Emerging trends in gerontology and geriatrics: Implications for the self-care of the elderly

Increases in the world's older population have posed a significant challenge to available health care resources. For many older people, informal initiatives represent a necessary, rather than an optional health care strategy in the absence of alternatives. Those individuals with the greatest health and economic dependencies are often held responsible for their reliance on subsidized long-term care services. This tendency to blame the victim appears to transcend fundamental philosophic differences which have traditionally distinguished some collectivist and individualist societies. Although health care has been viewed traditionally by health professionals as their domain, self-care and lay initiatives have recently been recognized by professionals as important to the health care of different population groups including older people. The concept of self-care has been used in various ways by different people to describe a wide range of personal health behaviors encompassing lay care, self-help, enlightened consumerism, and various preventive measures as antidotes to the impairments of old age. This paper reports some of the outcomes of an international project which reviewed geriatric self-care in different countries and health care systems. Various influences on the evolution of interest in geriatric self-care were identified including: similarities and differences in health care systems: demographic changes; cohort differences; the emergence of professionals with specialized training in geriatric health care; and, the salience of biomedical models in addressing the health problems of aging. The role of professionals, especially those trained in geriatrics, is examined with an acknowledgment of the importance of a self-care strategy that is independent of professional dominance. The increasing inadequacy of health care systems to deal with a burgeoning older population makes it especially important for professionals and consumers to work together on the development of health care initiatives which decrease dependency on formal services and support positive health behavior. As more people move into old age, an increasing number will be better informed about their own health and about the health care system, and also more interested in prevention and health maintenance. They may also be less likely to defer to the professional's judgment in making health care decisions. This paper concludes with a caution regarding self-care as a potential 'two-edged sword.' For the somewhat healthier and better educated elderly, effective self-care will be an important tool of prevention, health maintenance, and consumer protection. For the chronically impaired and most dependent elderly, self-treatment may be their only, and often inadequate resource.