A Case Study: Challenges and Issues Caring for the Older Adult Across the Spectrum of Settings

Caring for frail older adults presents unique challenges for the primary care provider. Advancing age is associated with physical and cognitive decline related to increased co-morbid conditions including arthritis, heart disease, pulmonary disease and diabetes. Eighty-year-old Mrs. X illustrates the challenges and issues providers face daily caring for the complex population in the present fragmented health care environment in the United States. The challenges and issues faced by those caring for the frail elderly include lack of coordination and continuity of care for patients with multiple conditions, the nursing shortage, polypharmacy and soaring medication costs, and transportation and access to health care services. There are emerging models of care for the frail elderly; however barriers exist to implementing these models routinely in the present health care system. Barriers to implementing these models include: 1. lack of continuity between ambulatory, acute, and long term care. 2. financing dependent upon employer, age, and type of service. 3. transportation and access to appropriate health care services. 4. inconsistent results of studies of alternative models of care. With the growing older population we must address the health care needs of this frail, medically needy group.