et al., 2004). Self-management extends beyond basic adherence to treatment guidelines; it includes such things as self-monitoring and the application of appropriate cognitive, behavioral, and emotional responses.

The evolution of the patient’s role includes an increasing emphasis on collaborative care. Health care professionals and patients are familiar with the traditional provider-patient treatment model, in which providers assume responsibility for all decisions (Funnell, 2000). However, the role of the patient has undergone a redefinition in recent years and their role is now considerably more expansive. This has altered the environment that older adults will encounter as they enter their retirement years and, in most cases, begin to utilize the health care system more extensively.


In an ideal model of collaborative care, patients first work with their providers to set realistic goals; this requires skills in collaborative goal setting and in the development of an action plan (Bodenheimer et al., 2002; Hibbard, 2003). Then, once the goals and the plan are set, patients are responsible for executing the daily routines that are necessary to effectively treat or ameliorate their conditions; this part of the process is termed self-management.

Self-management interventions are designed to help patients understand how their behaviors affect their illness and their lives and to use that information to shape their decision making. They address real-world challenges, such as those encountered by patients who are both diabetic and asthmatic and have trouble maintaining their exercise regimens. Only a small percentage of the educational content of self-management programs concerns disease-specific information. The majority of the content deals with generic lifestyle issues, such as exercise, nutrition, and coping skills. This self-management education supplements—but does not replace—traditional patient education, and it emphasizes the acquisition of skills rather than just knowledge (Wagner, 2000). Studies show that teaching patients these types of self-management skills is more effective than providing information alone (Bodenheimer et al., 2002).

Self-management is predicated on the assumption that patients have both the ability to understand basic health care information (“health literacy”) and the ability to use that knowledge to help manage their own care (“patient activation”)1 (Greene et al., 2005). Individuals with low health-literacy rates report having poorer health status and using fewer preventive services (Williams et al., 1998). In general, older adults tend to have lower health literacy and lower activation levels than younger adults


These concepts would not apply to older adults with significant cognitive impairments.

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