A significant development in medicine is the recognition that patients should be treated as active agents in their health care. Contemporary consumers show increased interest in becoming more personally involved in decisions about their health, as evidenced by the popularity of such resources as WebMD and the marketability of health-related products and services. In the context of the traditional office visit, self-management is an inevitable part of treatment, since patients ultimately decide when to initiate the process and to what extent they will adhere to recommended courses of action prescribed by health care professionals.
Geriatric medicine is no exception to this trend. A guiding assumption of this chapter is that older adults' self-management of health behaviors is central to understanding the etiology, treatment, and downstream consequences of illness, chronic disease, and disability. An appropriate model for 21st-century geriatric medicine will focus on creating a partnership between health care professionals and their patients and will require that health care professionals have a working knowledge of what motivates older adults to initiate health behaviors and the potential reasons for success or failure in self-management. The early sections of this chapter will define and provide a conceptual framework for self-management; later sections will review key studies in the area and offer guiding principles and suggestions for incorporating patient self-management into practice. Mastering this knowledge will enable geriatric health care professionals to deliver state-of-the-art care to their patients.
In 2003, Noreen Clark noted important distinctions among terms such as self-care, disease management, self-regulation, and self-management. Establishing clear definitions is an important first step in ensuring that health care professionals understand how to integrate self-management with clinical practice.
Using Clark's distinctions as a guide, self-care involves actions taken by an older adult to maintain a desired health status without the interaction or assistance of a professional. Examples might include taking herbal supplements or participating in a yoga class at the YMCA independently, without any advice or monitoring by health care professionals.
Although self-care is important in the lives of older adults, in this chapter, we are interested in health behaviors that either do or should directly involve health care professionals. Such behavior falls under the rubric of either disease management or self-management. Clearly, older adults managing chronic disease and disability must frequently consult health care professionals and adhere to the various therapies they prescribe. Adherence implies that the older adults perceive that they have an active role in making decisions about, and carrying out, a particular regimen. It implies a collaborative relationship between patient and health provider. In contrast, compliance suggests an unquestioning and passive response by the patient and a provider–patient relationship that is one-way and top–down. Adherence has been shown to be better in promoting persistence and motivation than compliance, underscoring the necessity for collaboration in health care.
How, then, does disease management differ from self-management? Disease management involves both the health care system ...