Health Systems for Elderly in Arabian Gulf Region

Presented in International Healthcare, Hospital Management, Nursing, and Patient Safety Conference Holiday Inn Dubai, UAE & Virtual
Poster Presenter Name: Prof. Asmaa Alyaemni
Global Journal of Healthcare, Hospital Management, Nursing, and Patient Safety
Unified Citation Journals, Nursing 2024, ISSN 2754-0952
Affiliation: King Saud University

Keywords: Elderly healthcare, Healthcare system in Arabian Gulf, Health care abroad, Home health care services, Arabian Gulf region.

Abstract:

This research study examines the health systems for elderly in Arabian Gulf region. It focus on health systems for the elderly in the Arabian Gulf region on examining the health care infrastructure, policies, and services tailored to the elderly population in countries such as Saudi Arabia, the UAE, Kuwait, Oman, Qatar, Iraq and Bahrain, considering factors like demographics, healthcare access, quality of care, home health care services, human resources in elderly healthcare, patient satisfaction and challenges faced by elderly in accessing healthcare services. The study is review in nature, where the study evaluates the current health systems in Arab Gulf region. The findings highlight that the changing life style, easier access to the modern healthcare facilities along with other factors has led to increased life expectancies throughout the region. This resulted in an increased number of elderly people who often have more than one chronic disease and complex needs. This aging population had to be looked after well and special facilities and services were developed in almost all countries to cater for their needs. It is concluded that these developments have led to better disease management, increased health awareness, and a decrease in communicable diseases in the region. The countries have also invested in medical education, with numerous medical schools and universities offering medical courses. A sincere effort has been made to highlight all the progress and advances made in the past few decades by these rapidly developing nations towards the health care of their elderly.

The healthcare sector is on the rise across the Gulf region, where plans to boost the industry to help diversify the economy away from oil and gas are continuing apace. Technology, digitalization, and healthcare consumers with greater awareness of healthcare trends have driven a large organic improvement in the industry’s fortunes, backed by government and private investments. The influx of wealth related to oil revenues has seen unprecedented development in the region in the past century. This led to increased life expectancy – highest life expectancy is in Qatar with an average 80.88 years in 2024, a 0.18% increase from 2023– and a desire to improve the care for elderly. The cultural norms and religious doctrines played a great role in shaping the healthcare services for the elderly. This was indeed mad e possible with the abundance of wealth and will to spend this financial resource for improvement of quality of healthcare.

Introduction:

To understand the health systems for elderly in the Arabian Gulf one must understand some historical, socio-economic and geographical facts related to this region. Arabian Gulf states are seven Arab states which border the sea west of Strait of Hormuz. These are Qatar, Saudi Arabia, Bahrain, UAE, Oman, Kuwait and Iraq covering an area of 2.9 million square kilometers. Iran is not part of this. All these states except Iraq are part of Gulf corporation council (GCC), which is an intergovernmental political and economic union.  In the early part of last century oil was discovered in this region, this led to flow of wealth. Since then, some of the above economies have moved or are trying to move away from the oil-based economy. The exploration of oil and the revenue it generated was somewhat staggered among the countries with Oman being the latest to be able to export their oil in 1967.

The importance of the Persian Gulf stems from its massive energy deposits. Sixty-five percent of the world’s known oil reserves are in the Persian Gulf countries, which produce over a third of the world’s daily output. (By comparison, North America holds 8.5 percent of the world’s reserves.) Saudi Arabia ranks first in reserves, with 261 billion barrels, followed by Iraq (100 billion), the U.A.E. (98 billion), Kuwait (96.5 billion), and Iran (89 billion). The Persian Gulf is also rich in natural gas, with Iran and Qatar holding the world’s second and third-largest reserves, respectively.

The oil brought wealth and with-it better living and health conditions for the residents. However, several wars including the Iraq-Iran war from 1980 to 1988 and the two Persian Gulf War’s – first one desert storm from Aug 1990 to Feb 1991 and second one Dec 2005 to May 2006 – fought with Iraq by US led coalitions had a significant impact on the lives of the people in Iraq. Most of the infrastructure collapsed in Iraq after the Gulf wars and this affected the living, housing, and health care for all including the elderly.

All but one Gulf States have been ruled by a monarchial system with strong base among the masses, this led to a unidirectional leadership with a strong desire to improve the quality of life of its people. Rapid continual development of infrastructure, improved education, better sanitation, modern hospitals and promising primary health care facilities has led to improved life expectancy and better care for elderly in the region. These countries are currently experiencing an increased demand for health care services due to an immense population growth, increasing life expectancy and higher incidence of non-communicable diseases (NCDs)

Social norms of the Arab world and tribal culture give special respect and status to the elderly. The social pressure to look after the elderly within the family and stigma associated with care homes also has an impact on the care. The elderly population in Arab world is seen in high regard in any household, with great care and respect being paid to them by their families and communities. However, as they age, they often require assistance through formal and informal care to enable them to live a dignified life.

2. Health Care structure:

2.1 Urbanization and its effects: Urbanization is widely seen as a tool for economic growth and cities as engines for economic growth. Arabian Gulf region has seen unprecedented growth and development in form of urbanization in the past few decades. Qatar as an exception for Arabian Gulf region had the data reached an all-time high of 99 % in 2022 and 85% of its population living in urban areas in 1960s. Kingdom of Saudi Arabia had only 30% of its population living in urban region, this has now increased to almost 85%. United Arab Emirates had 73% of its population living in urban areas in 1960 and now it is increased to 87% in 2022. Oman had only 16% of its population living in urban region, this has now increased to almost 88%. Bahrain had 82% of its population living in urban areas in 1960 and now it is increased to 89%. The population of Kuwait had urbanized 74% in 1960 to almost 99% in 2022. Iraq had only 42% of its population living in urban region, this has now increased to almost 71%. Urbanization leads to economic growth, increased access to education and healthcare, a more diverse cultural environment, increased trade, better investment opportunities, more livelihood options, foreign investment, reduced unemployment, and improved transportation facilities. These benefits contribute to a vibrant and progressive urban life, offering residents and businesses various advantages. This rapid urbanization has increased the Need for development of more cities. Petrochemical industry, infrastructure development, financial services all needed man power, the local governments could not always produce this man power and a significant number of both low and high skilled workers are traditionally hired in the GCC countries. Most of these expatriate workers often retire back to their own countries.  Although rapid urbanization has its adverse effects in case of GCC it has led to improved living conditions, better sanitation, rapidly developed and improved primary health care centers as well as very well-equipped tertiary hospitals. This all has contributed towards a much-increased life expectance in this region. The life expectance of Kingdom of Saudi Arabia for example has improved from 48 years on an average in 1964 to 75.83 years in 2024, a 0.19% increase from 2023. Similarly, the life expectance in Qatar has improved from 63 years in 1964 to 80.88 years in 2024, a 0.18% increase from 2023. The current average life expectancy for Bahrain in 2024 is 77.86 years of age. The current average life expectancy for UAE in 2024 is 78.60 years, a 0.18% increase from 2023.

The current average life expectancy for Oman in 2024 is 78.78 years, a 0.25% increase from 2023. The current average life expectancy for Kuwait in 2024 is 75.96 years, a 0.14% increase from 2023 and the current average life expectancy for Iraq in 2024 is 71.21 years, a 0.19% increase from 2023. As expected, there have been adverse effects of this rapid urbanization as well- with lifestyle changes, such as sedentary behavior, unhealthy diets, and increased stress levels, social unrest, often exacerbated by rapid, unplanned urban expansion. These factors contribute to the rise of non-communicable diseases (NCDs) like diabetes, cardiovascular diseases, and obesity. Poor air and water quality, insufficient water availability, waste-disposal problems, and high energy consumption are exacerbated by the increasing population density and demands of urban environments. (Khan et al., 2017)

The rapid and often unplanned urbanization can also bring profound risks, especially in developing countries. These urbanization risks include increased social instability, threats to critical infrastructure, potential shortages of water and other vital resources, and the potential for the devastating spread of disease – as the COVID-19 pandemic has underlined. However, when urbanization is rapid and unplanned, a combination of high population density, aging populations, poverty and lack of infrastructure can have a negative impact on public health, primarily by fostering conditions in which communicable diseases can flourish. In GCC countries this has not been the case, industry is mostly petrochemical and not comparable to industrialization of other countries like China or Taiwan. Hence, the positive effects of urbanization have been more pronounced including better access to health care and greener spaces. Amidst an ageing and expanding population, and the increasing prevalence of lifestyle diseases, the healthcare sector is fast emerging as a priority for GCC countries as they work to diversify their economies away from a reliance on oil production and this has shaped their future planning for healthcare development in the region.

 2.2 Development of Healthcare system in Arabian Gulf:

Kingdom of Saudi Arabia had its ministry of health formed in 1925. It is documented that in 1949 Saudi Arabia had around 111 doctors and fever than 100 hospital beds in the whole country. Since then, Saudi Arabia has done huge advances in organizing its health care structure. Now there are over 415 governmental hospitals and 127 private hospitals in the kingdom with more than 270 run under the ministry of health umbrella.

