Health Dictionary glossary

glossary health insurance terms and health glossary for interpreters
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Dr.DavidWllker,United States,Professional
Published Date:11-07-2017
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WHO/WKC/Tech.Ser./04.2 WHO Centre for Health Development Ageing and Health Technical Report Volume 5 A GLOSSARY OF TERMS FOR COMMUNITY HEALTH CARE AND SERVICES FOR OLDER PERSONS WORLD HEALTH ORGANIZATION 2004 TABLE OF CONTENTS INTRODUCTION..........................................................................................................1 GUIDING CONCEPTS AND PRINCIPLES..................................................................3 HEALTH AND COMMUNITY CARE TERMS...............................................................7 ADMINISTRATIVE, MANAGEMENT AND FINANCIAL TERMS ...............................57 STATISTICAL / RESEARCH TERMS IN COMMUNITY HEALTH CARE..................71 REFERENCES...........................................................................................................91 APPENDIX A..............................................................................................................95 APPENDIX B..............................................................................................................97 INDEX ........................................................................................................................99 INTRODUCTION In recent years, the provision of adequate and cost-effective care for the rapidly increasing number of older persons in societies has received enhanced attention from national and local governments, international organizations, nongovernmental organizations (NGOs), and the scientific and service communities, as well as the general public. Major issues concern the need for an integrated and more comprehensive approach towards meeting the special needs of older persons, their families and communities. This requires multisectoral and interdisciplinary cooperation. However, cross-sectional dialogue and exchange of ideas and views on policy formulation, research, education and budgetary allocation is being hampered by a lack of common or shared definitions and terminology. While a number of glossaries and dictionaries relating to health and community care have been produced by various authorities in different constituencies, at present there is no internationally accepted common set of definitions for many of the relevant terms used to describe health, health care and services, including primary health care and community health care for older persons. The WHO Kobe Centre International Meeting on Community Health Care for Older Persons in Urban Areas, held in Bangkok, Thailand, from 10 to 12 July 2001, identified a pressing need for standardization of terminology in community health care for older persons and, as a major recommendation, proposed: “Definition and standardization of basic concepts and functions and functions of community health care for older persons into a glossary, utilizing existing WHO definitions where appropriate, in order to promote a common language for cross-city programme description and information dissemination. This glossary development will be the 1 first step towards further collaboration” . This project is the result of the WHO Kobe Centre’s commitment to produce a glossary that, it is hoped, will facilitate international and within-country exchange in this important area. As a first step, the glossary was constructed via a search of the literature. Where appropriate, existing WHO definitions have been included, but the glossary has been expanded by reference to a number of sources, as listed in the References. The second stage of the process involved professional review of the draft glossary. The aim of that review was to examine: • the relevance of the terms included; • the choice and arrangement of words and phrases for each term; and • identification of terms not included in the draft. An invitation to comment on the draft glossary was sent to more than 100 individuals around the world who were identified as experts in the field of community health care and services for older persons. Around one quarter (Appendix A) responded with comments about individual definitions and suggestions for additional terms. The glossary was then the subject of a critical comprehensive review by a 1 Community health care for older persons in urban areas –- proceedings of a WHO international meeting, Bangkok, Thailand, 10-12 July 2001. Kobe, Japan, WHO Centre for Health Development, 2002. 1 meeting of experts, held in Kobe, Japan, in October 2003. A list of participants in the workshop is included in Appendix B. As a result of that meeting, a further draft was prepared and this final version was produced after further consultation with the participants of the expert meeting. The glossary is structured in a number of sections, reflecting the nature of the terminology. The first and most expansive section provides health and community care terms. The other sections include administrative, management and financial terms; and statistical / research terms in community health care. The glossary begins with a discussion of the concepts and overarching perspectives that have guided the development of community health care for older persons. This final glossary is the result of a collaborative effort and thanks is given to all those who provided their time and expertise. 2 GUIDING CONCEPTS AND PRINCIPLES The development of community health care for older persons is a worldwide phenomenon that has seen the emergence of a range of programmes and services in many different settings, principally in the developed world, but increasingly also in developing countries. Recognizing the need for a more community-based approach and more orientation towards older persons and their families in the delivery of coordinated health and social services, a variety of models for community care for ageing populations has evolved. These developments have been guided, to varying degrees, by a range of concepts and principles that have influenced the way in which programmes and services have been shaped. The WHO definition of health as “…a state of complete physical, mental and social well-being and not merely the absence of disease or 2 infirmity” has been a seminal influence, as has the WHO Alma Ata Declaration on Primary Health Care. A range of other declarations and policy statements has also influenced the process, including the