Integrated care systems for elderly people

The care of the frail elderly is characterised by fragmentation and discontinuity within and between sectors, resulting in frequent and inappropriate hospitalisations and premature nursing home placement. Integrated models of care in Europe, and North America have proven to be effective in improving health status, satisfaction and utilisation of resources in the frail elderly. The purpose of this article is to describe these programmes and the community geriatrics unit of Geneva, which provides health care to a frail elderly population in collaboration with other partners in the primary care sector. The main objective of the unit is to enable the frail elderly to stay at home using a multidisciplinary comprehensive geriatric approach and coordinated long-term follow-up.