Health services in Saudi Arabia have improved tremendously over the past 10 years. The infrastructure, the number of hospitals and health centers and medical facilities have all improved, matching international standards. The national budget allocates an average of SR80 billion annually toward healthcare. The Vision 2030 document says, “We are determined to optimize and better utilize the capacity of our hospitals and health centers and enhance the quality of our preventive and therapeutic health care services.” (Gurajala, 2023)

Qatar’s Healthcare sector began developing in 1950s.  In 1958 the first hospital called Rhumailla Hospital was opened and this served the whole country. In 1978 Qatar’s ministry of health developed a comprehensive plan to build primary care health centers in the country which provided preventive and curative medical services. In 1979 Hamad Medical Corporation was founded which ran 5 hospitals and several primary care centers providing health care to all citizens and residents of Qatar. Later in 2012 Primary Health Care Corporation was established and all primary care health centers were taken over by this corporation, since then there has been major development of these and more health centers across the country. There are clinics run for worker class by Qatar Red Crescent organization. More recently there has been development and major spending on Sidra Hospital which is primarily a women and children’s hospital.

Oman’s health care system was not well developed till 1970. After the accession of sultan Qaboos to the throne in 1970 the ministry of health was developed in Oman. Prior to this there were only two small hospitals and a few dispensaries in the country. The Ministry of Health is the main health care provider and regulator of healthcare services in the country. Other healthcare providers include Armed Forces Medical Services (AFMS), Royal Oman Police Medical Services (ROPMS), Sultan Qaboos University Hospital (SQUH), Diwan Medical Services (Diwan MS), Petroleum Development Oman Medical Services (PDOMS), and other private sector providers. The overall effect of this development has been positive. It has seen increased health awareness due to health education and better disease management. This has been well appreciated and acknowledged by WHO as well the cases of communicable diseases in Oman have decreased considerably. Polio was eradicated in the country in 1993, hepatitis cases have decreased by more than 75% and malaria has been nearly eradicated in the country. Ministry of Social Development of Oman has developed social care home, elderly companion project and national elderly house care programs.

The Ministry of Health and Prevention was founded in 1970 in UAE. It has expanded considerably in its working and organization since then, Currently the health minister over seas the working and performance under whom there are 4 undersecretaries responsible for hospitals, health center, polices & licensing and Support services. There are six medical districts under its domain, principally one for each emirate. Standards of health care in UAE are generally high Traditionally health care was free for all in UAE – like elsewhere in GCC countries – reflecting a high standard of public spending over decades since the oil boom. Healthcare used to be free in UAE but in 2001 UAE introduced charges for expatriates to reduce the public funding and increasing cost of expatriate workers a move driven for a need of hiring locally. This followed with an introduction of health insurance for expatriates, but a vast majority of migrant workers remain without health insurance. A considerable number of wealthy locally and expatriates travel abroad to Thailand and western countries for health checks and Health care management.

As with most of the Arabian Gulf region modern medicine was introduced in early 20th Century in Kuwait by British, Turkish and Americans. The first hospital in Kuwait was built in 1912 this was a huge milestone however it was not sufficient to treat the whole country, it brought the idea of hospital medicine into the country. Soon after there was a women’s hospital built in 1919. It was not before 1949 when the first government hospital was built in Kuwait named as Amiri Hospital under the patronage of Sheikh Ahmad Al-Jaber Al-Sabah the Amir of Kuwait at that time.

As there had been early western interest in the region with the ongoing industrial revolution and finding of oil reserves in the Arabian Gulf, Bahrain was one of the visited places by Americans and European in middle to late 19th century. The first healthcare service established in Bahrain was developed as an American Missionary dispensary in 1893. Many decades later a psychiatry hospital was established in 1932 which remains the only hospital providing such service to date.

There are about 26 medical schools in Kingdom of Saudi Arabia and 2 universities teaching medicine each in Qatar, Oman and Bahrain. United Arab Emirates has 4 medical schools whereas Iraq has 19 medical universities, it is however not clear how many of these medical universities in Iraq have full faculty to teach the medical course after years of war and turmoil. There are also nursing schools in each individual countries however most of the demand of the nursing profession in the Arabian Gulf region is met by trained nurses from abroad, mainly Philippines and India.

2.2.1 Role of the Elderly in the Arab Society:

The elderly population is defined as people aged 65 and over. The share of the dependent population is calculated as total elderly and youth population expressed as a ratio of the total population. Elderly people tend to concentrate in few areas within each country, which means that a small number of regions will have to face several specific social and economic challenges due to population ageing. These demographic trends have several implications for government and private spending on pensions, health care, and education and, more generally, for economic growth and welfare.

Regardless, of their dependence elderly are highly respected in the Arab world, elderly command respect and honor not only from their family but in general from the whole society. They are seen as a source of wisdom, experience, advice and Vision by the family and society. Families often abide by their orders, wishes and commands; this provides them with the status of leaders in the family and society. Religiously as well, Islam commands respect for elderly, especially for one’s parents. In Arab world, it is enabling the elderly to live in conditions of dignity and security, without being subject to any exploitation or abuse, physical or mental, and they should be treated fairly, regardless of their age, gender, racial or ethnic background, or whether they are disabled, and regardless of their financial status Or any other situation, and to be appreciated regardless of the extent of their economic contribution

3. Health system of Arabian Gulf region

Cooperation in health field among the GCC States began in the mid-seventies of the twentieth century when the GCC Health Ministers held informal meetings such as the one held in Geneva (16 May 1975) on the sidelines of the meetings of the General Assembly of World Health Organization. Such cooperation developed, after consultations among the concerned States, into the establishment of “The Council of The GCC Health Ministers” since 1991.

Considering the field of health as an important sector in the GCC activities and recognizing the steps that the joint health action has achieved within the framework of coordination and cooperation, the subsequent efforts have completed achievements of the Office, benefiting from the comprehensive perspective and the political support provided by working within the framework of the GCC. In this connection, the objectives set forth in the GCC Chart and in the Economic Agreement were the basic grounds for the efforts of coordination and cooperation among the bodies concerned with health affairs in the GCC States, with a view to achieving the following objectives:

       Development of coordination and cooperation among Member States in the preventive, therapeutic and rehabilitative health fields.

       identifying the concepts of the various health affairs and the endeavor to unify them, arrange their priorities and adopt common programs.

       Opening new channels of convergence with the international experience and enhancing cooperation with the Arab and international health organizations.

       Procurement of high quality, safe and effective medicaments at appropriate prices through the program of group purchasing of medicaments and medical supplies.

3.1 Achievements of Arabian Gulf region in the health Field

The joint health work in the health field has attained several achievements, which are the following:

1. According equal national treatment to GCC citizens, in respect to the provision of health services, in all Member States. That was achieved by the issuance of the Supreme Council’s resolution providing for same national treatment of GCC citizens at public hospitals, clinics and health centers.
2. Facilitation of the movement of organ implantation teams across GCC States. An agreement was made between the Ministries of Health, Customs Departments and Passport Departments on a common form for entry of medical teams and on the common card borne by mobile medical teams.
3. Increasing customs tariff on tobacco products from 50% to 100%. This resolution came into force in all Member States. The GCC Member States are considering further increasing tobacco tariff to be 150%.
4. Proper disposal of medical waste at hospitals and health centers. The Supreme Council (20th session, Riyadh, November 1999) adopted the “Unified Law for Management of Healthcare Wastes”. The Law provides for developing an effective mechanism for coordination between relevant ministries and agencies at each Member State concerning application of proper measures for the disposal of medical waste.
5. Establishing societies for the GCC physicians and registering them at the GCC States, such as the Society of Doctors of Nose, Ear and Throat (Bahrain), Society of Cosmetologists (UAE), Society of Orthopedists (Bahrain) and Society of Ophthalmologists (Kingdom of Saudi Arabia).
6. Formation of a GCC Committee for Pharmaceutical Control to ensure protection of individuals and development of the control bodies with a view to procure good high-quality medicaments that are conforming to the technical conditions and the requirements of drug registration.
7. The “Food Safety Committee”: This is a permanent technical committee composed of representatives of the food control bodies at the GCC States. The committee ensures safety, validity and quality of the consumer foodstuffs and that all foodstuffs imported into the GCC States conform to the safety and quality requirements and to the approved GCC standards and accompanied with the necessary health certificates.
8. Group purchasing of medicaments and medical supplies: Cooperation in this field has achieved great success in obtaining competitive and reasonable prices from drug manufacturers. (Alawi & Alkhazim, 2012)

3.2 Health Care Abroad

Governments in almost all countries in the Arabian Gulf region have traditionally funded health care for their citizens abroad. While the healthcare systems were being developed in their own countries certain patients preferred to travel abroad to western countries to be looked after. This practice has continued to date and while there are now state-of-the-art facilities available in most of these countries still a certain percentage of the patients travel abroad funded by government for their health care. Often these patients are complex needs patients with multiple co-morbidities. Most government-funded patients would travel to

European or North American hospital however there has been a growing percentage in recent years of patients travelling to Thailand and India for their routine health checks as well. There is no published figure of how much individual countries spend in funding health care abroad.