United Nations Principles for Older Persons and the WHO Active Ageing Policy Framework. In addition, a broad definition of what is encompassed by community health care has been enunciated by the WHO Centre for Health Development as “Community health care aims to add new scope and value to the existing primary health care approach in providing integrated health and social services by public and private partnership to meet the increasing health and welfare needs of older persons and their families at community level”. There are also a number of overarching perspectives which need to be kept in mind in development of community health care for older persons, including the following: Rights of older persons Older people must be acknowledged as integral members of society and must have the right to enjoy a good quality of life and full equity in access to the services necessary for optimal health. The positive contribution of older persons to development, and as a resource for their families, communities and society, must be recognized. Life-course perspective Health in old age is determined by patterns of living, exposures and opportunities for health protection over the life course. Thus, the health of older persons should be viewed in the context of the whole of life. The life-course perspective recognizes that ageing takes place within a sociohistorical context that differentially provides resources to individuals based on gender, socioeconomic status and race/ethnicity. The lifelong impact of differences in access, as well as individual choices, can create disparities in health and well-being in later life. Programmes directed towards health of older persons, to be ultimately effective, will need to work collaboratively and facilitate the efforts of those seeking to improve the lifestyles, environmental risk exposures and opportunities for health protection at earlier ages. This is especially true for the prevention of those disorders that, at least 2 Preamble to the Constitution as adopted by the International Health Conference, New York, 19–22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records, no. 2, p. 100) and entered into force on 7 April 1948. 3 in part, have their origins in earlier life, such as osteoporosis, vascular diseases and most cancers. Healthy ageing The primary objective of health policies directed towards older persons must be to promote the attainment and maintenance of ‘healthy’ and ‘successful’ ageing in advanced years. The emphasis should be on people-centred health maintenance and improvement through promotion of a positive approach to health and healthy lifestyles, in addition to the traditional goals of disease prevention, treatment and rehabilitation. The challenge is to understand and promote those factors that keep people healthy, with a focus on both personal and external resources. Access to comprehensive care Comprehensive health care must be available to people as they age. These services should be aimed at minimizing the deleterious effects of disease and should promote the achievement of personal health potential and a high quality of life for the whole of the population. Family / community orientation Recognition and support should be given to the networks of older persons, that is, their families, neighbourhoods and communities, as it is often these informal sources of support that offer significant assistance. In the developing nations in particular, many of the older population are an integral part of family structure and thus intergenerational relationships and exchanges are very important. There are also changes occurring in patterns of intergenerational co- residence and the strength of family linkages in many places. Social changes, such as migration, urbanization and increasing numbers of women joining the labour force, have meant that generations of a family may live separately and, therefore, increasing numbers of older people, particularly women, are living alone. Community services, such as home help, community centres and day care should, therefore, be oriented towards helping older people remain in the community as long as possible. Cultural perspective There is an extraordinary diversity of cultures throughout the world and within many nations and communities. Beliefs, behaviours and attitudes to health and ageing are greatly influenced by traditions, religious beliefs and values. These elements must be taken into account in any approach to deal with the issues associated with ageing. There are many positive influences upon ageing, such as traditional respect for elders and the role of families in providing care, which need to be fostered and utilized to contribute to attainment of improved quality of life for older persons. Traditional health practices should be recognized and, where appropriate and demonstrably safe, should be incorporated as complementary or alternative treatment modalities. Gender variation The importance of recognizing and responding to the differences in experience of ageing between men and women has been increasingly acknowledged. Differentials in mortality, morbidity and disability have been widely described. Women are more likely than men to suffer poverty and reduced lifetime economic 4 opportunities that negatively impact on late life resources. In addition, the vital role of women as carers is an important consideration. Cohort perspective Research studies have demonstrated substantial variation between different cohorts of older people. Any analysis of ageing issues and programmes designed to deal with these should take account, as far as possible, of cohort variations. Planning processes need to consider that the recipients of programmes now at the planning stage may ultimately be younger cohorts with somewhat differing experiences, attitudes and expectations of ageing than the present older persons. This is especially true of countries that are rapidly developing demographically and socioeconomically. Age-friendly services The WHO Perth Framework for Age-Friendly Community-Based Health Care 2002 notes: “As an overarching principle, health care services must aim to provide the highest attainable standards of health, conducive to promoting active ageing and health over the life course and to maintaining life in dignity. Towards this end, health care services must meet the following essential criteria: availability; accessibility; comprehensiveness; quality; efficiency; non-discrimination; and age- responsiveness…. The principle of non-discrimination should be upheld to ensure equal distribution and treatment, as well as the prevention of abuse, taking into account the economic, social, psychological and physical vulnerability of older persons”. Integration of community health and welfare services “Systems that integrate and coordinate health and welfare programmes will be both more effective and efficient in addressing the type of health care needs of many older persons. Integration is a basic requirement both in and among health and welfare sectors. The community health care (CHC) framework is proposed as a means of updating the PHC approach to better address the needs of older adults. The proposed approach provides a framework for integrating health and welfare systems and strengthens older peoples’ connections to their family and communities regardless of abilities or 3 disabilities” . The formulation of this glossary has, wherever possible and appropriate, been guided by the broad principles set out above. 