Drawing on material from qualitative interviews, this article examines self-care as a response to physical symptoms commonly experienced by older people. The analysis indicates that older persons approach, interpret, and treat their symptoms within both biomedical and psychosocial frameworks. Self-care responses appear to be learned early in life, reinforced throughout the life cycle, and formed in consultation with professional as well as lay persons. Symptom responses reflect and reinforce the meaning of social relations in individuals' lives, providing a symbolic medium for the assessment of present and past relationships, cross-generational connections, and past troubles and issues of personal identity. Findings suggest that categorizing sources of care into professional, informal, or self overly simplifies the symptom experience of older adults. Self-care goes beyond the acknowledgment of discomfort and subsequent treatment of symptoms; it involves the representation and interpretation of the self.
Chronic mentally ill persons in the community depend on an array of psychological, social, and medical support services that are delivered by public and private sources and are under the auspices of diferent levels of government, In response to problems of fragmentation and disorganization of these services, improved coordination has emerged as a major objective of contemporary mental health policymaking. This article describes the major coordinating approaches that have been developed, analyzes barriers to their implementation based on insights from the policy sciences and other literatures, and examines the basis of coordination's appeal as a service system reform strategy.
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