The importance of geriatric care has been recognized, and geriatric evaluation and management units and interdisciplinary teamwork are well established in Iceland (Jonsson, 1998). Interest among physicians in formal geriatric training has increased rapidly during the past 10 years, and in 2002, 15 fellowship-trained geriatricians had appointments at academic hospitals. Iceland was one of the first countries to adopt the comprehensive Resident Assessment Instrument (RAI) in nursing homes from the United States by a mandate in 1996. A crucial consequence of the international adoption of the RAI is that comparison of long-term care between countries has become feasible (Jonsson and Palsson, 2003). More interRAI assessment tools currently are being adopted in Iceland such as home care, post-acute care, and mental health, all paving the way toward a seamless information system in elderly care and formation of a longitudinal database.
Icelandic law mandates use of the Nursing Home Preadmission Assessment (NHPA); no one can enter a nursing home without undergoing this certified need assessment. A multidisciplinary team performs the NHPA; the team consists of a physician, nurse, and social worker. The assessment is in standard form and content. It remains valid for up to 18 months and is expected to be revised if the applicant's condition or situation changes during this time (Johannesdottir and Jonsson, 1994).
The NHPA system generates national and regional waiting lists for the currently 3,700 nursing home beds available. Based on analysis of the NHPA database for the period 1992 to 2001 in the Reykjavik metropolitan area, the average enrollment age of men in nursing homes in Reykjavik was 82.7 years, and for women, 84.4 years. Men were about one-third of residents in nursing homes. The mean survival in nursing homes in Reykjavik was 2.5 years for men and 3.1 years for women (Ingimarsson, 2004).
The structure of care for the elderly is similar in the five Nordic countries (Sweden, Finland, Denmark, Norway, and Iceland). A close collaboration exists between the Nordic professors in geriatric medicine. This collaboration has already produced strategic documents relating to geriatric assessment and geriatric rehabilitation (Jonsson et al., 2002; Sletvold et al., 1996).
In 1999, an Institute on Gerontological Research (IGR) was established by the University of Iceland and Landspitali University Hospital. As an umbrella-like organization its main goals are to coordinate and facilitate broad research and collaboration in gerontology at the University of Iceland and the University Hospital. Researchers from the IGR are involved with, to mention but few, research at DeCODE company (Alzheimer's and longevity studies), the AGES study, and European and Nordic collaboration (Jonsson et al., 2003; Fialova et al., 2005).
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