3 Development of Health and Welfare Systems – Adjusting to Ageing – Proceedings of the Valencia Forum 2002, Valencia, Spain, 1–4 April 2002. Kobe, Japan, WHO Centre for Health Development, 2002. 5 HEALTH AND COMMUNITY CARE TERMS A abuse Mistreatment or neglect of an older person(s) through the intentional or unintentional behaviour of another person(s). Abuse may be collectively perpetrated or politically motivated. This abuse may be physical, psychological, sexual, financial and/or systemic. One type of abuse is usually accompanied by other types. See also “neglect”. access The ability of an individual or a defined population to obtain or receive appropriate health care. This involves the availability of programmes, services, facilities and records. Access can be influenced by such factors as finances (insufficient monetary resources); geography (distance to providers); education (lack of knowledge of services available); appropriateness and acceptability of service to individuals and the population; and sociological factors (discrimination, language or cultural barriers). accessibility Removal of the barriers to entering and receiving services or working within any health care setting. active ageing The process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age. activities of daily living (ADL) A concept of functioning – activities of daily living are basic activities that are necessary to independent living, including eating, bathing and toileting. This concept has several assessment tools to determine an individual’s ability to perform the activity with or without assistance. See related “instrumental activities of daily living (IADL)”. activity coordinator A trained staff member who is responsible for leisure activities in a health care programme. Activity coordinators develop programmes for people based on individual abilities and interests. acute care / acute health care Care that is generally provided for a short period of time to treat a new illness or a flare-up of an existing condition. This type of care may include treatment at home, short-term hospital stays, professional care, surgery, X-rays and scans, as well as emergency medical services. acute disease / illness A disease which is characterized by a single or repeated episode of relatively rapid onset and short duration from which the patient usually returns to his/her normal or previous state or level of activity. An acute episode of a chronic disease (for example, an episode of diabetic coma in a patient with diabetes) is often treated as an acute disease. adaptation (of residence) Permanent fixtures or alterations to a home to help someone get about or manage better (distinguished from ‘aids’ or ‘equipment’, which are more portable). adapted living facility / housing Housing that has been specially built for, or changed to a certain standard to accommodate people with disabilities. admission The initiation of care, usually referring to inpatient care, although the term may be used for day or community care as well. 7 adult care home / residential facility A residence which offers housing and personal care services to a number of residents. Services (such as meals, supervision and transportation) are usually provided by the owner or manager. Usually 24-hour professional health care is not provided on site. See also “assisted living facility”. adult day care See “day care centre”. adult placement A type of foster care in which an older person lives with an approved family. advance care planning Planning in advance for decisions that may have to be made prior to incapability or at the end of life. People may choose to do this planning formally, by means of advance directives, or informally, through discussions with family members, friends and health care and social service providers, or a combination of both methods. advance directive A mechanism by which a competent individual expresses his or her wishes should circumstances arise in which he or she no longer is able to make rational and sound decisions regarding his or her medical treatment. Usually ‘advance directive’ refers to orders for withholding and/or withdrawing life support treatments at the end of life, made by writing living wills and/or granting power of attorney to another individual. adverse event / reaction Any undesirable or unwanted consequence of a preventive, diagnostic or therapeutic procedure. advocacy for health A combination of individual and social actions designed to gain political commitment, policy support, social acceptance and systems support for a particular health goal or programme. Advocacy also has a role in creating awareness in the minds of the community regarding the rights of older persons. advocacy scheme Services which seek to ensure that a person’s views are heard and his or her interests represented. advocate 1 A person who acts on behalf of another, usually for a cause or plea. 2 To support or suggest an idea, development or way of doing something. aetiology / aetiological See “etiology”. after-care Care provided to individuals after their release from institutional care. age discrimination Unfair or unequal treatment of people on the grounds of age. aged The state of being old. A person may be defined as aged on a number of criteria including chronological age, functional assessment, legislation or cultural considerations. aged care Services provided to people deemed to be aged or elderly. aged care assessment team Multidisciplinary team of health professionals that is responsible for comprehensive assessments of the needs of older persons, including