Implementing care for healthy ageing

Abstract

The WHO concept of Healthy Ageing (ie, the process of developing and maintaining the functional ability that enables well-being in older age) has initiated a global discussion about the need for shifting paradigms to reorient health and social services towards person-centred and coordinated models of care. In particular, the integration of health and social care services is critical to provide the basis for comprehensive information sharing and service delivery to support the evolution of the older person over time. The capability to monitor and respond to an older person’s changing health and social care needs will enable prompt and personalised health and social care plans to be implemented.The implementation of an integrated care approach involves all the settings where persons age, but also requires a concerted action among micro (clinical), meso (service delivery) and macro (system) level. The community is of particular relevance given the primary objective of "ageing in place". However, from the perspective of the continuum of care and services acting synergistically, all health and social care settings (including long-term care facilities and hospitals) need to evolve and embrace an integrated way of operating to support functional ability in older people, while maximising resource and information sharing efficiencies.In this paper, we explain that government actions to promote well-being in older age should be built on a seamless continuum of care starting from the assessment of the older person’s intrinsic capacity and functional ability with the final aim of providing care aligned with the individual’s needs and priorities.

Unpacking the design, implementation and uptake of community-integrated health care services: a critical realist synthesis

“…The implementation of an integrated care approach involves all the settings where the targeted population dwell and function (communities), but also requires a concerted action among microlevel (clinical), mesolevel (service delivery) and macrolevel (system). 54 The community is, therefore, of relevance as it represents where the actors reside and function. To this end, we used integrated-community health systems and patient-centred lenses to delineate our study boundaries and capture the complexity of how and why community-integrated care initiatives are designed, implemented and used.…”

The development of a platform to ensure an integrated care plan for older adults with complex care needs living at home

“…The need for integrated care delivery systems is increasingly accepted (Baxter et al. , 2018; Cesari et al. , 2022; Goodwin et al.…”

“…This population often requires access to a wide range of health, social and community services, with increasing intensity and over a longer period of time. As complexity grows, so does the need for more appropriate approaches than the present ones, which are mainly oriented towards acute episodic care (Cesari et al, 2022;Struckmann et al, 2018). Fragmentation and discontinuity of care often leads to malpractice, misdiagnosis and increased costs (Stange, 2009).The need for integrated care delivery systems is increasingly accepted (Baxter et al, 2018;Cesari et al, 2022;Goodwin et al, 2021).…”

“…This population often requires access to a wide range of health, social and community services, with increasing intensity and over a longer period of time. As complexity grows, so does the need for more appropriate approaches than the present ones, which are mainly oriented towards acute episodic care (Cesari et al. , 2022; Struckmann et al.…”

“…As complexity grows, so does the need for more appropriate approaches than the present ones, which are mainly oriented towards acute episodic care (Cesari et al, 2022;Struckmann et al, 2018). Fragmentation and discontinuity of care often leads to malpractice, misdiagnosis and increased costs (Stange, 2009).The need for integrated care delivery systems is increasingly accepted (Baxter et al, 2018;Cesari et al, 2022;Goodwin et al, 2021). Numerous integrated care initiatives have been developed (Struckmann et al, 2018), but their effective implementation remains a challenge (Auschra, 2018).…”