Disease Management of the Frail Elderly Population
Judy Y. Reyes
Success stories of disease management programs have heightened the interest of healthcare payors and providers in the adoption of disease management principles for their aging members. However, caution is needed for rapid adoption, as several crucial characteristics within the aging population may clash with disease management principles. When developing disease management programs, the characteristics of the frail elderly must be considered, otherwise there may be a potential for misapplication of disease management principles. For example: (i) frailty is a state rather than a condition; (ii) the complex needs of frail elders are less straightforward and therefore make it more difficult to apply a formalized set of treatment guidelines; (iii) the mental health and cognitive issues may challenge the reliance on self-management; and (iv) the involvement of caregivers may broaden the scope well beyond clinical care. This article summarizes several successes of disease management programs and examines the critical components leading to their success, including patient self-management and education, better provider coordination, risk stratifying tools, and the use of evidence-based guidelines. In considering the possibility of using disease management principles to care for the frail elderly population, this article demonstrates that more research, discussions, and practical applications are needed prior to widespread program implementation. The frail condition experienced by many older adults is not just the sum of several disease conditions; therefore, merely combining several disease management programs to serve this population may prove to be less effective than is hoped. Hence the pursuit of more effective approaches to providing care for an aging population continues. Disease management for the frail is most effective when the treatment integrates both the social and medical needs of the patient and caregivers. It is also essential to manage the patient's multiple diseases even though the patient selection and primary focus may be on the primary disease.
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