their suitability for hospital, home or institutional care. ageing / aging The lifelong process of growing older at cellular, organ or whole- body level throughout the life span. 8 ageing / aging in place Meeting the desire and ability of people, through the provision of appropriate services and assistance, to remain living relatively independently in the community in his or her current home or an appropriate level of housing. Ageing in place is designed to prevent or delay more traumatic moves to a dependent facility, such as a nursing home. ageing of the population See “population ageing”. ageism The negative stereotyping or discrimination of people on the basis of age. agent (of disease) A factor, such as a micro-organism, chemical substance, form of radiation, or excessive cold or heat, which is essential for the occurrence of a disease. A disease may be caused by more than one agent acting together or, in the case of deficiency diseases, by the absence of an agent. aid An item, such as a walking frame or a shower chair, which helps people to manage the activities of daily living. alarm See “emergency alarm”. allied health personnel Specially trained and licensed (when necessary) people in occupations that support and supplement the functions of health professionals. For the older population, such health personnel may include home health workers and nursing assistants. See also “auxiliary worker”. allopathy A system of medicine based on the theory that successful therapy depends on creating a condition antagonistic to, or incompatible with, the condition to be treated. Thus, drugs such as antibiotics are given to combat diseases caused by the organisms to which they are antagonistic. alternative and complementary health care / medicine / therapies Health care practices that are not currently an integral part of conventional medicine. The list of these practices changes over time as the practices and therapies are proven safe and effective and become accepted as mainstream health care practices. These unorthodox approaches to health care are not based on biomedical explanations for their effectiveness. Examples include homeopathy, herbal formulas, and use of other natural products as preventive and treatment agents. alternative medical system A complete system of theory and practices that has evolved independently of, and often prior to, the conventional biological approach. Many are traditional systems of medicine that are practised by individual cultures throughout the world. Traditional Oriental medicine and Ayurveda, India’s traditional system of medicine, are two examples. ambulatory care Health services provided on an outpatient basis in contrast to services provided in the home or to persons who are inpatients. While many inpatients may be ambulatory, the term ambulatory care usually implies the patient travels to a location to receive services and no overnight stay in hospital is required. Many surgeries and treatments are now provided on an outpatient basis, while previously they were considered reason for inpatient hospitalization. ambulatory setting A type of institutional organized health setting in which health services are provided on an outpatient basis. Ambulatory care settings may be either mobile (when the facility is capable of being moved to different locations) or fixed (when the person seeking care must travel to a fixed service site). 9 ancillary service Support service provided in conjunction with medical or hospital care. Such services include laboratory, radiology, physical therapy and inhalation therapy, among others. anthropometrics The measurement of the size and proportions of the human body. appraisal See “geriatric assessment”. appropriate health technology Methods, procedures, techniques and equipment that are scientifically valid, adapted to local needs and acceptable to those who use them and to those for whom they are used, and that can be maintained and utilized with resources the community or country can afford. assessment See “geriatric assessment”. assessment appeal process A process that allows a person who has been assessed to dispute the assessment, and which provides for the assessment to be changed. assessment system A structured process developed to ensure that assessment is relevant, consistent, fair and valid. The system requires rules of operation, a regular review process and competent assessors. assisted living See “residential care services”; “assisted living facility”. assisted living facility / assisted care living facility Establishment which provides accommodation and care for older or disabled persons who cannot live independently but do not need nursing care. Residents are also provided with domestic assistance (meals, laundry, personal care). assisted suicide The act of intentionally killing oneself with the assistance of another who provides the knowledge, means or both. assistive device Equipment that enables an individual who requires assistance to perform the daily activities essential to maintain health and autonomy and to live as full a life as possible. Such equipment may include, for example, motorized scooters, walkers, walking sticks, grab rails and tilt-and-lift chairs. assistive technology An umbrella term for any device or system that allows individuals to perform tasks they would otherwise be unable to do or increases the ease and safety with which tasks can be performed. attendant care Personal care for people with disabilities in non-institutionalized settings generally by paid, non-family carers. autonomy The perceived ability to control, cope with and make personal decisions about how one lives on a daily basis, according to one’s own rules and preferences. auxiliary worker A worker who has less than full professional qualifications in a particular field and is supervised by a professional worker. avoidable hospital condition / admission A medical condition for which hospitalization could have been avoided if ambulatory care had been provided in a timely and efficient manner. 