Helge Garåsen The Trondheim Model - NSDM

In the publication Scenario 2030 the Norwegian Board of Health (Helsetilsynet) has
concluded that the most common diseases among elderly patients will increase by 40 to 60 %
by the year 2030 (49).
In Great Britain a report by an expert team at the University of Leicester (9) has used data
from the MRC Cognitive Function and Aging Study, a national representative sample of
people aged 65 and over, and have explored the effect of different health scenarios on the
future numbers of older people with disabilities. The team concluded that the ageing of the
population alone, with no alteration in the prevalence of the diseases (dementia, stroke,
coronary heart diseases and arthritis) will result in a 67 % increase in the numbers of disabled
over the nest 20 years. This report also considers that the effects of improvements in
population health from reduction in levels of obesity and other health behaviours, control of
vascular risk factors, better treatments or technologies, could considerably reduce the
numbers of disabled older people; nevertheless the numbers of disabled people will still
increase by 57 % (9).
An OECD report has suggested that in 13 countries, where data are available, an aging
population will create an increase in age-related social expenditures from an average of under
19.5% of Gross Domestic products in 2000 to almost 26 % of GDP by 2050, with old-age
pension payments and expenditure on health care and long term care each responsible for
approximately half of this increase (1,52).
2.2 A revisit to the principle of LEON
In all Western societies modern health care consists of many different professions, specialised
general and university hospitals, rehabilitation units and several different care alternatives at
community level and at secondary level. As a consequence many patients can be exposed to a
large number of different health personnel, providing different kinds of care that is not always
coordinated in the space of a short period of time. This is especially the case for the elderly.
One important future issue will be to develop better understanding of when patients need care
at a general hospital, at a community hospital, at a nursing home, by home care or treatment at
an outpatient department, by a general practitioner or a multiprofessional team.
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