AN ALTERNATIVE CONCEPTUALIZATION OF HEALTH AND HEALTH-CARE - ITS IMPLICATIONS FOR GERIATRICS AND GERONTOLOGY

The problem-oriented biomedical paradigm that directs health care in m ost of the Western hemisphere is insufficient for clinical geriatrics and gerontology. A new framework must be constructed that is more opti mistic, longitudinal, collaborative, and humane. I describe a goal-ori ented approach that achieves these objectives. This paradigm requires a functional, open-ended definition of health. The term usual is subst ituted for normal, and problems are reframed as challenges. Life is vi ewed as a series of adventures, and illness and death are recognized t o be essential features of life. An outline of general health care goa ls and an example of a goal-oriented care plan format are provided to guide educators and clinicians who wish to begin to apply the model in their work.