Abstract
AbstractMedical science has made magnificent advances by dividing complex problems into their component parts. The strength of clinical trials, and the resulting evidence‐based clinical guidelines, is that they isolate a particular phenomenon or therapy from its context to assess its effect without the confounding of diverse contextual factors. However, the health and health care of whole people, and particularly older people who often live with multiple chronic conditions, is context‐dependent. Older people are not well served by the current fragmented medical knowledge and organization of health care, which is impersonal, often ineffective, and dangerous. More helpful approaches to health care for older people begin with the whole of the person in their family and community circumstance, and then examine the parts of people (including individual strengths, as well as diseases and disabilities) in context.We interpret three case studies in light of research on what patients and primary care clinicians say matters in health care. What matters are 11 domains of care: accessibility, a comprehensive, whole‐person focus; integrating care across acute and chronic illness, prevention, mental health, and life events; coordinating care in a fragmented system; knowing the patient as a person; developing a relationship through key life events; advocacy; providing care in a family context; providing care in a community context; goal‐oriented care; and disease, illness, and prevention management.The health and health care of older people requires contextualized knowledge and personal knowing, supported by integrated systems that treat health care not as a commodity, but as a relationship.
Published Version
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