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In Search of a New Paradigm of Care for Older Adults with Chronic Illness

Laura N. Gitlin, Ph.D.
Jefferson Center for Applied Research on Aging and Health (CARAH)
Professor, Department of Occupational Therapy
Thomas Jefferson University

Prepared for the AOTF 2008 Research Colloquium

The dramatic aging of our population poses critical challenges to our current health care system. In contrast to the acute medical model in which our present health care system is based, chronic illness represents the primary condition confronting older adults. Chronic illnesses are characterized by their complexity, syndromal nature, functional limitations, and the need for on-going self-management and care coordination, and home and environmental strategies to support declining abilities. The grave mismatch between the needs of an aging society and existing health delivery and payment structures warrants our immediate attention and movement towards a new paradigm of care that addresses the psycho-social-cognitive-medical needs of older adults in a coordinated, systematic way informed by prevailing evidence.

A primary consequence of chronic illness is functional limitations, or the inability to fully participate in basic and instrumental self-care and leisure activities. Thus, occupational therapists in particular, with their expertise in person-environment fit and activity analysis have an important role on the interprofessional team caring for older adults with chronic illness. This presentation examines population trends and explores its implications for new delivery systems, discusses the specific role of occupational therapists in the care of older adults, and presents evidence from two randomized trials of the effectiveness of occupational therapy with this population. The presentation provides an understanding of the possibilities of a new paradigm of care and what that might look like with occupational therapists centered at the helm of a team approach.

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