Learning Objective #1: gain information about needs and problems of care for older people living in the community

Learning Objective #2: gain knowledge how to use partipatory action research to implement continuity of care for older people in the community

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Background: This research was conducted in one of the communities in Thailand which the number of older people has reached 8 percent of its total population. Most of these people have at least one chronic illness which leads to dependency and disability. However, proper and continuous care for older people cannot be sucessfully accomplished.

Objective: To develop a continuity of care model for the elderly with chronic illnesses living in the community

Methodology: Participatory action research (PAR) was used in this study. Participants consisted of older people with chronic illnesses, family members, community leaders, healthcare staff, and volunteers. All participants collaboratively worked to analyze existing needs/problems of care for older people, then developed a continuity of care model. The qualitative data were obtained through focus-group discussions, in-depth interviews, and observations and analyzed by using content analysis. The quantitative data were obtained through questionnaires and analyzed by using frequency and percentage distributions.

Results: From this study, the needs/problems of care for older people were as follows: 1) older people had inadequate health knowledge; 2)healthcare staff and volunteers had inadequate knowledge concerning care for older people and had no definite plan for continuous care; and 3)no effective cooperation among people in the community. According to PAR, a continuity of care model was established and presented in the forms of various projects covering three aspects: health education, working improvement, and community funding.

Conclusion: A continuity of care model was necessary to improve care for older people but needed to be responsive to their needs and existing problems. From the use of PAR, people were empowered and enabled to develop the model by themselves.