A critical perspective Carmel Martin MD PhD

1. My Journey 2. ‘Trajectories’ in Aging Dilemmas. Myths, Metaphors and Complexity Science. Frames and reframing – ‘gentle action’. 3. Mi Journey

Journeys of illness, innovation and service development in Primary Health Care Systems in Australia, UK, Canada and Ireland (even US). A particular focus is to improve chronic illness care around trajectories of illness and wellness using complex systems theory applied though IT systems.

Kenneth Howse January Keynote Luncheon: Health Policy. Challenges of Population Aging: Perspectives from the Oxford Institute of. Ageing.

Compression of Morbidity? Fries JF, Bruce B, Chakravarty E. Compression of morbidity : a focused review of paradigms and progress. Journal of aging research 2011;2011: doi: /2011/

Cosco TD, Stephan BCM, Brayne C. Deathless models of aging and the importance of acknowledging the dying process. Canadian Medical Association Journal. 2013;185(9): Critical transition

Harriet Thompson

 Aging well is the target ( ‘blockers’ in the ED or hospitals with failing body or mind are failures?).  Death, dying, frailty, illness and dependency are unwelcome social problems, not natural phenomena.  Aging, politically and bureaucratically, understood through lens of finance e.g. economic dependency ratios vs characteristics or expanded social capacity.  Aging individuals assumed to be predetermined and fixed in developmental possibilities e.g. individuals 65+ are socially disengaged through retirement.

Healthcare (and other institutions) founded on linear models which fail to recognize and adapt to the dynamics of aging and illness

Technology rescue of illness Personal self- determination and management of bio-psychosocial journey

Arth The illness narratives: suffering, healing, and the human condition / Kleinman—Basic Books, 1988 ur Kleinman, 1988

Gentle Action. Peat Learning from trajectories and adapting with gentle actions in harmony with their context

 Individual journeys  Group or cohort trajectories  Populations  Systems and services  Cultural, social and economic metaphors and myths

 Understanding and acting on  Historical influences – mature subjectivity, characteristics, capacity for self-organization  Current influences – family and community relationships, health systems and social services dynamics, culture of health and social systems  Future opportunities – understanding dynamic trajectories and their emergence, self- organizing capacity and adaptation

 Mi Journey aims to utilize 21st century ICT system and services to improve quality of life and illness and support mature subjectivity in older adults  From critical transitions (first ‘emergency’ hospitalization to home and beyond)  Owned by individual and intimates  Connected with and directing institutions  Supported by personal advocates and lifelong learning  Enhancing characteristics and social contribution.

 Journey Guides: A Journey Guide is a new type of mature social carer to provide personal support via telephone/videolink to patients in the community. Journey Guides use the PJP to generate alerts and assist patients to navigate their individual health and social care journeys.  Technology Enhanced Learning (TEL): Patient tailored TEL self education usable by older adults in relation to key areas of self management and determination and a validated interdisciplinary TEL program for health/social care workers will promote a unified holistic approach and create a shared mental model across boundaries.  The Patient Journey Platform (PJP): PJP will enable the capture, storage and analysis of individual health and social care journeys and service profiles, in order to monitor, predict, and individualize care. Data management, fusion and analytics services. As an open platform, PJP enables research and evaluation throughout Europe. PJP will be the first Platform as a Service (PaaS) proof of concept focused on the patient journey across both the health and social care domains.

Experts from health services research, primary care, management studies, systems science, and organizational behavior