title: Primary care and care for older persons: position paper of the European Forum for Primary Care.
abstract: This article explores how to address the needs of the growing number of older patients in primary care practice. Primary care is not a fixed organisational structure but a combination of functional characteristics which has developed variably in European countries with differing responses  to the emerging needs of older persons. Multimorbidity, frailty, disability and dependence play out differently in older persons; a key challenge for primary care is to provide a response that is adapted to the needs of individuals - as they see them and not as the professional defines  them. Indeed, growing experience shows how to involve older persons in taking decisions. Contrary to popular opinion, older persons often rate their quality of life as high. Indeed, comprehensive primary care offers health promotion and prevention: also older people may benefit from measures  that support their health and independence and some case descriptions show this potential. Although most people prefer to be in their own environment (home, community) during the last stage of life, providing end-of-life care in the community is a challenge for primary care because it requires  continuity and coordination with specialist care. Successful models of care however do exist. Delivering seamless integrated care to older persons is a central theme in primary care. Rather than disease management, in primary care, case management is the preferred approach. Proactive geriatric  assessment of individual medical, functional and social needs, including loneliness and isolation, has been shown to be useful and its place in primary care is the subject of further research. Clinical practice guidelines for multimorbidity are badly needed. Non-adherence to medication, linked  to multiple and uncoordinated prescriptions, is a widespread and costly problem. Successful approaches in primary care are being developed, including the use of electronic patient files. With the general practitioner (GP) as the central care provider, primary care is increasingly teamwork,  and the role of nurses and other (new) professions in primary care is developing constantly. The composition and coordination of teams are two components of one of the major complexities to address: how to provide individualised care with standardisation at organisation the level. (Lack of)  Coordination with specialist care remains a widespread problem and needs attention from policy makers and practitioners alike. Alignment with home care and social services remains a challenge in all countries, not least because of the different funding arrangements between the services. Further  priorities for research and development are summarised.
authors.affiliation: Department of Family Medicine, Ghent University, Belgium.
authors.forename: Pauline
authors.initials: P
authors.lastname: Boeckxstaens
authors.forename: Pim
authors.initials: P
authors.lastname: De Graaf
mesh_terms: D000368:Aged; D000375:Aging; D003153:Community Health Services / Q000458:organization & administration*; D003191:Comprehensive Health Care / Q000458:organization & administration; D003299:Cooperative Behavior; D005060:Europe; D015577:Geriatric Assessment / Q000379:methods; D006301:Health Services Needs and Demand; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration*; D012934:Social Isolation; D012947:Social Work / Q000458:organization & administration; D013727:Terminal Care / Q000458:organization & administration