forts need to be made to reduce the wide variation in practice protocols among providers, which should further enhance the quality of care for older adults.

The principle of comprehensive care also includes taking into account the increasing socio-demographic diversity of older adults. The number and percent of ethnic minorities in the older population is increasing dramatically, and even within ethnic groups there is tremendous cultural diversity. Health care providers need to be sensitive to the wide variety of languages, cultures, and health beliefs among older adults. Other segments of the older population face additional challenges. For example, older adults in rural areas often face isolation and barriers to access for some services.

The second principle underlying the vision of care in the future is that services need to be provided efficiently. Providers will need to be trained to work in interdisciplinary teams, and financing and delivery systems need to support this interdisciplinary approach. Care needs to be seamless across various care delivery sites, and all clinicians need to have access to patients’ health information, as well as population data, when needed. Health information technology, such as interoperable electronic health records and remote monitoring, needs to be used to support the health care workforce by improving communication among providers and their patients, building a record of population data, promoting interdisciplinary patient care and care coordination, facilitating patient transitions, and improving quality and safety overall. Giving providers immediate access to patient information, especially for patients who are cognitively impaired and unable to provide their own clinical history, may reduce the likelihood of errors, lower costs, and increase efficiency in care delivery.

Efficiency can be further improved by ensuring that health care personnel are used in a way that makes the most of their capabilities. Expanding the scope of practice or responsibility for providers has the potential to increase the overall productivity of the workforce and at the same time promote retention by providing greater opportunities for specialization (e.g., through career lattices) and professional advancement. Specifically, this would involve a cascading of responsibilities, giving additional duties to personnel with more limited training in order to increase the amount of time that more highly trained personnel have to carry out the work that they alone are able to perform. While the necessary regulatory changes would likely be controversial in some cases, the projected shortfall in workforce supply requires an urgent response. This response will most likely have to involve expansions in the scope of practice at all levels, while at the same time ensuring that these changes are consistent with high-quality care.

The third principle is that older persons need to be active partners in their own care, except when they are too frail, mentally or physically, to do so. Such partnerships need to include the adoption of healthy lifestyles,



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