Biology, primary care, family, and community. A basis for rational geriatric care

The evolution of health-care policy for the elderly must address existing gaps in the current system, the dilemma of increasing costs, and the problems associated with hospitalization and nursing-home use. A major fault of current approaches is their focus on these latter two institutions and the resultant increasing fragmentation of care. An approach based on the five principles of primary care may be more rational. Primary, secondary, and tertiary prevention, based on an understanding of the biology of aging and imbedded in the framework of primary care, must be a major focus of such policy evolution. The principles of primary care must be combined with two based on context, family sensitivity and community orientation, to provide the basis for policy that is truly responsive to the broad needs of the elderly and their families. Policies evolving from such an orientation may begin to address not only current financial concerns, but also the ethical issues frequently encountered in caring for the elderly.