Integrating Care for Older People: New Care for Old, a Systems Approach

Integrating Care for Older People: New Care for Old, a Systems Approach

Integrating Care for Older People: New Care for Old, a Systems Approach

Integrating Care for Older People: New Care for Old, a Systems Approach


Highly Commended in the Public Health category of the 2003 BMA Medical Book Competition.'The book is also helpfully laid out. 'Signposts' in right hand margins link issues discussed in different parts of the book. Each chapter has a short summary of contents at the start, an overview at the end and 'headline points'- short bullet points designed to reinforce key messages in the reader's mind. The end of each chapter also includes references and further suggested reading... This book will repay study by anyone involved in planning or delivering services for older people- particularly those working to try to implement 'joined up' services. From this perspective, the book is genuinely inspirational. It shows how much can be achieved by working in this way and -more importantly- how it was done.'- Journal of Interprofessional Care'This is an important book... It needs to be read and understood by everyone involved in caring, but especially by those with the power to influence change- which is increasingly purchasers and senior managers. It also provides a valuable guide to a large literature and has useful examples of questionnaires, data collection forms and clinical vignettes.'- International Journal of Geriatric Psychiatry'This book is unique and brilliant at the same time. It shows the limits of what any given healthcare professional can accomplish and the amazing, seemingly impossible feats that an effective team caring for older persons can accomplish. The commentary on leadership in healthcare and the ways in which healthcare teams evolve and work is excellent. It is not in the least dry, but rather invigorating as one sees the concepts, values, and visions manifest in clever solutions to problems... It weaves in the history of geriatrics seamlessly. The enthusiastic anticipation in the excellent foreword is amply justified. The concepts here are universal... Every medical library should possess this remarkable book.'- Doody's Reviews.

The authors of this book share their practical experience of implementing a multi-agency approach to the support of older people. They show how systems thinking can help with the complexity of developing a model of care that co-ordinates medical, social and community services. They offer insight into the effective use of on-going assessment, evaluation, costing and information technology, with examples.They demonstrate how they achieved a 'one-stop' rapid response to emergencies and a multi-level approach to risk management. They also show how enabling the older person to become an equal partner in decision-making, both as an individual user and as a citizen, reduces dependency, and can prevent current problems such as overlap and duplication of service and inappropriate admission to hospital and residential care. They offer models of consultation and guidance on running participative groups.This resource meets the growing need for material on multi-agency practice and is an invaluable tool for all those working across organisational and professional boundaries to deliver an integrated care system for older people.


We are pleased and honoured to write a foreword to this volume. We have heard bits and snatches of the evolution of the EPICS project in South Buckinghamshire for over a decade, but it is impressive to see it laid out so clearly. It is a story well worth telling, replete with lessons for many. For those who are sceptical about systems theory or believe systems theory is impossible to reconcile with an emphasis on the human being, Christopher Foote and Christine Stanners illustrate how a systems approach can be used in the service of putting the older person’s interests, preferences, and basic humanity first. For those systems theory enthusiasts who give little thought to the people who pass through the system, the authors illustrate the emptiness of that approach. The book radiates a concern for the older person for whom the system is supposed to work and for those who labour in that system, but it also makes clear that without a systematic approach we are doomed to make little progress. Emily, lying on an emergency room gurney provides a strong leitmotiv as the authors help us understand that we may not even be asking the right questions about why she is lying there in a state of unnecessary crisis.

This book fills an important void. At a time when most Western societies face a pandemic of chronic illness, the authors have pointed to an effective way to approach the necessary reorganization of health care. At a time when many depair about how to improve the healthcare system, viewing physicians as intransigent, this book suggests that it is possible (although not always easy) to secure doctors’ co-operation in improving the care system. The recommendations are realistic. They do not call for a revolution, or even a reformation. Rather, they suggest how to build on the current infrastructure to make gradual but goal-directed modifications to bring our health and social service systems into more proper alignment with the realities of a world dominated by chronic illness.

The authors refer at one point to ‘wicked questions’, which can open the doors to new insights. Despite the title of this book, which implies a focus on the care of older people, we are tempted to ask what would happen if indeed the concept of age were eliminated. Should care be redefined to look at the generic issues of chronic disease and frailty regardless of age? Especially in the United States, where virtually the only . . .

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