Rational home care based on the disability model

Industrialized countries face the challenge of increasing home care services to the growing number of functionally dependent elderly. The disability model suggests that social and health policy should be directed at supporting the caretakers and providing the social and physical environment to allow elderly maximum opportunities to be physically and socially active. The natural trajectory of ageing is punctuated by critical events which can place the patient on a steeper, lower trajectory of decline. Efforts could be made to identify these at the earliest point and to educate the patient, the caretakers, and the primary care physician. Functional disability is multideterminant and once established cannot be easily sorted out or treated. Sensitive techniques for detecting the earliest problem might allow more effective intervention. Research areas and goals for improved medical education are suggested.