistics 2024. https://data.tuik.gov.tr/Bulten/Index?p=Istatistiklerle-Yaslilar-2024-54079 (Accessed: 10.05.2025).
2. Erci B. Public Health Nursing. 2nd ed. Elazığ: Nobel Tıp Kitabevleri; 2016.
3. Abrignani MG, Lucà F, Abrignani V, Pelaggi G, Aiello A, Colivicchi F, et al. A look at primary and secondary prevention in the elderly: The two sides of the same coin. Journal of Clinical Medicine. 2024;13(15):4350.
4. Turkish Statistical Institute. Elderly Profile Research 2023. https://data.tuik.gov.tr/Bulten/Index?p=Turkiye-Yasli-Profili-Arastirmasi-2023-53809 (Accessed: 02.05.2025).
5. World Health Organization. Ageing and health. https://www.who.int/news-room/factsheets/detail/ageing-and-health (Accessed: 12.06.2025).
6. Republic of Turkey Ministry of Health, General Directorate of Public Health. Primary Health Care. https://hsgm.saglik.gov.tr/tr/bbsh.html#:~:text=Birinci%20basamak%20sa%C4%9Fl%C4%B1k%20hizmeti%2C%20sa%C4%9Fl%C4%B1%C4%9F%C4%B1n,ve%20yayg%C4%B1n%20sa%C4%9Fl%C4%B1k%20hizmeti%20sunumudur (Accessed: 05.06.2025).
7. Değer MS, Altaş ZM. Historical Development of Primary Health Care Services in Turkey. https://www.medipol.edu.tr/sites/default/files/document/SD_65_-20-25.pdf (Accessed: 10.06.2025).
8. Kayabek İ, Sivrikaya SK. Geriatric care in primary health care services and problems that are encountered. YOBU Faculty of Health Sciences Journal. 2021;2(3):141-147.

9. Kringos D, Boerma W, Bourgueil Y, Cartier T, Dedeu T, Hasvold T, et al. The strength of primary care in Europe: An international comparative study. British Journal of General Practice. 2023;63(616):e742–e750.
10. Akman E, Tarım M. Turkey and England health systems: Comparison of primary health care. International Journal of Health Management and Strategies Research. 2020;6(2):303–316.
11. Turaman C. Planning elderly care at the basic level of health services. Turk J Geriatr. 2001;204(1):22–27.
12. World Health Organization. Health of the elderly. https://www.emro.who.int/elderly-health/agefriendly-phc-centres/ (Accessed: 18.06.2025).
13. World Health Organization. Age-friendly Primary Health Care Centres Toolkit. https://www.emro.who.int/images/stories/elderly/documents/age-friendly-phc-centretoolkitdec08.pdf (Accessed: 20.09.2025).
14. Tavares J, Santinha G, Rocha NP. Implementation of the World Health Organization age-friendly principles: A case study from Portugal. International Journal of Environmental Research and Public Health. 2023;20(15):6532.
15. Shih CI, Hung TW, Chen W, Yang HF, Chia SL, Chang YH, et al. Difficulties and countermeasures in implementing age-friendly policies in primary health centers in Taiwan. BMC Health Services Research. 2022;22(1):1346.
16. Ketenci S, Akpınar NG. Evaluation of polypharmacy in elderly individuals in the scope of family medicine elderly patient follow-up. Journal of Uludağ University Medical Faculty. 2022;48(3):279–285.
17. Republic of Turkey Ministry of Health, General Directorate of Health Information Systems. Disease Management Platform Project User Manual. https://hsgm.saglik.gov.tr/depo/birimler/kronikhastaliklar-ve-yasli-sagligidb/Dokumanlar/Rehberler/HYP_Kullanim_Kilavuzu.pdf (Accessed: 01.06.2025).
18. Özkaya H. Primary Health Care Services for the Elderly and Disabled. https://www.medipol.edu.tr/sites/default/files/document/SD_65_WEB-76-77.pdf (Accessed: 09.06.2025).
19. Memişoğlu K. We made a new start to the value-based approach in health through family medicine. https://www.saglik.gov.tr/TR-106196/saglikta-deger-bazli-yaklasima-ailehekimligi-uzerinden-yeni-bir-baslangicyaptik.html (Accessed: 01.06.2025).
20. Aslan D, Ertem M. Elderly Health: Problems and Solutions. 1st ed. Ankara: Palme Yayıncılık; 2012. https://www.halksagligiokulu.org/Kitap/DownloadEBook/2370919e-e018-4a8e-ab8f-469234e83ed9 (Accessed: 12.05.2025).
21. Presidential Legislation Information System. Family Medicine Practice Regulation 2013. https://www.mevzuat.gov.tr/mevzuat?MevzuatNo=17051&MevzuatTur=7&MevzuatTertip=5 (Accessed: 01.06.2025).
22. Mutlu HH, Coşkun FO, Sargın M. The incidence and awareness of vaccination among people aged 65 and over applied to a family medicine outpatient clinic. Ankara Med J. 2018;18(1):1–13.
23. Okur E, Hintistan S. Vaccination programs for individuals over 65 years of age and nursing. Journal of Ege University Nursing Faculty. 2018;34(3):148–156.
24. Yılmazer TT, Dişcigil G. Individual preventive health approach in advanced age. In: İzbırak G, editor. Elderly Health in Primary Care. 1st ed. Ankara: Türkiye Klinikleri Family Medicine - Special Topics; 2019. p.39–44.
25. Lionis C, Midlöv P. Prevention in the elderly: A necessary priority for general practitioners. European Journal of General Practice. 2017;23(1):203–208.
26. Takahashi PY, Okhravi HR, Lim LS, Kasten MJ. Preventive health care in the elderly population: A guide for practicing physicians. Mayo Clinic Proceedings. 2004;79(3):416–427.
27. Republic of Turkey Ministry of Health, General Directorate of Primary Health Care Services. Elderly Health Modules Training Guide for Trainers 2011. https://hsgm.saglik.gov.tr/depo/birimler/kronikhastaliklar-ve-yasli-sagligidb/Dokumanlar/Kitaplar/Yasli_Sagligi_Modulleri-Egitimciler_Icin_Egitim_Rehberi.pdf (Accessed: 05.06.2025).
28. Öztürk A, Özenç S, Canmemiş S, Bozoğlu E. Preventive health measurements in geriatric period. TJFM&PC. 2016;10(1):34–41.
29. Bektaş H, Kalav S. Comprehensive geriatric assessment. International Refereed Journal of Nursing Researches. 2017;11:201.
30. Kanadlı KA, Sazak Y, Tosun N. Multidisciplinary team approach in multidimensional geriatric assessment and the role of nurse. Journal of Geriatric Science. 2021;4(1):15–22.
31. Republic of Turkey Ministry of Health, General Directorate of Public Health. Multi-Factor Elderly Assessment and Follow-up Guide for Primary Health Care Institutions (Family Health Worker). 2025. https://hsgm.saglik.gov.tr/media/attachments/2025/06/13/asC-yasli-degerlendirmekilavuzu.pdf (Accessed: 01.06.2025).
32. Parker SG, McCue P, Phelps K, McCleod A, Arora S, Nockels K, et al. What is comprehensive geriatric assessment (CGA)? An umbrella review. Age and Ageing. 2018;47(1):149–155.
33. Aslan D. Aging from a Public Health Perspective. 1st ed. Ankara: Hipokrat Yayıncılık; 2023.
34. Welsh TJ, Gordon AL, Gladman JR. Comprehensive geriatric assessment – a guide for the non-specialist. International Journal of Clinical Practice. 2018;72(1):e13016.