Clinical challenges in the care of frail older persons

The clinical challenges of meeting the needs of frail older persons are essentially those encompassed by chronic disease multiplied by the special problems presented by aging, namely the presentation and management of disease and the special syndromes associated with geriatrics. The need to develop an approach to the care of frail older persons reflects a more general need to address system reform for chronic disease. The steps include new roles for patients and their families, the use of information technology to monitor changes in patients' status more continuously and to intervene in a more timely way, and a re-evaluation of the use of personnel at all levels. At present, we know more about how to deliver effective chronic care than we practice. The barriers to implementation include both a general reluctance to change and negative financial incentives to implement what has been shown to be effective.