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This chapter addresses the following Geriatric Fellowship Curriculum Milestones: #1, #40
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Learning Objectives
Understand the role of health care provider (HCP)–patient collaboration in promoting the self-management of health behavior in geriatric patients.
Integrate the principles of self-management into daily clinical practice.
Be able to collaborate with older adults in developing realistic and relevant health goals.
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Key Clinical Points
The traditional biomedical model of care follows a top-down format, where HCPs are expected to fix problems, and patients play a passive and compliant role. In contrast, collaborative self-management emphasises the patient-HCP partnership: the patient is an active agent with valuable knowledge, who is involved with (a) identifying the problem, (b) selecting an appropriate treatment regimen, (c) making detailed action plans, and (d) evaluating and providing feedback to the HCP on outcomes.
When working with patients, HCPs should keep in mind the five As advocated by the AMA: assess, advise, agree, assist, and arrange for action.
Older adults engage in self-management in response to a conscious health goal or to remove barriers in the path toward goals; health-related goals most often stem from concerns related to detection or prevention behavior; that is, older adults want to identify, alleviate, or avoid a specific physical or psychological symptom/condition.
The major factors driving self-management include setting a clear standard or goal, self-monitoring progress, feedback, self-evaluation, corrections, and enhancing self-efficacy beliefs.
Groups can be a powerful tool for teaching self-management skills to older adults. In bringing people together with a common problem and/or goal, group members actively collaborate with, learn from, and support one another. With time and practice, older adults develop the skills necessary for self-management. After these skills have been learned, HCPs need to actively transition members away from the group by slowly reducing group dependency.
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Self-management is an essential factor for the long-term success of individuals who live with chronic disease and/or physical disability. Approximately 80% of older adults have at least one chronic disease, and the number of aging individuals in North America and throughout the world is growing rapidly. Despite provision of standard care by health care providers (HCPs), distressing statistics related to patient adherence suggest that something is amiss. Consider these few of many examples: only 40% of patients actually have the confidence to make recommended health behavior change; patients only recall about 50% of the information their physician communicates; and, of the 28% of individuals receiving physician advice to change physical activity, fewer than 40% received help related to specific plans and fewer than 42% received follow-up support. The care and treatment of chronic conditions cannot progress unless there is a conscious effort to change HCP’s training and, of equal importance, their practice.
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Fortunately, these issues are increasingly being acknowledged in public health settings and by groups like the American Medical Association (AMA). A significant development is the recognition that ...