10 B basic health service A network of health units providing essential health care to a population. Basic health services include communicable disease control, environmental sanitation, maintenance of records for statistical purposes, health education of the public, public health nursing and medical care. bereavement A process of loss, grief and recovery, usually associated with death. board and care home See “adult care home”. burden of disease The total significance of disease for society beyond the immediate cost of treatment. It measures years of life lost to ill-health as the difference between total life expectancy and disability-adjusted life expectancy. C care The application of knowledge to the benefit of a community or individual. There are various levels of care: intermediate care: A short period of intensive rehabilitation and treatment to enable people to return home following hospitalization or to prevent admission to hospital or residential care. primary care: Basic or general health care focused on the point at which a patient ideally first seeks assistance from the medical care system. It is the basis for referrals to secondary and tertiary level care. secondary care: Specialist care provided on an ambulatory or inpatient basis, usually following a referral from primary care. tertiary care: The provision of highly specialized services in ambulatory and hospital settings. care chain / chain of care 1 A well planned entity of inter- and intra-organizational care processes to solve the complexity of problems of an individual, and accompanied by systematic follow-up actions. Care chains are integrated to the extent that there are no gaps, barriers or breaks in the process leaving the older person without proper care. 2 A description of the different parts of care. care-dependent Persons with chronic illnesses and/or impairments which lead to long-lasting disabilities in functioning and reliance on care (personal care, domestic life, mobility, self direction). care home A residential facility that provides accommodation and offers a range of care and support services. Care homes may provide a limited number of services to support low dependency or may provide a wide range of services to cater for the continuum from low to high dependency care. See “assisted living facility”; “high dependency care facility”. care management See “case management”. care need Some state of deficiency decreasing quality of life and affecting a demand for certain goods and services. For the older population, lowered functional and mental abilities are decisive factors that lead to the need for external help. 11 care package A combination of services designed to meet a person’s assessed needs. care pathway An agreed and explicit route an individual takes through health and social care services. Agreements between the various providers involved will typically cover the type of care and treatment, which professional will be involved and their level of skills, and where treatment or care will take place. See also “care plan”; “care programme”. care plan A dynamic document based on an assessment which outlines the types and frequency of care services that a client receives. It may include strategies, interventions, continued evaluation and actions intended to help an older person to achieve or maintain goals. care programme A documented arrangement of integrated care, based on the analysed needs of a specific group of people, from intake to supply of care and services, as well as the intended outcomes, and including a description of the way the arrangement should be applied in order to match the needs of individual persons. caregiver A person who provides support and assistance, formal or informal, with various activities to persons with disabilities or long-term conditions, or persons who are elderly. This person may provide emotional or financial support, as well as hands-on help with different tasks. Caregiving may also be done from long distance. See also “formal assistance”; “informal assistance”. caregiver burden The emotional, physical and financial demands and responsibilities of an individual’s illness that are placed on family members, friends or other individuals involved with the individual outside the health care system. caregiver burnout A severe reaction to the caregiving burden, requiring intervention to enable care to continue. carer See “caregiver”; “formal assistance”; “informal assistance”. case conference A meeting of all professionals (often including carers) interested in an individual’s care. case management A continuous process of planning, arranging and coordinating multiple health care services across time, place and discipline for persons with high-risk conditions or complex needs in order to ensure appropriate care and optimum quality, as well as to contain costs. case mix A method by which a health care provider measures the service needs of the patient population. It may be based on such things as age, medical diagnosis, severity of illness or length of stay. case severity A measure of intensity or gravity of a given condition or diagnosis for an older person. 12 catchment area A geographic area defined and served by a health programme or institution, such as a hospital or community health centre, which is delineated on the basis of such factors as population distribution, natural geographic boundaries, and transportation accessibility. By definition, all residents of the area needing the services of the programme are usually eligible for them, although eligibility may also depend on additional criteria. cause of death For the purpose of national mortality statistics, every death is attributed to one underlying condition, based on information reported on the death certificate and using the international rules for selecting the underlying cause of death from the reported conditions. See “International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10)”. cause-of-death ranking Cause-of-death ranking for adults is based on the List of 72 Selected Causes of Death, HIV Infection, and Alzheimer's Disease. The List was adapted from one of the special lists for mortality tabulations recommended for use with the International Classification of Diseases, ninth revision. Two group titles – “Major cardiovascular diseases” and “Symptoms, signs, and ill-defined conditions” – are not ranked based on the list of 72 selected causes. In addition, category titles that begin with the words “other” and “all other” are not ranked. The remaining category titles are ranked according to number of deaths to determine the leading causes of death. When one of the titles that represents a subtotal is ranked (for example, unintentional injuries), its component parts are not ranked (in this case, motor vehicle crashes and all other unintentional injuries). centenarian A person who is 100 years or older. challenging behaviour Behaviour which is difficult and complex to manage, even within a therapeutic environment. The behaviour may be related to organic or non-organic