Of the wealthy countries, Israel is among those with the youngest population, on average, in the world – thanks to its high birth rate, especially among observant Jews and Bedouin.
But ironically, at the same time, it has among the largest and growing absolute numbers of elderly – as a consequence of its high longevity rates, second only to Japan. How will it cope in the years ahead with the aging population, especially the post-World War II baby boomers?
This parallels the irony that although Israelis have constantly been exposed to terror attacks, and the country has been forced to take part in wars with its neighbors since its independence 77 years ago, nevertheless, its citizens are still ranked the eighth “happiest” in the world. AT 93 AND still going strong, Ben-Gurion University of the Negev Faculty of Health Sciences Prof. (emeritus) Shimon (Seymour) Glick has seen and done nearly everything in medicine, so he has all the qualifications to discuss Israel and aging.
Care for the aging, he said, “requires specialization in geriatrics, but there are too few of them here, and it isn’t a lucrative field. Doctors want to see people get well and not, eventually, die.”
Glick shared that at a conference on cancer with Prof. Yechiel Schlesinger, head of pediatrics at Shaare Zedek Medical Center (SZMC), Schlesinger said “ that his late father – Dr. Falk Schlesinger, who was director-general of the hospital for two decades – declared that he didn’t get his satisfaction from curing people but from caring for people.”
Israelis are now living much longer, which means they need more medications for chronic illnesses and are hospitalized for longer periods.
Israeli longevity is exceptional – the average life expectancy of Jewish women in 2022 was 85.1 years, followed by Muslim women with a life expectancy of 81.8 years, Jewish men at 81.5 years, and only 77 years among Muslim men.
But the share of those elderly who enjoy good health is relatively low compared to Scandinavia, for example.
“Medical centers advertise their obstetrics services – delivering babies – because they get generous state subsidies, and the health funds prefer young families as members because they are cheaper to treat,” Glick noted.
“But it is fortunate that, in general, Israelis are close to their parents and grandparents and respect the elderly.”
Geriatrics must become a priority in Israel
However, respect is not enough. Geriatrics has to become a priority.
Israel’s elderly population is steadily growing, currently standing at 1.2 million people in 2024, with 39,000 Israelis joining the 65-and-over age group.
“We need devoted geriatricians who are interested in the field. When I studied in New York, I specialized in internal medicine and worked in Coney Island Hospital, where there were many old Jewish patients.
“Once you make it a priority and establish special programs for prevention and treatment of geriatric diseases and research in the field, you can do anything. President Franklin D. Roosevelt had polio; although he tried to hide that fact from Americans, so much money was raised for research into the disease.
“There’s also a problem that young doctors generally refuse to go to the periphery of the country and prefer the wealthier and more prestigious center.”
A. Mark Clarfield, professor of geriatrics (emeritus), agreed with Glick. “Israel has a very strong community structure, good family dynamics, and a strong support system. When somebody in the family is sick, Israelis take off work, even for a grandchild.
“This wouldn’t happen in the US, England, or Canada,” said the Canadian-born Clarfield, who is assistant director of the BGU’s Faculty of Health Sciences’ Center of Global Health and chairman of the Health Ministry’s National Council on Aging.
“There aren’t enough general hospital beds in Israel, especially important for the elderly; that’s the bedrock of any health system. There have never been, even though new medical centers are being planned due to the continuous growth of the overall population.
“We’re at the lower end when compared to average beds per capita in the OECD. There aren’t enough nurses and doctors, even though more medical schools have opened. People also live longer, in part because there is little alcoholism, and the religion and culture are very well developed.”
Clarfield added that in medical schools here, of 250 weeks of study to become an physician, students get only a week or two in geriatrics.
He believes that students should get at least four weeks’ exposure to it.
“If they encounter a woman patient in the emergency room who broke a wrist, they should investigate what caused her to fall and whether she has osteoporosis (thinning of the bones). She probably got dizzy in the supermarket or at home; she was not run over by vehicle.
“These are sentinel symptoms – basic stuff, but if a doctor hasn’t been exposed to geriatrics training, a cast will be placed and the older patient sent home without the appropriate follow-up . Geriatrics is a low-status profession but is low-tech, and high-touch.”
Clarfield continued: “Students and residents are not exposed to it, so they don’t choose to go into it. There are also the subconscious issues like the doctor himself getting old – if one is lucky – and one day dying.
“When I came to Israel in 1992, there were no geriatricians in the community clinics of the health funds. That being said, there has been a lot of progress, and if you’re good, you get the requisite respect.”
He added that while telemedicine – observing and treating patients online – can help, “one can’t replace the experience of doctors seeing you in person. Artificial intelligence will be a tool, but it won’t replace doctors in any field.