3.3 Elderly health Policies in the GCC Countries

The facts and figures of the GCC countries demonstrate that life expectancy is increasing although the state statutory pensionable age is still very low compared to countries across the world. The GCC economy is largely energy dependent, and governments do not have any policies towards their older populations. With improving healthcare, lifespans are increasing, but approximately a quarter of the GCC population would be over

The age of 65 by 2050, according to a Deloitte’s January 2018 report on Life Sciences and Healthcare Predictions: GCC Trends. This stands in stark contrast with current demographics in the region—40% of people in the Middle East are under 25.

When a country has a larger proportion of elderly people, who are generally dependents (either of family members or the government), it increases the government’s costs as the officials would need to accommodate the needs of the older population. This is especially a problem in countries where the dependents outnumber a young, working population. However, a 2015 report on world population aging by the United Nations notes that an older population does not necessarily mean more healthcare spending if healthcare systems are changed to suit the new demographic balance. (Hussein et al., 2019)

3.4 Home health care services

Home healthcare is defined as care provided at home by licensed healthcare professionals who cater to medical treatment needs or by professional caregivers who provide daily assistance to ensure that activities of daily living (ADL) are completed. The key drivers of home healthcare in the GCC are Increase in ageing population, Disease profile of the region, Technology supporting remote monitoring, Convenience and comfort of home, Augment hospital bed density and efficiency.

Recent investments in the home healthcare sector in the GCC are as follows.

• Aster DM Healthcare acquired Abu Dhabi-based Wahat Al Aman Home Healthcare LLC for an estimated amount of USD 28.6 million in 2019
• Mediclinic Middle East acquired Abu Dhabi based Ayadi Home Healthcare in 2022
• Air Liquid entered the KSA home healthcare sector with the acquisition of the respiratory division of Thamar Al Jazirah Company (TAC). Its Home Healthcare division specializes in the distribution of respiratory equipment and sleep disorder diagnosis services.

The home healthcare segment is comparatively easy to enter, requires no capital cost and mainly requires a workforce pool. Therefore, healthcare players are recognizing its potential and expanding their services to cater to this demographic. Home Health care has various benefits, it is often cost-effective, it improves the clinical outcome and is a practical solution to the bed occupancy challenge faced by many hospitals. It helps release the pressure from hospitals, helps in early discharges and frees the beds for more acute cases to be managed in the hospitals. It is understood that hospitals cannot keep all elderly patients in hospitals till they fully recover. Often elderly patients may take a long time to recover from their illnesses or may have illnesses, which might not recover at all, and patients with permanent disabilities must be managed in the community or in their homes. These elderly patients still need specialized care at home; they need specialized equipment for them to be looked after in their own environment among their near and dear ones. This complex intermediate and long-term care at home needs special skills and expertise that is not possible for every family to provide. Hence the need for home health Care services, which has evolved across the globe but is in different stages of development worldwide. Arabian Gulf region has been at the forefront of this specialized care development due to its cultural boundaries and ability to invest financially into the development of such services.  (Al Anazi et al., 2020)

HHCS should not be confused with home care. HHC is more medically oriented toward helping patients recover from injuries while home care usually includes housekeeping services like cooking and cleaning and helping patients with daily activities (Griffin, 2009). Home health services include wound care for pressure sores or a surgical wound, patient and caregiver education, intravenous or nutrition therapy, injections, and monitoring serious illness and unstable health status (Medicare, n.d.)

4. Hospitals

The Arab world and tribal culture give special respect and status to the elderly. The influence of a person often increases with age both in the family and among the tribe, the elderly are often considered as an asset, and this leads to better care arrangements for them. The norms, religious and cultural traditions of these countries place the duty of care elders. GCC countries have well equipped tertiary hospitals with developed geriatric services in most of them.

4.1Kingdom of Saudi Arabia

Kingdom of Saudi Arabia is the largest country in this region with an area of 2.15-million-kilometer square. With such a large area to cover with population scattered around most of its 13 administrative regions there was always a need of good hospital services to be scattered around the country. There are various government and semi-government health care providers in the country with many government agencies providing their own services like security forces, National Guard and Saudi airlines. These services are for employees and their families. There are about 497 governmental hospitals and 211 private hospitals in Saudi Arabia, 287 of them are under Ministry of Health.

The Ministry provides the elderly with comprehensive care (health, social and psychological) through social care homes spread throughout the regions of the Kingdom, which currently number 12 homes, in addition to providing financial and in-kind assistance to needy  elderly people and their families through the Social Security Agency,  prosthetic devices such as wheelchairs, medical beds, hearing aids, etc. , and the program Home care for the elderly within the family through a program of follow-up visits. Within the National Transformation Program, the Ministry is working on initiatives to establish five model oases for the elderly that are compatible with their needs, including all health services, physical therapy, and a recreational club, and enabling the private sector to establish 13 specialized civil associations for the elderly whose services cover all regions of the Kingdom.

The region of Riyadh had the most hospitals in the Kingdom of Saudi Arabia in 2021, at 110 hospitals. Almost half of Riyadh’s hospitals were Ministry of Health facilities. The demand for healthcare and the number of hospitals in Saudi Arabia have both increased over the years. Since 2010, the total number of physicians in the Kingdom of Saudi Arabia has almost doubled. The proportion of Saudi physicians in the country has grown over time in comparison to non-Saudi physicians, and in 2020 the total number of physicians in Saudi Arabia exceeded 110 thousand.

In 2023, Saudi Arabia’s digital health industry was expected to lead the Gulf Cooperation Council (GCC), followed by the United Arab Emirates (UAE). Early in the year, Saudi Arabia launched Seha Virtual Hospital, the region’s first and the world’s largest virtual hospital. The hospital has a capacity of more than 400 patients, with an expanding network of medical facilities, services, and staff. Saudi Arabia’s Ministry of Health opened its first center for the elderly and geriatric diseases at King Abdulaziz Hospital. King Abdullah bin Abdulaziz University Hospital (KAAUH) is a 406-bedded teaching hospital, accredited by JCIA and CBHAI. Presently there are centers of excellence in women’s health, pediatric and adolescent health, including a Child Development Center specializing in autism and attention disorders. There is also provision of integrated services in internal medicine, psychiatry, orthopedic, urology, colorectal, breast, bariatric, plastic and endocrine surgery and ophthalmology, dental and maxillofacial surgery. The organization has commenced the journey to Magnet recognition, an accreditation awarded to exceptional health care organizations. Dar As-Salama Medical Hospital is fully licensed as a general care hospital in Saudi Arabia with 140 beds and offers its services to patients whose medical needs can be met within the capability of the hospital’s staff and facilities that include geriatric services.

In addition to improvements in the infrastructure for the care of older adults, there have been improvements in the availability of healthcare professionals who are trained in the field. For example, there has been a significant increase in the number of geriatricians, with more than 20 geriatricians registered with the Saudi Commission for Health Specialties (SCFHS) in 2019 (Saudi Commission for Health Specialties). This was supported by an increase in the number of geriatric medicine scholarship training opportunities for physicians who are located outside KSA, mainly in North America. This has resulted in a collaboration with the Middle East Academy for Medicine of Aging (MEAMA) and the development of several workshops and training programs that have helped to train multidisciplinary teams that include nurses, pharmacists, physiotherapists, occupational therapists, social workers, and other medical workers. Several of these trainees attended four sessions over two years that resulted in these trainees earning certificates from the MEAMA. In addition, several nurses have attended postgraduate training sessions in the field of aging. Furthermore, a postgraduate master’s degree in geriatric nursing is available from the Princess Noura Bint Abdulrahman

University in Riyadh. In response to the increase in the older adult population and in preparation for 2030 Vision, the MOH, in collaboration with other government sectors, implemented several strategic measures, including the following:

• Introducing the National Strategy for Older Adults Health Services, which was implemented as the “Older People Health Program” in a primary health care setting.
• Stressing preventive services, including the Comprehensive Geriatric Assessment (CGA) and healthy aging promotions.
• Expanding the scope of future health services for the older adults to secondary and tertiary care services.
• Improving curative, rehabilitation, and home healthcare services for the older adults.
• Encouraging universities to incorporate geriatric medicine into their curriculum (Khoja et al., 2018)

4.2 Qatar

In Qatar elderly patients are seen and managed in most tertiary hospitals in general but it also has a geriatric department in Rhumailla hospital in Doha. It is a teaching hospital, well equipped, and accredited by Joint commission international. The staff is highly trained, with many physicians trained in Europe and the USA. The teaching unit is also accredited by ACGME-I.   Patients are referred via different departments of other major hospitals, private services as well as primary care centers across the country. There are more than 13 hospitals under Hamad Medical Corporation. All these facilities provide elderly care. Admissions to these hospitals are through Emergency department. Qatar has dedicated dialysis centers, which cater for patients of all ages including elderly. There is a National Cancer Research Centre in Doha also providing palliative nursing care services at home for those who may wish to spend their last days among their loved ones in their own familiar environments. The major hospitals are located strategically in the country in all 4 directions with major road access. There is an easy referral system among different hospitals and units with most of those providing elderly care working for the same corporation. There is Neurology unit providing care for stroke patients and a recently inaugurated Qatar Rehabilitation institute with state-of-the-art facilities to provide rehabilitation for all elderly patients. Hamad Medical Corporation has various departments catering for the medical needs of the elderly from all angles of care. There is also a separate Bone and Joint hospital in Doha.