predisposing factors. chiropody See “podiatry”. chiropractice A system of medicine based on the theory that disease is caused by malfunction of the nervous system, and that normal function of the nervous system can be achieved by manipulation and other treatment of the structures of the body, primarily the spinal column. A practitioner is a chiropractor, Doctor of Chiropractic (DC). choice Those seeking care have options between and within health care units, including opportunities for gaining specialist care and second opinions, or to deny care. chore service Help with chores, such as home repairs, gardening and heavy house cleaning. chronic care The ongoing provision of medical, functional, psychological, social, environmental and spiritual care services that enable people with serious and persistent health and/or mental conditions to optimize their functional independence and well-being, from the time of condition onset until problem resolution or death. Chronic care conditions are multidimensional, interdependent, complex and ongoing. 13 chronic condition / disease A disease which has one or more of the following characteristics: is permanent; leaves residual disability; is caused by non- reversible pathological alternation; requires special training of the patient for rehabilitation; or may be expected to require a long period of supervision, observation or care. chronic hospital A facility that serves patients who do not need acute care or care in another kind of specialty hospital and whose needs for frequency of monitoring by a medical practitioner and for frequency and duration of nursing care exceed the requirements for care in a comprehensive care or extended care facility. classification of disease Arrangement of diseases into groups having common characteristics. Useful in efforts to achieve standardization in the methods of presenting mortality and morbidity data from different sources and, therefore, in comparability. May include a systematic numerical notation for each disease entry. Examples include the International Statistical Classification of Diseases, Injuries and Causes of Death. client A person who seeks or receives services or advice. client group A category in a classification or typology of clients. Clients can be classified in various dimensions, e.g. by dependency level, by diagnosis. client quality The outcome of care/service from an individual/user’s point of view. It is how well the care service supports the client/user to improve his/her quality of life. clinic A facility, or part of one, devoted to diagnosis and treatment or rehabilitation of outpatients. See “outpatient services”; “ambulatory care”. clinical care Professional specialized or therapeutic care that requires ongoing assessment, planning, intervention and evaluation by health care professionals. clinical condition A diagnosis (e.g. myocardial infarct) or a patient state that may be associated with more than one diagnosis (such as paraplegia) or that may be as yet undiagnosed (such as low back pain). clinical event Services provided to patients (history-taking, physical examination, preventive care, tests, procedures, drugs, advice) or information on clinical condition or on patient state used as a patient outcome. clinical governance A framework through which health organizations are accountable for continuously improving the quality of their services and safeguarding high standards of care. clinical information system An information system that collects, stores and transmits information that is used to support clinical applications (e.g. transmission of laboratory test results, radiology results, prescription drug orders). Electronic medical records are one method by which clinical information systems can be created. 14 clinical observation Clinical information, excluding information about treatment and intervention. Clinical information that does not record an intervention is by nature a clinical observation. The observer may be the patient or related person (information about symptoms, family history, occupation or lifestyle) or a health care professional (information about physical signs, measurements, properties observed or diagnoses). While information about the nature of a planned or performed treatment is excluded by the definition, clinical observations may be recorded on the results of a treatment, on progress during the course of a treatment, or on the result of a treatment. clinical pathway A multidisciplinary set of daily prescriptions and outcome targets for managing the overall care of a specific type of patient, e.g. from pre-admission to post-discharge for patients receiving inpatient care. Clinical pathways are often intended to maintain or improve quality of care and decrease costs for patients in particular diagnosis-related groups. clinical performance measure An instrument that estimates the extent to which a health care provider delivers clinical services that are appropriate for each patient's condition; provides them safely, competently and in an appropriate time- frame; and achieves desired outcomes in terms of those aspects of patient health and patient satisfaction that can be affected by clinical services. clinical practice guideline A systematically developed statement to assist practitioner and patient decisions about appropriate health care for one or more specific clinical circumstances. clinical significance A conclusion that an intervention has an effect that is of practical meaning to older persons and health care providers. Even though an intervention is found to have a statistically significant effect, this effect may not be clinically significant. In a trial with a large number of participants, a small difference between treatment and control groups may be statistically significant, but clinically unimportant. In a trial with few participants, an important clinical difference may be observed that does not achieve statistical significance. (A larger trial may be needed to confirm that this is a statistically significant difference). clinical trial A controlled research study of the safety and effectiveness of drugs, devices or techniques that occurs in four phases, starting with the enrolment of a small number of people, to the later stages in which thousands of people are involved prior to approval by the licensing authorities (for example, the Food and Drug Administration). code of conduct A formal statement of desirable behaviour that research workers or practitioners are expected to honour. There may be penalties for violation. cognitive testing In surveys, studying the process of interpretation of questions and the formation and reporting of responses by respondents to learn how to make the questions more accurately obtain the data the questionnaire is seeking. cohort A set of people born during a specific time period; also a set of people born during a historical era that creates different inter-cohort characteristics such as size, composition, experiences and values. The term “cohort” has been broadened to describe any designated group of persons who are followed or traced over a period of time. co-housing A form of planned community in which people live together, each with his or her own dwelling or living space, but there are also some common areas and joint activities may be arranged. 