Tailoring care for older adults: understanding older adults' goals and preferences

The increasing amount of older adults with multi-morbidity and increasing care complexity demands a fundamental change in care delivery. It entails a shift from a disease-oriented approach to a tailored approach for frail older adults. Nowadays, proactive integrated person-centred care is strived for in order to face these aging population challenges and achieve tailored care. Despite all efforts, the effects of these care reforms are unclear and the reasons for their hampered implementation are not fully understood. Therefore, the realist evaluation approach can be of help, which focusses not only on the outcomes of new care initiatives, but also on the mechanisms and context in which these reforms take place. We used this approach to study the role of goal setting within proactive care services for frail older adults. We evaluated three different perspectives in this regard: the extent to which goal setting programs have improved outcomes for older adults, the mechanisms of goal setting within proactive care, and the context of older adult’s preferences inferencing these outcomes and mechanisms. Multiple resources were combined (medical records, audio-taped assessments, older adults’ self-reported preferences and wellbeing status, and semi-structured interviews with older adults and care professionals), which led to the following conclusion: Tailored care for older adults experiencing frailty and multi-morbidity by means of goal setting and involvement adapted to their engagement preferences, supports their need for holistic care, but can only have an impact on individual goals when embedded within a durable contact with professionals who actively align care with each other. Of course, this demands for future research, as well as commitment of policy makers and care professionals