Various private hospitals of international standard have sprung out in recent decades in Qatar. All medical facilities in Qatar are regulated by ministry of Public Health to maintain a high standard and Qatar Council of Health Care practitioners regulates all practicing health care providers.

4.2.1 Home Healthcare Services in Qatar:

Qatar has an elaborate network of services to provide care at home for the elderly. As emphasized elsewhere, the cultural norms are to look after the elderly at home to the extent it is possible, both families and healthcare services provide as much care at home as possible.

Hamad Medical Corporation has set up a separate department, which hires and provides nurses to look after homebound elderly patients in their homes. This, however, cannot cater for the need of all those who might need care at home. These nurses may work in shifts with the same patient, often providing 24-hour nursing care to those in need.

In 2006 Hamad Medical Corporation started the country’s first Home Health Care Services department. At its inception this was a very small department with a handful of nurses. Over the years the Home Health Care services of Hamad Medical Corporation have grown into the biggest service provider of this kind in the Middle East and perhaps in the world. Currently there are about 1900 patients under its care, mostly elderly patients, however, it also provides care for children with chronic disease and certain home bound younger adults. HHCS (department as it is known) has been accredited by “Joint Commission international” since 2011. This is a 3 yearly accreditation; the mission of the Joint Commission on Accreditation of Healthcare Organizations is to continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations. The department of HHCS has grown to a considerable size and now managed by a team of highly skilled senior staff, including directors of nursing, Assistant Executive director to look at the overall management of the department and a medical director to oversee the medical side of the service. The Department now has more than 125 trained nurses providing regular nursing care at the homes of elderly patients.

There is a team of Allied health professionals including respiratory therapists, which look after the patients who are on home oxygen therapy and those who have non-invasive or invasive ventilation at home. There are separate teams of occupational therapists providing assessments at the beginning of the admission of an elderly patient to the Home Health Care services and providing continuous support if it is needed. A team of well-trained physiotherapists on a regular basis also provides physical therapy. The department has a small team of clinical Pharmacists who not only perform visits for these patients and do medication reviews, patient education and whole medication therapy management but also participate in departmental surveillance exercises. The department has a patient medication Management committee that monitors and analyses all medication errors and forms policies. There is also a clinical Practice guidelines committee looking at the clinical work provided by all the clinicians of the department.  There are also wound care specialists’ nurses, patient and family educators and dieticians in the service which all perform care at the homes of the elderly patients in Qatar.

Home Health Care services is a purely government funded service which is free for all citizens and residents of Qatar alike. This service is actively supported by Geriatrics department of the corporation, which provides psycho-geriatric assessments at home for dementia patients or those who might suffer from any mental health issues. There are also falls assessment clinics and memory clinics run by the geriatric department, which looks after mobile patients in the hospital outpatient clinics.

The Primary Health Care services (PHCC) of Qatar also have its own Home Health Care services department that also provides services to over 60 years of age individuals in Qatar. There is some overlap in the services provided by the PHCC and HMC Home Health care services, but HMC takes more complex need patients whereas PHCC only provides services to Qatar nationals. Since PHCC has over 24 health centers across the country it is more feasible for them to send nurses sometimes even on daily basis to administer medication or wound dressings for short periods of time till the family or the care givers are themselves trained to do it.

Hamad Medical Corporation has also started a mobile doctor services program under the direct guidance of Her Excellency Hanan Al Kuwari, the minister of health in Qatar. This service provides urgent medical care at patients’ homes. Mobile doctor services have a strong team of over 55 physicians who provide 24-hour medical cover, they are accompanied by highly trained nurses and paramedics who can also act as an interpreter if needed. Most of the doctors are trained in western training and Arabic is not their first language. Hence having a trained paramedic who can do interpretation often saves valuable time for the patient and improves patient safety as well.  There are also private care providers providing home visits by doctors and nurses, but these services are not well developed yet. In future there is a plan to introduce medical insurance for residents of Qatar, this might see an increase in services provided by private organization for the elderly at home.

Qatar has many both trained and untrained care givers providing care at home. A lot of trained nurses, often hired by families themselves, provide care for home bound or bed bound patients at home. Home health care services both provided by PHCC and HMC actively engage these nurses and educate them on how to manage these patients safely at home, these nurses are often Hired from Philippines and India both countries are known to have reasonable standard of training for their nurses. They also converse well in English which makes it easier for the government organizations to train them further. Families and care givers are always given contact numbers to ring in case of any concerns or emergencies and then appropriate help is dispatched based on the assessment and need of the patient.

Home Health care services are looking into providing more autonomy to the families and caregivers of its patients in future.

A considerable number of patients are on anti-coagulation therapy that needs regular INR monitoring, it’s been looked into at present to provide Point of care testing machines to these caregivers and educate them on how to

Safely monitor the INR of their patients. A plan of providing tele-monitoring devices to check vital statistics of the patients is also in the pipeline. This will provide more up-to-date monitoring of home bound patients to their physicians and nurses and will free up services to provide wider coverage to

Those who might need it. Current statistics show that HMC HHCS services perform over 55,000 home visits per year and this number is increasing fast.

4.3 Bahrain

Bahrain is the smallest nation in the region in contrast to its closest neighbor Saudi Arabia. Bahrain is an island which has only one bridge connecting it to KSA. It has an area of only 765 kilometer Square and a population of about 1.5 million people. Health care is free for nationals as it is in other GCC countries and subsidized for expatriates living and residing in the country. There are 3 main public hospitals in the country but several other high standard private hospitals covering this small country. In 2020, there were 788 healthcare facilities licensed in the Kingdom of Bahrain. The HCF department received 136 applications for opening new healthcare facilities that varied from hospitals and various health centers in different specialties and 90 facilities have been granted approval and licensed. By the year 2021, the HCF department had licensed a total of 831 healthcare facilities throughout the country, comprising of 21 hospitals, 301 centers, and 96 clinics.

The Supreme Council of Health, which helps implement the national health strategy, regulates doctors, technicians, and other professionals, ensuring that they are qualified to provide the highest levels of service. The Ministry of Health also provides medical care to the elderly patients in the Kingdom through mobile units and home visits for those who are unable to visit health centers. The elderly also receive social services from the Ministry of Social Development, which include day care services, residential care services, and social assistance. Muharraq Maternity & Geriatric Hospital, Royal Bahrain Hospital, Middle East Hospital provides specialized geriatric services.

4.3.1 Home Health Care services in Bahrain:

Bahrain although is the smallest state in the region, it has invested well in its home health care services. It provides its services to a variety of patients not limited to the elderly. It provides nursing care, diagnostic facilities including laboratory investigations as well as point of care blood testing and on-call doctors to visit sick patients at home.  Mobile units were provided to the elderly in health centers, which provide nursing services and elderly care in their home, especially for those unable to reach the health center. This service was transferred from the Ministry of Social Development to the Ministry of Health in 2008.

The mobile unit for the elderly consists of a specialized team consisting of a nurse, a home visit technician and a health driver, where the unit starts from the health centers and the team makes home visits to the elderly to provide them with the necessary health care, nursing and family counselling services, as well as personal care and provision appropriate needs of the elderly. The mobile unit for the elderly consists of two teams, one for men and the other for women. The team comprises four staff members (one qualified nurse, two home visits technicians and a health driver). The team uses a bus for home visits, and the units have been distributed to five mobile units to cover work in all health regions in the kingdom of Bahrain, where each unit has eight employees and two buses. A nursing supervisor directly supervises the work of the units, and reports to a senior Services Coordinator for primary health care.

4.4 UAE

The UAE has a comprehensive, government-funded health service and a rapidly developing private health sector that delivers a high standard of health care to the population. Public healthcare services are administered by different federal and emirate-level regulatory authorities including the Ministry of Health and Prevention, Health Authority-Abu Dhabi (HAAD), the Dubai Health Authority (DHA) and the Emirates Health Authority (EHA).

In the United Arab Emirates there are 157 hospitals and 5369 health centers. The country is divided into 53 public hospitals and 104 private hospitals. The total number of beds increased from 16,872 in 2019 to 18,005 in 2020 comprising of 9,649 beds in the government sector and 8,356 beds in the private sector. The Bed occupancy rate for Government Sector in 2019 reached 51%. Since its establishment, the United Arab Emirates has been keen to provide the best health services and provide high-quality care up to international standards, including curative, preventive and promotional services, in addition to implementing strategic programs to combat chronic and communicable diseases and care for children and mothers, through the implementation of health strategies facing Challenges and technologies. The Ministry of Health and Prevention launched several initiatives for the benefit of senior people. One of these initiatives is to create a database to monitor the life expectancy of older people in the country and expand the healthcare programs.

The Vita Elderly Care Complex in Dubai act as a Centre of excellence for healthcare services for both Emiratis and expatriates aged 65 and above. The facility includes an outpatient geriatric medical Center, an advanced nursing home, an Alzheimer’s center, an elderly day-care center, a rehabilitation facility, a ventilated care center, a home care center and home health monitoring.