15 communal 1 Belonging to, or used by, a group of people rather than a single person. For example, communal open space is useable public open space for recreation and relaxation of residents of a development that is under the control of a body corporate. 2 Of, or related to a commune, where all means of production and services are held in common. The collective unit takes responsibility for meeting the needs of its members. communal care Assistance provided free of charge or at reduced rates to members of a group or society. Other members of the group or society generally provide care on a voluntary basis. community A group of people, often living in a defined geographical area, who may share a common culture, values and norms, and are arranged in a social structure according to relationships which the community has developed over a period of time. Members of a community gain their personal and social identity by sharing common beliefs, values and norms which have been developed by the community in the past and may be modified in the future. They exhibit some awareness of their identity as a group, and share common needs and a commitment to meeting them. community action for health Collective efforts by communities which are directed towards increasing community control over the determinants of health and thereby improving health. community alarm See “emergency alarm”. community-based care / community-based services / programmes The blend of health and social services provided to an individual or family in his/her place of residence for the purpose of promoting, maintaining or restoring health or minimizing the effects of illness and disability. These services are usually designed to help older people remain independent and in their own homes. They can include senior centres, transportation, delivered meals or congregate meals sites, visiting nurses or home health aides, adult day care and homemaker services. community care Services and support to help people with care needs to live as independently as possible in their communities. community empowerment Involves individuals acting collectively to gain greater influence and control over the determinants of health and the quality of life in their communities. Community empowerment is an important goal in community action for health. community equipment See “aid”. community health The combination of sciences, skills and beliefs directed towards the maintenance and improvement of the health of all the people through collective or social actions. The programmes, services and institutions involved emphasize the prevention of disease and the health needs of the population as a whole. Community health activities change with changing technology and social values, but the goals remain the same. community health care Includes health services and integrates social care. It promotes self care, independence and family support networks. 16 community health centre An ambulatory health care programme, usually serving a catchment area which has scarce or non-existent health services or a population with special health needs. These centres attempt to coordinate federal, state and local resources in a single organization capable of delivering both health and related social services to a defined population. community health information network (CHIN) An integrated collection of computer and telecommunication capabilities that permit multiple providers, payers, employers and related health care entities within a geographic area to share and communicate client, clinical and payment information. community health needs assessment The ongoing process of evaluating the health needs of a community. Usually facilitates prioritization of needs and a strategy to address them. community health worker A trained health worker who works with other health and development workers as a team. The community health worker provides the first contact between the individual and the health system. The types of community health worker vary between countries and communities according to their needs and the resources available to meet them. In many societies, these workers come from and are chosen by the community in which they work. In some countries they work as volunteers; normally those who work part-time or full-time are rewarded, in cash or in kind, by the community and the formal health services. community involvement The active involvement of people living together in some form of social organization and cohesion in the planning, operation and control of primary health care, using local, national and other resources. In community involvement, individuals and families assume responsibility for their and their communities' health and welfare, and develop the capacity to contribute to their own and their communities’ development. community medicine The study of health and disease in the population of a defined community or group and the practice of medicine concerned with groups or populations rather than individual patients. community mental health centre An entity which provides comprehensive mental health services (principally ambulatory), primarily to individuals residing or employed in a defined catchment area. community visitor scheme A scheme utilizing volunteers to visit, spend time with and become friends with an older person in his/her place of residence. co-morbid condition Conditions that exist at the same time as the primary condition in the same patient (e.g. hypertension is a co-morbidity of many conditions, such as diabetes, ischemic heart disease, end-stage renal disease, etc.). Two or more conditions may interact in such a way as to prolong a stay in hospital or hinder successful rehabilitation. compliance A measure of the extent to which persons undergo an assigned treatment or regimen, e.g. taking drugs, undergoing a medical or surgical procedure, following an exercise regimen, or abstaining from smoking. comprehensive geriatric assessment (CGA) A process which includes a multidimensional assessment of a person with increasing dependency, including medical, physical, cognitive, social and spiritual components. Can also include the use of standardized assessment instruments and an interdisciplinary team to support the process. 