Special population: Older adults

Abstract

The ability of modern medical care to successfully treat acute infections, trauma, and other medical emergencies has allowed many Americans to live into old age, when the focus of medical treatment is now largely on the management of chronic illness. Chronic conditions are more common in adults aged 65 years and over than in younger adults. The key objectives of care for older adults with chronic health problems are (1) to help the individual maintain his or her quality of life, (2) to support relatives and other caregivers, and (3) to arrest or slow down the rate at which functional abilities are lost. The approach to the assessment and management of chronic illness in older adults requires the clinician to consider several distinctive factors such as frailty, geriatric syndromes, iatrogenic illness, health literacy, social support, decision-making capacity, rehabilitation, and the integration of long-term services and social supports. Over the past 20 years, a wide range of care models directed at providing improved quality of care, at lower cost to older adults with multiple chronic illnesses, have been developed and tested. These care innovations have been implemented in a variety of settings, hospitals, transitions/post-acute-nursing homes, and outpatient care. Many of these models have a strong evidence base, but have not been widely disseminated. Health-care providers can learn the principles central to the provision of excellent care to chronically ill older adults.