Also, Obaidallah geriatric Hospital in Dubai is considered a leading specialized hospital for providing physical, and mental treatment and rehabilitation services for senior citizens. On March 20, 2020, the hospital was fully evacuated and prepared for the pandemic, with three isolation wards accommodating 126 beds. COVID patients were received on April 1, 2020. Subsequently, the building was evacuated, and services for senior citizens were restored in March 2022 with a capacity of 40 beds. Obtained international health accreditation (JCI) in 2017 and was reaccredited in 2021. Received international accreditation as a primary stroke center from the American Heart Association (AHA) in 2022.

4.4.1 Home Health Care services in UAE:

Emirates Health Services provides mobile clinic services in remote areas of Fujairah and Ras Al Khaimah. The services include medical care, rehabilitation, natural treatments, preventive measures, dental, optical, dermatological and diabetes treatments. The mobile clinic in Ras Al Khaimah does not offer dental treatments.

Ministry of Community Development provides primary healthcare and social, psychological and physical therapy to UAE nationals who are at least 60 years at the elderly care centers or through their home care program. Red Crescent Authority offers various programs for the elderly and coordinates with the elderly care centers across the country to organize various activities and events that draw attention to the issues of old people. On special occasions, such as the International Day of Older Persons which falls on October 1, the authority organizes field visits to elderly care homes to understand the needs of the ageing people and provide them with psychological support and special gifts. Red Crescent Authority also formed a team of caregivers and trained them to achieve its humanitarian mission in the elderly care arena. In Abu Dhabi, Sheikh Khalifa Medical City in Abu Dhabi city and Al Tawam Hospital in Al Ain offer home care services to all UAE nationals.

Abu Dhabi Rehabilitation Centre is the only Centre that provides specialized care for the elderly in Abu Dhabi city. It admits senior citizens who have nobody to take care of them. Abu Dhabi Rehabilitation Centre offers a few city and social services including diagnosis, consultation, physical therapy, speech therapy, psychotherapy, exercise therapy, water cure, work therapy, family counselling and integration into society.

In Al Ain, the municipality provides mobile unit service. Through this service, the elderly and people of determination can request a customer service representative to visit them at their premises and process their service requests. Community Development Authority in Dubai runs ‘Elderly Happiness’ and ‘Home Care (Weleef)’ initiatives that ensure rehabilitation, care and happiness of senior citizens. Dubai Health Authority provides home care services to both Emiratis and expatriate residents. DHA provides comprehensive geriatric assessment, nursing care, home safety evaluations, rehabilitation and nutrition assessment among others. Sharjah provides home care service which involves accompanying the elderly citizens to the hospitals and nursing them back to health.

4.5 Kuwait

Kuwait’s public healthcare sector accounts for more than 80% of the healthcare spending in country. Currently, Kuwait’s Ministry of Health is the owner, operator, regulator, and financer of many healthcare services rendered, pharmaceuticals purchased, and medical equipment acquired in the country. The government operates 28 general and specialized hospitals. The private sector is expected to grow moderately in the coming years, with private firms estimated to account for 15-20% of healthcare spending. Kuwait aspires to create world-class healthcare providers as well as to improve the quality of healthcare in treatment centers, such as the Kuwait Cancer Center, the Kuwait Chest Disease Hospital, the Kuwait Radiology Center, the Ibn-Sina Center for Ophthalmology, and the Desman Research Center for Diabetes.  The country has a well-established primary care network of more than 100 polyclinics distributed across Kuwait.

According to the Ministry of Health, the private sector will be instrumental in the overall development of the medical sector. The private healthcare market is estimated to grow by 15-20% in the coming years. Currently, a total of 16 private hospitals (totaling about 1200 hospital beds) provides private medical services in Kuwait. Several new private hospitals are expected to open in the next few years, adding 1,800 hospital beds. Although the government offers free healthcare services, patients are willing to pay a premium for private treatment to reduce waiting times and treatment schedules. Private hospitals also serve Kuwait’s sizeable expat population. In certain fields, such as obstetrics and gynecology, local patients pay a premium for high-end services offered by private hospitals. The government of Kuwait launched the Afiya insurance program in 2016 for Kuwaiti retirees, covering more than 135,000 Kuwaitis. The program provides generous coverage at private hospitals and clinics – in addition to retirees’ existing coverage with the public health system. Such soaring healthcare spending reflects the government’s priority to improve the quality of life for both citizens and expatriates, as well as to treat more Kuwaiti patient’s in-country. Currently, Kuwait sends thousands of patients along with their families abroad for treatment each year at a high cost.

4.5.1 Programs for elderly care in Kuwait

Kuwait has committed itself to develop strategies, plans and programs that addresses the needs of older adults with a view to providing integrated health care. Shown by having His Highness Sheikh Sabah Al-Ahmad Al-Jabber Al-Sabah Prize for Research in Health Care for the Elderly and in Health Promotion under the umbrella of World Health Organization as well as including older adults care program among the 7 pillars of Kuwait National Development Plan 2035. Moreover, issuing the National Health Strategy for the Care of the older adults in the State of Kuwait and the Attached Executive Plan (2016-2020). And establishing Geriatric Health Services Administration in Ministry of Health with main terms of reference including Development of health services for the elderly including physical, psychological, social services as well as implementing preventive, rehabilitative programs and home care. Along with development and implementation of awareness plans concerning aging and care of the elderly with strengthening the role of the family and community in their care. The older adult’s health services are provided in primary health care clinics with special 17 clinics for older adults distributed in many Kuwait cities.

4.5.2 Home care health services in Kuwait

The  main challenges are facing the Readiness of the Health System for the care of older adults in Kuwait including the development of health services for the elderly, in accordance with the needs of the Kuwaiti society through infrastructure support , the provision of qualified and trained staff (multidisciplinary team), the introduction of new services to provide integrated health care at different levels of health service, whether preventive, acute, long-term or rehabilitating services and providing home care services through a mobile unit offering treatment services, prevention and treatment of emergency cases.

4.6 The Sultanate of Oman

Oman is noted for its strong fundamentals in the national healthcare system. In fact, the country’s healthcare sector has witnessed commendable growth over the last few decades. While the government has a strong presence in the sector, making available advanced health solutions and patient care services to people, it has always welcomed and encouraged the private healthcare providers to contribute to transforming Oman into a regional healthcare hub.

When His Majesty became the Sultan of Oman, the country had just two hospitals. Over the last 45 years, under His Majesty the Sultan’s visionary leadership, Oman’s health sector registered amazing growth. The government policy focused heavily on ensuring access to basic universal healthcare for all Omani citizens, and subsidized health services for expatriates.

Today, Oman has nearly 70 quality hospitals, with over 6,400 beds, offering a range of specialized and general patient care services across the country. Its healthcare system greatly benefited from foreign medical expertise which in turn helped improve the skills of the country’s homegrown medical professionals. The new hospitals, medical centers, and clinics in the pipeline are expected to play a major role in achieving Oman’s Health Vision 2050, a long-term strategy issued in 2014 that aims to support the government’s goal of providing an equitable and responsive healthcare system, which in turn will create a productive population. Against this backdrop, the entry of Burjeel Hospital into Oman heralds a totally new dimension to private premium healthcare in the Sultanate.  Burjeel Hospital started recently its operations in Oman in the commercial hub of Al Khuwayr (Muscat).

Nearly 70,000 elderly people in Oman are under the Ministry of Health’s elderly care programme, which was created to ensure that they are given prompt, affordable and continuous healthcare. On the occasion of the International Day of the Elderly, Dr Ahmed Al Wahibi, senior consultant of family and community medicine at Ministry of Health, called for raising awareness about the presence of this elderly care programme, and asked families to enroll them with this scheme.

By the end of 2018, close to 68,680 elderly were enrolled in the programme, which is being carried out by primary healthcare institutions in the country. This constitutes 44.8 per cent of the total elderly population in Oman, with the total elderly population – those who are aged above 60 – constituting six per cent of the population. In 2018, 14,810 additional people were enrolled in the Ministry of Health’s elderly care programme, among whom 4.1 per cent suffered from diabetes, 4.6 per cent had hypertension, 4.9 per cent had dyslipidemias, 1.2 per cent had thyroid disorders, 0.8 per cent had prostate disorders, 0.2 per cent presented malignancies, and 2.4 per cent were diagnosed with other medical issues. The Ministry also provides a community nursing service where the team visits the elderly at home and provides them the necessary medical care.

4.6.1 Scope and Services Provided for the Elderly in Oman

The  National  Program  for  the  Elderly,  Care  was  launched  by Directorate  General  of Primary  Health Care,  MOH.  The Elderly Care Service is one of the essential services provided in primary health care facilities by all health professionals for all Omani citizens, 60 years of age and older.  These services begin early interventions with screening and full assessment of older adults at PHC. The assessment focuses on the clinical, psychological, and social needs of the elderly. These services have been incorporated into community  health  nursing services  to  improve  service  outcomes  and  optimize  the  use  of government resources. The program provides comprehensive assessment  and screening  of  elderly  persons  in  the  community  through  a  pre-designed clinical  protocol. It promotes optimal health for elderly by maximizing independence, identifying strengths of the elderly, and working in collaboration with the client to enhance or maintain these strengths.  Geriatric health nurses facilitate a healthy environment as well as encourage mutual goal setting and decision making among the elderly, family, and nurse. They also encourage elderly people to exercise their rights and responsibilities.  In addition, they work collaboratively with other sectors to establish and  offer  a  continuum  of  services  across  the  community  by utilizing the  available resources and  by facilitating the  elderly to access these resources.