“Old people as patients are complicated. Their reserves are reduced. We are bad at accepting the fact of eventual death. The aged need a living will and (at all ages) an enduring power of attorney so a relative can make decisions on treatment if the patient is unable to.”
Asked to comment, Shaare Zedek Medical Center president Prof. Jonathan Halevy – who has advised Reichman University on its establishment of the new Dina Recanati School of Medicine – agreed that “geriatrics does not have its proper proportion in curricula of Israeli medical schools.”
“It is often perceived and taught only as part of internal medicine, but it definitely calls for a different emphasis and thinking,” he said. “I fully agree that training of medical students in the clinical years should include at least two-to-three weeks in geriatric departments and that academic geriatricians must teach the students about the many unique aspects of this discipline.”
He added that “unfortunately, this was not carried out at Reichman’s new medical school. It should be changed.”
According to Nadav Davidovitch, an epidemiology and public health professor, the outgoing dean of BGU’s School of Health Sciences, and now chairman of the Taub Center for Social Policy Studies’ Health Policy Program in Jerusalem – the entire health system must be restructured.
“By 2050, there will be no Holocaust survivors left. But the next elderly generation, while living long lives, will not live that long without disability. There will be Alzheimer’s and Parkinson’s disease, loneliness, depression, and a need for rehabilitation,” said Davidovitch.
“Israel is among the few countries that has a plan for the elderly, but while we plan well, we don’t implement well enough. I’m realistic; it won’t happen immediately, but if there is enough political will, it will happen soon.”
He urged that more long-term geriatric homes be located close to kindergartens so they can be close to children; the benefits were vividly portrayed on Channel 11 TV’s Four and 80 series, produced by the late geriatrician Prof. Yoram Maaravi.
As in the UK, pharmacists here should be able to give injections to reduce the burden on nurses and doctors. The local authorities must be more involved in disease prevention and nutritional security.
IN THE COMING decade, the age group that will grow the fastest is the post-war generation of baby boomers, according to Dr. Shirli Resnizky of the Welfare and Social Affairs Ministry.
“They need more medical services, so they will put a burden on the medical system. The ministries do care about the elderly. In 2015, they were recognized as a strategic population,” she said.
“The coronavirus pandemic created more awareness in government and the need for help to the elderly,” added Resnizky, who also works with ESHEL (The Association for the Planning and Development of Services for the Aged in Israel) at Jerusalem’s Myers-JDC-Brookdale Institute.
Resnizky specializes in studying social and health services for the elderly, family caregivers, long-term and end-of-life care, evaluating the needs of the aging population, and the array of programs provided for them.
In recent years, she has headed studies on the integration of health and social services, legal guardianship, advanced-care planning, and National Insurance Institute laws.
She holds a bachelor’s degree in sociology and international relations and a master’s degree in sociology, both from the Hebrew University of Jerusalem, and a doctorate in gerontology from the University of Haifa.
“A significant problem is that not one ministry – but six plus voluntary organizations – deals with the aging. I see gaps between the politicians and medical professionals who do their best.”
“Manpower is a big challenge to the health system, especially with the lack of geriatric experts,” continued Resnizky. “The number rose in the last decade, but it is still not enough to cover the country’s needs, especially in the community and periphery.
“Family physicians are front line, but geriatricians are needed in many cases to understand the entire picture. Due to the fact that they often suffer from multiple diseases, older persons often are exposed to poly-pharmacy – taking many drugs together.
“There aren’t many places where the elderly can get a comprehensive assessment. There are more geriatric and palliative nurses who treat pain, but not enough.”
The health funds, noted the ESHEL expert, predicted that there will be “a revolution of treatment in the home. That’s what most patients and their families want, but they need help. There will be more telemedicine but not all the elderly know how to use smartphones and computers.
“The major change will be more doctors and nurses visiting homes instead of hospitalization. It’s also cheaper for the health funds. However, there is no uniformity among the insurers and the various regions of the country; those living in the periphery don’t get what they need.”
Robots are widely used to support the elderly in countries like Japan; this doesn’t exist here, she said, but they should.
“ESHEL has studied the use of technology for society and the individual. I’m optimistic, as people like to cope with the challenges of system. Most caregivers – including those who come from abroad – work well and with love to those they help.
“Over 80% of family members help to care for the elderly. In Arab society, there are fewer elderly, but their aging rate – now 5% – will be 12% very soon, compared to 13% among the general Israeli population today.
“Old age begins among Arabs much younger than in Jews because of smoking and physical work; they lack the awareness about what is healthy.”
Experts disagree on what humanity’s maximum longevity will be. Some say it won’t go beyond Moses’ biblical age of 120. Others say there won’t be such a limit, as bio-printable parts – whereby living tissue will be used to replace diseased organs – will become available, Resnizky concluded. ■