Aging in the Americas: Innovations to Bring Integrated and Person-Centered Care to Life

Healthcare models (CM) are at the critical cross-roads between the policy level and the implementation levels of the health system, theoretically with a bi-directional relationship. CMs have been defined as the way health services are delivered for a person, population group, or patient cohort as they progress through the stages of a condition, injury, or event (Agency for Clinical Innovation, 2013; Dadich et al., 2025). Primary care-based models for community-dwelling older people face unprecedented challenges amid population aging: a widening gap between healthy life expectancy and life expectancy at birth (Martinez et al., 2021), growing care costs, health workforce burnout, and scarcity (Garber & Skinner, 2008). Simultaneously, evolving care user profiles reflect societal and environmental shifts over the past 50 years, for example, internet-informed patients, adults managing multiple chronic conditions for longer periods of time and throughout different stages of the life course, and users afflicted by increasing levels of socioeconomic hardship and social isolation (Duffner et al., 2024; Gavin, 2023). Thus, healthcare systems are at a crucial historical stage that demands proactive policies and innovation suited to local contexts. Primary healthcare (PHC) offers the best framework for achieving the necessary integration with a territorial approach. The Pan American Health Organization collaborates with member states in the Americas, scoping from Argentina to Canada, including the Caribbean. The region spans CMs with huge variations in the magnitude of the target population, management, and funding mechanisms (e.g., fee-for-service, value-based care, centralized public schemes, private schemes), usually with a less diverse assortment of care providers within member states compared with the US. However, most of the CMs in the Americas were designed in the post-war period. The resulting CMs have reminiscences of the second half of the 20th century initially focused on treating infectious diseases through episodic interventions, often neglecting social and environmental health determinants. Today, this CMs have crucial gaps: poor acknowledgment of the health needs of older people, episodic care delivery centered in a pharmacological approach, fragmentation within the health sector, disconnection from other sectors crucial for health and development (e.g., social protection), and poor linkage with the community’s life (Aggarwal & Williams, 2019; Arora et al., 2021). Policymakers and health system leaders must face the challenge of re-designing healthcare systems to align them with the new users’ profiles. It is time to be creative and find ways to respond to the health needs of older people instead of continuing to offer disease-centered services that have proven inefficient in improving healthy life expectancy. Many countries in the region currently have a window of opportunity to prepare for the demographic transition, which can be defying due to the persistent inequities and scarce resources that challenge efforts to overcome key barriers and foster effective intersectoral collaboration (Gonzalez-Bautista et al., 2021). This article outlines a vision for bridging policy gaps in integrated, older person–centered care and aligning healthcare with user needs under a life course approach. It is time to be creative and find ways to respond to the health needs of older people instead of continuing to offer disease-centered services that have proven inefficient in improving healthy life expectancy. The terms “person-centered care” (Conference on Person Centered Medicine, 2015; Liang et al., 2010; Liao et al., 2023) and “life course approach” (Kuh et al., 2013) are widely used in theoretical discussions and academic papers but often lack clarity at the policy level and practical implementation at CM, due to sectoral silos and limited cross-sector integration (Horgan, 2020). Simply put, person-centered care is the aggregate of services adapted to target the population’s health needs, preferences, and values, which follows, by definition, an integrated CM (Centers for Medicare and Medicaid Services, 2023). The life course approach is applied to CMs when health outcomes/health needs are considered along a trajectory, building health over the life course and not only acting to target health issues episodically, favoring a prospective outlook. Adopting a life-course approach to CMs could reduce long-term healthcare expenditures and high-dependency care costs. Failure to invest in PHC-based CMs now could lead to significantly higher economic and social costs in the future. PHC is the driving strategy to achieve a sustainable health system that promotes universal health access and coverage, implying that all people and communities have access, without any kind of discrimination, to comprehensive, appropriate and timely, quality health services determined at the national level according to needs, as well as access to safe, effective, and affordable quality medicines, while ensuring that the use of such services does not expose users to financial difficulties, especially groups in conditions of vulnerability (Pan American Health Organization, 2024). The life-course approach represents an innovative perspective for transforming health systems toward person-centered care. Operationalizing “person-centered care” and “life-course approach” is a milestone in transitioning from the disease- to the health-focused paradigm. For this purpose, we define health needs as “the biological, mental and/or social characteristics of an individual or a population that require sound interventions, which, if not developed, can compromise life and/or modify health trajectories.” It is fundamental to acknowledge that not all health needs are perceived by individuals, as they will be influenced by their values, preferences, and priorities, and health needs are not static and homogenous as they evolve throughout life, depending on the situation and context. It is crucial to have multisectoral interventions sustained by the best available evidence to respond to the diversity of health and social needs. Addressing the wide array of health needs in primary care poses a complex duty from the policy, management, and implementation levels. To facilitate the innovative design and organization of care provision, we consider the following domains of health needs: Optimizing health and functional trajectories: This involves monitoring and promoting optimal health and abilities over time, identifying risks of functional decline early, and implementing preventative or rehabilitative interventions (Alcazar et al., 2021; World Health Organization, 2021). Comprehensive risk and disease management: This involves a forward-looking approach to managing chronic conditions, multimorbidity, and related issues such as potentially inappropriate polypharmacy and geriatric syndromes. Emphasis is placed on holistic primary care that prioritizes functional health over traditional disease outcomes (Prior et al., 2023; Skou