5. Human resources in Elderly health care

A comprehensive model based on a ‘geriatric holistic’ approach that acknowledges the central role of primary care physicians does not only improve clinical outcomes but also reduces medical costs. This requires a larger and better trained workforce. Yet, geriatric competencies in all health curricula are largely lacking in the Arab region. Only few countries recognize geriatrics as a specialty on its own, and as elsewhere, geriatrics lacks the glamour of other specialties among young medical graduates. With the exception of Bahrain, Lebanon and Tunisia, the proportion of geriatricians does not exceed one for every 100,000 older persons. This in contrast to around one geriatrician for every 10,000 older persons in the United States. Remarkably, Tunisia includes a very high number of geriatricians owing to a medical educational system that allows medical graduates to study geriatrics without having to enroll initially in their internal medicine programme. There is a need to ensure that geriatric and gerontology proficiencies are integrated in medical, nursing and sociology schools and that workers in primary health care setting and occupational and physical therapists are trained on ageing and ageing-related conditions.

It is estimated that the number of health care workers in Saudi Arabia is more than 350,000 (Ministry of Health, 2017). The total number of physicians in the Kingdom of Saudi Arabia in 2021 amounted to around 122 thousand. The total number of physicians in the country increased from 70 thousand in 2011. The government will likely continue to spend heavily on health care, especially health care devoted to the care of the older adults due to the projections regarding the growth of this age group. A part of the vision of 2030 is to generate more than 400,000 jobs in the health sector (Kingdom of Saudi Arabia) and to accommodate and enhance the well-being of Saudi citizens. The plan includes the proper education and training of health care workers. Additionally, the government is focusing on primary care, which is a logical course due to the growth in the general population and in the older adult population with advanced chronic diseases. (Al-Hanawi et al., 2019)

Health workers are often trained to assist with current pressing health concerns, so there is a need to improve knowledge and skills in a holistic approach in geriatric care to deal with chronic problems. Health professionals should also develop competency in communication, teamwork and overcoming ageist attitudes. Multidisciplinary teams including geriatricians, general practitioners, nurses, social workers, pharmacists, dietitians, rehabilitation therapists, psychologists, community workers, and care coordinators are needed to provide integrated care. To ensure adequate number of caregivers, it is essential to improve the image and status of caregiving by increasing pay and benefits, working conditions, training and career opportunities. These issues are not properly covered in developed countries and the problem is even more severe in low-income regions. (Schönrock et al., 2015)

6. Psychiatry services

In Qatar, mental health services are being redefined and expanded, and this was realized with the launch of an ambitious National Mental Health Strategy in 2013. Traditionally, mental healthcare services in Qatar have been the remit of psychiatrists within secondary care, where a new strategy is supporting transition towards community-based care. The Kingdom of Saudi Arabia has developed an extensive hospital-based mental health system culminating in the passing of a mental health law in 2014. The Saudi Ministry of Health is the main provider of mental health services, with other government agencies providing psychiatric treatment for state employees. The Saudi government has established the Vision 2030 with the Health Sector Transformation Program that aims to improve quality and facilitate access to healthcare services equally across the country by providing e-health services and digital solutions to healthcare problems of its citizens and residents. In Oman, mental health services in general have slowly developed and according to the Omani Ministry of Health, there were only 57 psychiatrists and 432 nurses working in, or for, mental health facilities before 2014. In Bahrain, citizens and expatriate patients requiring psychiatric consultation are referred to the Psychiatric Hospital under the jurisdiction of the Ministry of Health’s free-of-charge service. In Kuwait, a review of mental health counselling and therapy revealed that it was still in a developmental stage.

Psychiatry department under HMC provides its home health care service run by psycho geriatric physicians and community mental health nurses. This service provides mental health services to the elderly who cannot leave the confines of their house due to physical or mental disabilities. Overall, it is evident that Arab Gulf countries have encountered various challenges appropriately serving their populations’ mental health needs. Given that mental health services are developing across Gulf countries.

7. Patient Satisfaction and complaints handling:

Patient complaints provide a valuable source of insight into safety-related problems within healthcare organizations. Patients are sensitive to, and able to recognize, a range of problems in healthcare delivery, some of which are not identified by traditional systems of healthcare monitoring (eg, incident reporting systems, retrospective case reviews). Thus, patient complaints can provide important and additional information to healthcare organizations on how to improve patient safety. Furthermore, analyzing data on negative patient experiences strengthens the ability of healthcare organizations to detect systematic problems in care. Of course no health care structure is complete without proper complaints handling procedures and gathering and acting upon patient satisfaction reports. Patient satisfaction surveys represent real-time feedback for providers and show opportunities to improve services/decrease risks. Patient centered care is the corner stone of modern medicine, an individual’s specific health needs and desired health outcomes are the driving force behind all health care decisions and quality measurements. Patients are partners with their health care providers, and providers treat patients not only from a clinical perspective, but also from an emotional, mental, spiritual, social, and financial perspective. Patient satisfaction reporting and complaints handling provides an insight into the working relationship of the health care providers and their patients and families. It also provides direction of improvement for the health care providers. Elderly health care services in Arabian Gulf countries are no exception to this process. Elderly who hold capacity might themselves provide feedback, give compliments or make complaints. Families of those elderly patients who do not have capacity and are dependent upon care givers and family members might also provide feedback, which can help to improve the services if gathered and acted upon effectively. Patient satisfaction gives direction to future improvement efforts. Patient satisfaction and continuity of care has direct relationship and dissatisfaction can lead to malpractice lawsuits that can cost loss of business and lead to financial Penalties.

Qatar health care providers have their individual customer service departments for the purpose of patient and visitor guidance, gathering patient satisfaction information and handling patient and family complaints. Hamad Medical Corporation whose aim is to provide safest, most effective and most compassionate healthcare to all its patients has a customer service department by the name of “Nesmaak” (meaning I am listening). This department holds regular patient and staff satisfaction surveys for all its hospitals, home health care and facilities. It handles complaints along with legal department of the corporation. The information gathered is then feedback to all

Departments and used for quality improvement. Another major health care provider of Qatar, Primary Health Care providers that has 21 health centers in the country also has on site help desks in all their health centers for their customer services. Patients can lodge complaints or give feedback directly to the Ministry of health through government websites. Social Media plays a major role in informal feedback and complaints. All health care providers are have their twitter, facebook accounts and actively follow the information pooled from these sources for provider better service.

In the Gulf Cooperation Council (GCC) countries (namely, Saudi Arabia, the United Arab Emirates (UAE), Kuwait, Qatar, Bahrain, and Oman), quality of care and value for patients are slowly penetrating the healthcare system. However, healthcare systems in the GCC are facing various challenges. For example, the region continues to record a high number of medication errors, which may suggest low-quality safety. Compared to other countries in Europe and North America, for example, quality has been of less importance in the GCC region, and the quality outcomes have been more negative. The areas of focus for the governments of the GCC countries would, thus, be different from those of other countries, concerning care quality. For instance, a study in Brazil showed that it is important to address the population’s health needs and problems, indicating that in this country, the priority areas are not as obvious as in the GCC. Thus, improving healthcare quality is a national priority for GCC governments in fulfilling the present and future health needs of the population. This role can, however, only be accomplished by focusing on the quality areas in research, since quality has emerged as one of the most important factors influencing patients’ choices between government and private hospitals in the GCC countries. Service quality is essential for health organizations to remain competitive and sustainable. As such, research into healthcare quality is needed to enhance quality care in the GCC and place improvements in care quality in the GCC region on a par with those in other countries.

Previous research in GCC countries indicates that the thoughts and satisfaction of patients play a crucial role in their assessment of the quality of the service they receive. The GCC countries have a mixed healthcare system that includes both public and private providers, with the government playing the primary role in funding and regulation. Furthermore, they have private health insurance providers, which primarily serve foreign citizens, who constitute an average of 70% of the total population in these countries. Through their respective public health systems, GCC countries manage a universal healthcare system that provides their citizens with free or subsidized medical services. On the other hand, foreign nationals residing or working in GCC countries are typically required to obtain private health insurance or an insurance through their employers. Although the healthcare systems in the GCC countries are similar, there is a subtle difference in the level of government investment in the healthcare sector. For example, Bahrain, the UAE, and Saudi Arabia make significant investments in their healthcare sectors to improve care quality and position themselves as medical tourism destinations.

A study was conducted to investigate and assess the average waiting time (WT) in Dubai primary healthcare services centers. Healthcare centers will face critical problems if WT is not solved properly. All patients who visit the health medical centers during such period are considered for the study purpose except those need emergency services.. The questionnaires are distributed in 12 healthcare centers throughout Emirate of Dubai in UAE. A total of 76,780 electronic medical records are audited for patients and 938 responses are analyzed for the employee survey. The study finds that about 45.2% of the patients were registered within less than 7 minutes of their visit and the mean WT was 11.7 minutes of entrance. While more than two third of them (75.3%) waited less than 30 minutes and the average consultation WT was 34.2 minutes. 65.9% of patients waited less than 28 days to get their appointment and the average appointment WT was 35 days. The data collected from employees denoted that the main causes of patients’ WT were high workload level, insufficient work procedure, employees-supervisor interaction problems and adequate facilities availability. There is a need for healthcare leaders and managers in charges in this sector to reduce patients’ complaints while waiting and to solve the WT problem in a planned manner.

