[Psychosocial aspects of health and functioning in old age: from determinants towards intervention]

A central issue within the area of social gerontology refers to the explanation why some older people--despite medical problems--function quite well at an older age while others do not. This paper describes a conceptual approach that enables us to understand individual differences in daily functioning in the chronically ill, thus providing a starting point for the development of interventions to improve daily functioning in old age. More specifically, the role of self-efficacy expectancies and perceived control in daily functioning of older persons are elaborated. The presented studies show that both concepts are not predominant but contribute in a consistent way to old people's daily functioning. This knowledge has resulted in the development and evaluation of psychosocial interventions to improve functioning and to reduce disability. Two examples of such interventions are described: the reduction of fear of falling and self-management of patients with congestive heart failure. The development and evidence of interventions to improve daily functioning in old age are still in their infancy but are promising. The encouragement of the further development of such interventions may help to improve health care for older people as they may fit within the perspective of older people themselves and may reduce the need of care.