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Disease Management of the Frail Elderly Population

  • Review Article
  • Published:
Disease Management & Health Outcomes

Abstract

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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Acknowledgments

No outside funding was used to assist in the preparation of this article. All of the authors worked for SCAN Health Plan while writing the article. Dr Levine was a Co-Principal Investigator for the IMPACT study referred to in the article, which was funded by the John Hartford Foundation (New York, NY, USA), the California Healthcare Foundation (Oakland, CA, USA), the Hogg Foundation for Mental Health (Austin, TX, USA), and the Robert Woods Johnson Foundation (Princeton, NJ, USA).

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Authors and Affiliations

  1. SCAN Health Plan Inc., 3800 Kilroy Airport Way, Long Beach, California, CA 90801, USA

    Stuart Levine (Medical Director), Judy Y. Reyes, Randy Schwartz, Dave Schmidt, Tim Schwab & Moon Leung

  2. David Geffen School of Medicine, University of California, Los Angeles, California, USA

    Stuart Levine (Medical Director)

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  1. Stuart Levine
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Correspondence to Stuart Levine.

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Levine, S., Reyes, J.Y., Schwartz, R. et al. Disease Management of the Frail Elderly Population. Dis-Manage-Health-Outcomes 14, 235–243 (2006). https://doi.org/10.2165/00115677-200614040-00006

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