Patient satisfaction plays a significant role in determining the health outcomes and in the quality of health-care services provided by any health-care organization. It is also directly associated with the patient–provider relationship and with the compliance of treatment plans of the patients. Patient satisfaction is measured by using several indicators that include services provided by the health-care professionals, cleanliness, quietness, and wait times. A study carried out by Fayeh in 2015 examined the impact of wait time reduction on patients’ satisfaction of outpatients’ pharmacy at Prince Sultan Military Medical City. The study tried to identify the factors influencing the patients’ wait time, their estimation for the procedures of dispensing the medicine, and the suggested ways to reduce the patients’ waiting time. The study recommended the following to reduce the wait time that includes advising the visitors of the availability or no availability earlier before he/she waits in the queue, giving the prescription to the pharmacist before waiting in the queue and a sufficient number of the pharmacists to cope up with the numbers of the visitors. Similarly, a study by Perez-Carceles et al showed a statistically significant relationship between patient satisfaction and patient perceptions of received information and perceived wait time but not with actual waiting time. Most of the Saudi public hospitals are aiming to reduce patient wait times and increase efficiency.

The Authority deals with medical complaints against healthcare providers and medical professionals working in the public and private sectors in Dubai. A medical complaint is any written or spoken expression of dissatisfaction with a healthcare service in the Emirate of Dubai. All medical complaints are handled by the Health Regulation Department of the Authority. Medical complaints filed against healthcare professionals or entities are dealt with in a timely, professional and consistent manner by the Health Regulation Department. The Department will only accept complaints related to a health service or its quality. All medical complaints will be considered, whether they are formal written complaints or a concern expressed towards a healthcare professional or institution in a customer feedback survey. The Department will investigate the complaint and determine whether or not a healthcare professional’s actions or inactions constitute malpractice.

8. Role of Media:

Mainstream media has an important role in influencing the views of public and education of masses on important aspects of community life. The Arab media plays an important and responsible role in this regard. There are health and nutrition shows, which not only educate patient and families, they do sign posting and help in promoting local and national health care agendas. Healthy aging initiative and world dementia observatories are being promoted via social media as well as mainstream media in Qatar.

Social media platforms (SMPs) have emerged as powerful tools for public health promotion. As the 6 countries of the Gulf Cooperation Council (GCC) have the highest internet and social media usage rates in the world, and according to the initiatives for the introduction of a new health system and strategies based on non-traditional methods according to the Saudi Vision 2030, this review aimed to investigate different SMPs use and impact on public health promotion in the GCC countries. Accumulating evidence indicated that diabetes knowledge, women’s health, breast-feeding practices, oral health, appropriate antibiotic use, physical activity, road safety awareness, quitting smoking, and breast cancer awareness, were the most common specified topics. Future research should focus on populations that are medically

Underserved and who have no or limited access to health-care facilities. Also, future research, in particular, the intervention type, is required to cover more countries in the GCC. (AlSadrah, 2021)

9. Other Healthcare initiatives for elderly care:

The United Nations Decade of Healthy Ageing (2021–2030) is a global collaboration, aligned with the last ten years of the Sustainable Development Goals, to improve the lives of older people, their families, and the communities in which they live. The World Health Organization was asked to lead the

Implementation of the Decade in collaboration with the other UN organizations and serves as the Decade Secretariat. Governments, International and regional organizations, civil society, the private sector, academia and the media are encouraged to actively contribute to achieving the Decade’s goals through direct action, partnering with others, and by participating in the Healthy Ageing Collaborative.

Global dementia observance is a web based data and knowledge exchange platform of key dementia information currently that is being developed by World Health Organization. Its conceptual framework includes 3 strategic domain policies, services, delivery and information research and 7 crosscutting schematic areas:

• Dementia as public health priority
• Dementia awareness and dementia friendliness
• Dementia risk reduction
• Dementia diagnosis, treatment, care and support
• Support for dementia carers
• Information system for dementia
• Dementia research and innovation

Policy changes to Medicare and Medicaid during the COVID-19 pandemic have reduced barriers to tele-health access and promoted its use.27 Professional medical societies have endorsed tele-health, whereas tele-health experts have documented improved patient health outcomes. Open Notes, a movement aimed at ensuring that all patients can access and edit their care records as needed, encourages communication and transparency among older adults, families, and providers through shared access to notes. Open access to health care records was mandated in the 21st Century Cures Act of 2016.

The WHO created a Global Strategy and Action Plan for Ageing and Health for 2016–2020. The vision of the five strategic objectives was identified in a world in which everyone has the opportunity to live a long and healthy life.

The first of the five objectives was a commitment to action on healthy ageing in every country. This goal was to create collaboration between governmental and non-governmental actors, including service providers, scientists, and designers to ensure the existence of political and operational platforms for successful multi-sectorial operations. The second objective was to create and develop environments that could be friendly to older people. Close coordination between multiple sectors and departments was necessary, as well as cooperation with many environments, including, of course, older people to create friendly environments for the elderly. The third of the five WHO global goals created in 2016 was to align all healthcare systems to meet the needs of older people. With age, the health needs of older people become more complex and chronic. It was necessary to change and modify the healthcare system to ensure free access to basic and complex medical services for the elderly. The fourth point in the Global Strategy was to create reliable and appropriate systems for providing long-term care (home, community and institutional). Worldwide, an increase in the number of elderly people who have care needs and support was observed. Each country should have an integrated long-term care system that focuses on the elderly. The fifth element of the Global Strategy is the improvement of checking, monitoring and studying of the topic of healthy ageing. Effective methods and indicators to evaluate these exponents are required to understand the health problems of older people satisfactorily and properly. (Rudnicka et al., 2020)

The WHO conducted the implementation of global action in December 2017. Qatar was one of the countries chosen in Middle East region to take part in this program. The reason for establishing this global initiative was that dementia is already a major cause of disability and dependency in the older people. As the global population ages, it is expected that the cases of dementia will increase tremendously and will triple from 50 to 152 million by 2050. The idea of healthy aging is an important one and in fact it was the logo for one year that celebrated

Elderly Day “adding life to years and not years to life.”

The Ministry of Health in Qatar is taking the initiative in promoting this concept in the country.  This is not an easy task, we all know changing habits is extremely difficult especially when it comes to old people who are used to certain things which they have followed during their life.  The new found wealth in the gulf region, which Qatar is a part of, has led to many great things happening with advances in healthcare, infrastructure and standards of living. But on the other hand, there were disadvantages, for example the use of cars has led to total dependency of people on them and therefore exercise has gone down quite a bit. In addition, the Arabian Gulf region is well known for its high incidence of heavy smoking which of course leads to health problems.  Reading unfortunately has become rare and people are using social media and television and IPad to entertain themselves.  Less reading means less use of the peoples brains and may lead in fact to increased risk of dementia.

Measures taken by the State of Qatar to improve healthy aging:

1. Education programs across the media, in the schools, regarding diet and exercise; People are being informed about the detrimental effects of unhealthy diet and sedentary lifestyle from an early age.
2. Building of sports club where the young people as well as the older ones can go and participate in the game that they like.
3. Increasing the number of parks where people can just come and walk in a very nice green environment.
4. Stringent laws are being implemented by the Traffic Department regarding speed limits and violations of traffic rules which would reduce the number of casualties and disabilities in the country.
5. There is a great public library where all kinds of books as well as technology are provided for the population free of charge. This helps to encourage people to come and read in order to keep their minds active and to reduce the risk of future dementia.
6. Education programs regarding increasing social activities between people, encouraging them to meet each other and talk to each other rather than just messaging using their mobile telephones.

All the above, although very useful, can only succeed if the population at large utilize them and follow the advice given. The problem is really where to start implementing healthy aging; this must start at an early age during childhood and in school.  Education is extremely important at this early age in order to instill new habit and get rid of the bad ones.  This is an uphill battle because people are influenced by global trends and communication has made it very easy for anything new that happens in the world to reach the region.  People are eating less and less at home and relying on restaurant food both the fast ones and regular ones.  This will definitely lead to a detriment in the health of the population as restaurants use high concentration of fat and salt in order to make their food palatable.  It is also extremely important to educate doctors at the primary level to instill healthy aging in their patients at any age.

Saudi Arabia is a particularly robust example of cross-border collaboration in healthcare. In a country-level comparison of documented healthcare collaborations, Saudi Arabia ranks third, surpassed only by China (currently ranked first) and the United Arab Emirates (currently ranked second). The trends in Saudi Arabia’s market largely reflect broader trends in international healthcare collaboration across both the region and the world.

NCHL’s data and analysis show four notable trends in Saudi Arabia’s market:

Cross-border collaboration in Saudi Arabia has grown rapidly. The first documented collaborations in the country began in 2007 — by comparison, several countries have international relationships that date back to the 1990s or earlier. In just 15 years, Saudi Arabia has widely expanded both the size and scope of international healthcare partnerships. The nature of collaborations reflects a particular focus on building healthcare capacity. Most identified collaborations in Saudi Arabia are either educational in

Nature or aim to increase the quality of and access to care through consulting, direct ownership, and joint venture agreements. The educational partnerships are primarily designed to increase the healthcare workforce’s access to training as well as facilitate cross-border knowledge sharing with international partners.