17 comprehensive health care Provision of a complete range of health services, from diagnosis to rehabilitation. comprehensive health system A health system that includes all the elements required to meet all the health needs of the population. computer-assisted diagnosis The use of information technology to assist health care professionals in diagnosis. This usually involves a dialogue between a computer system and a clinician. The systems are generally regarded as support systems for clinicians; the final responsibility for decision-making resides with the clinician. computer-assisted therapy The application of computer technology to therapy. concurrent review A review that occurs during the course of patient treatment. Concurrent review enables the medical practitioner or other health care provider to evaluate whether the course of treatment is consistent with expectations for the usual management of a clinical case. The review may also facilitate early identification of negative consequences of treatment (e.g. complications, failure to respond to therapy) that will affect the length of the care episode and outcomes. confidence A sense of assurance, faith or trust in a person, thing or oneself. confidentiality Privacy in the context of privileged communication (such as patient- doctor consultations) and medical records is safeguarded. congregate housing Individual apartments in which residents may receive some services, such as a daily meal with other tenants. Buildings usually have some communal areas, such as a dining room and lounge, as well as additional safety measures such as an emergency call system. congregate meals programme Delivery of meals and socialization activities to older adults in a designated location. consensus development Various forms of group judgement in which a group (or panel) of experts interacts in assessing an intervention and formulating findings by vote or other informal or formal means, involving such techniques as the nominal group and Delphi techniques. consent See “informed consent”. consent form A document used during the consent process which is the basis for explaining to people the risks and potential benefits of a study or care intervention and the rights and responsibilities of the parties involved. consultation A technique of interaction where the opinions of several stakeholders are sought before a decision is made. consumer One who may receive or is receiving services. continence management The practice of promoting and maintaining continence and the assessment, evaluation and action taken to support this. continuing care The provision of one or more elements of care (nursing, medical, health-related services, protection or supervision, or assistance with personal daily living activities) to an older person for the rest of his or her life. continuing care facility A facility which provides continuing care. 18 continuing care retirement community A community which provides several levels of housing and services for older people, ranging from independent living units to nursing homes, on one site but generally in separate buildings. continuing education Formal education obtained by a health professional after completing his/her degree and full-time postgraduate training. continuity of care The provision of barrier-free access to the necessary range of health care services over any given period of time, with the level of care varying according to individual needs. continuum of care The entire spectrum of specialized health, rehabilitative and residential services available to the frail and chronically ill. The services focus on the social, residential, rehabilitative and supportive needs of individuals, as well as needs that are essentially medical in nature. contraindication A clinical symptom, circumstance, condition indicating that the use of an otherwise advisable intervention would be inappropriate. A contraindication may be absolute or relative. An absolute contraindication is a situation which makes a particular treatment or procedure absolutely inadvisable. A relative contraindication is a condition which makes a particular treatment or procedure somewhat inadvisable, but does not rule it out (for example, X-rays in pregnancy). conventional medicine Medicine as practised by holders of a medical degree and their allied health professionals, some of whom may also practise complementary and alternative medicine. See “alternative and complementary health care”. coordinated care A collaborative process that promotes quality care, continuity of care and cost-effective outcomes which enhance the physical, psychosocial and vocational health of individuals. It includes assessing, planning, implementing, coordinating, monitoring and evaluating health-related service options. It may also include advocating for the older person. coordination within the health sector Organized collaboration, as necessary, among those providing the services at the same and different levels of the health system in order to make the most efficient use of resources, as well as within and among the various categories of health workers following agreement on the division of labour. It also means coordination of programmes or services to avoid duplication or inconsistency. coping An adaptive or otherwise successful method of dealing with individual or environmental situations that involve psychological and physiological stress or threat. core activities Activities which are essential for daily living, such as self care, mobility and communication. cost of illness The personal cost of acute or chronic disease. The cost to the patient may be an economic, social or psychological cost or loss to himself, his family or community. The cost of illness may be reflected in absenteeism, productivity, response to treatment, peace of mind, quality of life, etc. It differs from health care costs in that this concept is restricted to the cost of providing services related to the delivery of health care, rather than the impact on the personal life of the patient. See “burden of disease”. 19