Formative Care: defining the purpose and clinical practice of care for the frail

Bowman, C. & Meyer, J. (2014). Formative Care: defining the purpose and clinical practice of care for the frail. Journal of the Royal Society of Medicine, 107(3), pp. 95-98. doi: 10.1177/0141076813512298

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Abstract

The emerging population of older people with chronic, progressive degenerative diseases pose the greatest challenge to the sustainability of health and care systems but services are not well developed for their needs1,2 and robust metrics of experience lacking. Modern Medicine generally can be described in terms of prevention, diagnosis and the evidenced treatment of acute and long-term conditions. Additionally, and particularly, for older people needs assessment, rehabilitation, palliative and end of life care are well established. These clinical domains are broadly mirrored in social care where prevention, personalisation, enablement, empowerment and risk management are commonly cited.

The early phase of Geriatric Medicine highlighted the importance of Comprehensive Geriatric Assessment, treatment and rehabilitation in reducing care needs3 and the improvement of living conditions and general support.4 Collectively, these have successfully limited avoidable dependency. In recent years, development has focused on improving end of life care. However, ageing populations feature a growing number of older dependent people who are increasingly unresponsive to traditional treatment(s) but for whom dying and death is not imminently anticipated.

This emerging dependent population is increasingly recognized5 as is the complexity of managing multiple morbidities.6 However, there is little coherence to the purpose of medicine for this population in spite of frequent public, professional and political concerns with common themes of dignity, quality of life and affordability.7,8 The continued major failures of care9 and inadequate clarity over life status10 or monitoring measures to assess experience11 all point to a need for new thinking in this ‘clinical space’.

Item Type: Article
Additional Information: Bowman, C. & Meyer, J. Formative Care: defining the purpose and clinical practice of care for the frail. Journal of the Royal Society of Medicine, 107(3), pp. 95-98. Copyright © 2014, the authors. Reprinted by permission of SAGE Publications.
Uncontrolled Keywords: frailty, well-being, life quality, life trajectories, care homes, clinical purpose, integration, treatment strategy
Divisions: School of Health Sciences
URI: http://openaccess.city.ac.uk/id/eprint/14208

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