There is an increasing focus on specialization. As of September 2023, only 13% of the collaborations in Saudi Arabia are specialized. This means that that the collaboration has a limited

scope in terms of service lines covered by the relationship. While this is a small share of all collaborations in the country, it is noteworthy that almost every specialized collaboration began in the past five years. This demonstrates a shift towards addressing niche needs within the healthcare system. Some examples of

Specialized collaborations include:

In 2020, Jeddah Park Health established a collaboration with Johns Hopkins Medicine International through a “long-term clinical advisory engagement in developing the leading physical medicine and rehabilitation hospital in both the Kingdom of Saudi Arabia and MENA region. The collaboration calls for a general consultation from Johns Hopkins Medicine International on the planning, development, and launch of a standalone physical medicine and rehabilitation-focused facility.” International hospitals, healthcare information technology companies, and other healthcare-focused organizations continue to show strong interest in establishing new collaborations in Saudi Arabia – as do the national governments of their countries of origin. In a particularly recent example, in September 2023, the International Trade Administration of the US Department of Commerce led a delegation of 15 American healthcare companies — including five hospitals — on a healthcare-focused trade mission to Saudi Arabia.

Conclusion:

As it would be now evident to the reader that although there are a lot of similarities among the seven countries which form the states of Arabian Gulf Region there are still large differences as well. Most of the development seen in these countries was due to the oil boom while all these were countries were oil based economies. This brought lot of developed world countries interest to this region and resulted in rapid infrastructure development. This development was also in the field of health care, housing, and sanitation. The changing life style, easier access to the modern healthcare facilities along with other factors has led to increased life expectancies throughout the region. This resulted in an increased number of elderly people who often have more than one chronic disease and complex needs. This aging population had to be looked after well and special facilities and services were developed in almost all countries to cater for their needs.

Iraq is an exception among these states due to repeated wars it has endured since the first Gulf War. The latest fight against ISIL has caused a devastating blow to the country’s infrastructure as well. Iraq prior to 1990 had a modern health care service with well-equipped tertiary hospitals in major cities. Subsequent to the gulf war and imposed sanctions health care was also hit hard along with other services in the country. We have deliberately more or less excluded Iraq from the above discussion as there is no reliable and latest source available to verify what services currently exist for the health care of elderly in the country.

The Arabian Gulf countries have more or less been protectorates or dependencies of British Crown since the First World War. Kingdom of Saudi Arabia was the first one to gain independence in 1927 while others like Qatar gained full independence in 1971. The lack of full independence in the governance and full control of oil-based economy has seen these countries develop at different pace over the last century. While some like Qatar have caught up fast in the past 20 years some like Iraq have regressed due to its turmoil. The region itself is composed of several countries, covering a large area and a huge population. This complex scenario makes it a challenge to write all about the health care structure especially for the elderly patients under the same chapter. Wherever possible we have described the services individually for the countries comprising the region. It is inevitable that some aspects would be missed, however a sincere effort has been made to highlight all the progress and advances made in the past few decades by these rapidly developing nations towards the health care of their elderly.

References:

• Al-Hanawi, M. K., Khan, S. A., & Al-Borie, H. M. (2019). Healthcare human resource development in Saudi Arabia: Emerging challenges and opportunities – A critical review. Public Health Reviews, 40(1), 1–16.
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• Alawi, A., & Alkhazim, M. (2012). Healthcare Policies in GCC : Challenges and Future Directions- Workshop 17. 1–4
• AlSadrah, S. A. (2021). Social media use for public health promotion in the Gulf Cooperation Council: An overview. Saudi Medical Journal, 42(1), 9–20.
• Gurajala, S. (2023). Healthcare System in the Kingdom of Saudi Arabia: An Expat Doctor’s Perspective. Cureus, 15(5), 2021–2023.
• Hussein, S., Policy, H., & Associate, E. (2019). Older people ’ s health and care needs in the Middle East : Policy and practice perspectives within changing population structures The Middle East and North Africa. February.
• Khan, H. T. A., Hussein, S., & Deane, J. (2017). Nexus Between Demographic Change and Elderly Care Need in the Gulf Cooperation Council (GCC) Countries: Some Policy Implications. Ageing International, 42(4), 466–487.
• Khoja, A. T., Aljawadi, M. H., Al-Shammari, S. A., Mohamed, A. G., Al-Manaa, H. A., Morlock, L., Ahmed, S., & Khoja, T. A. M. (2018). The health of Saudi older adults; results from the Saudi National Survey for Elderly Health (SNSEH) 2006–2015. Saudi Pharmaceutical Journal, 26(2), 292–300.
• Rudnicka, E., Napierała, P., Podfigurna, A., Męczekalski, B., Smolarczyk, R., & Grymowicz, M. (2020). The World Health Organization (WHO) approach to healthy ageing. Maturitas, 139(February), 6–11.
• Schönrock, S., Schablon, A., Nienhaus, A., & Peters, C. (2015). What do healthcare workers in elderly care know about occupational health and safety? An explorative survey. Journal of Occupational Medicine and Toxicology, 10(1), 1–11.

Biography:

Accomplished 𝗮𝗰𝗮𝗱𝗲𝗺𝗶𝗰 𝗮𝗻𝗱 𝗿𝗲𝘀𝗲𝗮𝗿𝗰𝗵 𝗲𝘅𝗽𝗲𝗿𝘁 with 𝗼𝘃𝗲𝗿 𝟭𝟴 𝘆𝗲𝗮𝗿𝘀 of working in leading roles in the 𝗮𝗰𝗮𝗱𝗲𝗺𝗶𝗰 𝗮𝗻𝗱 𝗵𝗲𝗮𝗹𝘁𝗵𝗰𝗮𝗿𝗲 𝘀𝗲𝗰𝘁𝗼𝗿𝘀, and a 𝗽𝗶𝗼𝗻𝗲𝗲𝗿 𝗶𝗻 𝗶𝗻𝘁𝗿𝗼𝗱𝘂𝗰𝗶𝗻𝗴 𝗲-𝗹𝗲𝗮𝗿𝗻𝗶𝗻𝗴 𝘁𝗼 𝗵𝗶𝗴𝗵𝗲𝗿 𝗲𝗱𝘂𝗰𝗮𝘁𝗶𝗼𝗻 𝘁𝗵𝗲 𝗶𝗻 𝗸𝗶𝗻𝗴𝗱𝗼𝗺. Has a solid background in 𝗶𝗻𝗱𝘂𝘀𝘁𝗿𝗶𝗮𝗹, 𝘀𝗼𝗰𝗶𝗮𝗹, 𝗲𝗰𝗼𝗻𝗼𝗺𝗶𝗰, 𝗮𝗻𝗱 𝗽𝘂𝗯𝗹𝗶𝗰 𝗵𝗲𝗮𝗹𝘁𝗵 𝗶𝘀𝘀𝘂𝗲𝘀, and sound expertise in 𝗿𝗲𝘀𝗲𝗮𝗿𝗰𝗵 𝗲𝘅𝗰𝗲𝗹𝗹𝗲𝗻𝗰𝗲, 𝗵𝗲𝗮𝗹𝘁𝗵𝗰𝗮𝗿𝗲 𝗾𝘂𝗮𝗹𝗶𝘁𝘆, 𝗱𝗮𝘁𝗮 𝗮𝗻𝗮𝗹𝘆𝘀𝗶𝘀 𝗮𝗻𝗱 𝗿𝗲𝗽𝗼𝗿𝘁𝗶𝗻𝗴, 𝗵𝗲𝗮𝗹𝘁𝗵𝗰𝗮𝗿𝗲 𝗮𝗱𝗺𝗶𝗻𝗶𝘀𝘁𝗿𝗮𝘁𝗶𝗼𝗻 𝗮𝗻𝗱 𝗲𝗱𝘂𝗰𝗮𝘁𝗶𝗼𝗻, and always up-to-date with the 𝗹𝗮𝘁𝗲𝘀𝘁 𝗺𝗮𝗿𝗸𝗲𝘁 𝘂𝗽𝗱𝗮𝘁𝗲𝘀 𝗮𝗻𝗱 𝘁𝗲𝗰𝗵𝗻𝗼𝗹𝗼𝗴𝗶𝗲𝘀. A leader who 𝗲𝗳𝗳𝗶𝗰𝗶𝗲𝗻𝘁 𝘄𝗼𝗿𝗸 𝗲𝗻𝘃𝗶𝗿𝗼𝗻𝗺𝗲𝗻𝘁 that accommodates to growth, and an advocate for 𝗮𝗱𝘃𝗼𝗰𝗮𝘁𝗲 𝗳𝗼𝗿 𝘄𝗼𝗺𝗲𝗻’𝘀 𝗽𝗿𝗼𝗳𝗲𝘀𝘀𝗶𝗼𝗻𝗮𝗹 𝗹𝗲𝗮𝗱𝗲𝗿𝘀𝗵𝗶𝗽.

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