et al., 2022). Enhancing physical, social, and economic environments: Creating supportive environments that foster health and well-being, including safe homes, social inclusion and connections, economic stability, and accessible mobility, to improve functional capacity and reduce health inequities. Activating individual, family, and community agency: Empowering individuals to make informed health decisions and actively manage their well-being. Community engagement and health literacy are essential for enabling self-care and promoting equity in health outcomes. These domains aim at “building” health over the life course and are based on the Life Course Approach for Public Health and the Integrated Care for older People framework (Beard et al., 2016; Pan American Health Organization, 2021; World Health Organization, 2002) and were proposed after different technical discussions held with countries’ representatives. The guiding principle of these domains is to develop and preserve capacity and functionality (i.e., to have the capabilities that enable all people to be and do what they have reason to value; World Health Organization, 2015). The health system should keep a record of the trajectories of capacity and functionality of their populations (Domain 1). The diseases “waste off” the capacity and can be an expression of low capacity; the life course approach offers an opportunity to prospectively address risk and protective factors for diseases (Domain 2). Environments enable or hamper capacity building through beneficial deleterious exposures, as well as can increase or reduce exposure to risk factors and favor development, participation and integration in the community (Domain 3). Individuals and their families play an increasingly active role in the development and maintenance of their own capacity and overall well-being (Domain 4). The domains are interrelated because they cover different facets of the person and their health needs. Therefore, integrated health services should consider all 4 domains, address the issues under their influence, and refer to other sectors/services as needed (e.g., social protection Onder et al., 2017). Health systems can increase efficiency and support healthy aging with interventions to meet unsatisfied needs. This requires a new model of integrated health networks for the provision of care, which includes a broad spectrum of human resources and services that go beyond the health sector (Huaquía-Díaz et al., 2021; Tucker-Seeley et al., 2011). These networks must improve coordination between healthcare providers, social workers, and communities by integrating services within the health sector and externally with other (e.g., the social sector) and key stakeholders. The territorial approach of PHC allows networks to adapt to each region’s reality. Health systems can increase efficiency and support healthy aging with interventions to meet unsatisfied needs. This requires a new model of integrated health networks for the provision of care, which includes a broad spectrum of human resources and services that go beyond the health sector. Designing care with a holistic vision that integrates all domains of health needs, considering individual preferences and priorities, is the objective of this model of care. To be able to re-design PHC to this end, we propose three key axes and one transversal: Re-designing the CM centered on the health needs of people, families, and communities in the dynamics of their life trajectories and based on their values, preferences, and priorities. Updating the provision of services from incidental demand to respond to health needs in a holistic, comprehensive, continuous, proactive, and anticipatory manner for individuals, families, and communities throughout their life course allows the construction of healthy life trajectories. Adapting and strengthening integrated health service networks to enable expanded provision of health services. This constitutes an “open-source network” that allows the coverage of health needs by multiple health, social, educational providers, and community resources, preferably interconnected. A transversal axis focuses on using available innovations and technologies. Effectively implemented technology in integrated CMs can reduce out-of-pocket expenses and health inequities by lowering indirect costs through initiatives like telemedicine and home care. It can also empower users to take an active role in managing their health. See model suggested in figure 1. Model of care for a person-centered integrated care. It is also critical to consider human resources for this healthcare transformation. Professionals must be trained to effectively implement an integrated CM and improve their capacity and knowledge in geriatrics and gerontology. Many healthcare professionals lack knowledge about atypical presentations of diseases, geriatric syndromes, and normal aging processes. Different approaches and new professional roles can be used to implement this model and strengthen PHC, such as care managers and liaison professionals in secondary and tertiary care settings to ensure effective transitions. Creating interprofessional teams, task-shifting, and task-sharing can be key strategies in delegating specific tasks to less specialized health workers. Persistent policy gaps and outdated policies hinder healthcare systems reform in the Americas, fragmented health systems, low public health investment, workforce shortages, and limited first-level care capacity (Pan American Health Organization, 2022). Attention should be given to policies prioritizing health needs and a person-centered approach that considers building health trajectories, functioning, and the social determinants of health and fostering intersectoral collaboration for integrated healthcare networks. Health systems need to realign to the user’s needs, preferences, and values, which implies innovations at the policy and implementation level, focusing on PHC. Policymakers and health system leaders at the national and subnational levels can leverage this framework to design policies that incentivize integrated care and strengthen PHC networks. The application of the life course approach into these policies will favor addressing the needs of the diverse healthcare users and their different needs at each life stage. CMs must expand beyond the health sector, addressing broader health needs; policies can also favor the development of intersectoral action and establishment of governance mechanisms among the different sectors. At the policy level, allocating resources to holistic PHC and exercising proactive policymaking to achieve economic and social development is crucial. Finally, new health professional skills and competencies and the best use of data and technology are two important areas that are especially avid about innovations. In that respect, creative initiatives will maximize the health system’s efficiency in contributing to healthy aging. This publication was produced with support from the Universal Health Coverage Partnership, which assists more than 125 countries in accelerating progress towards achieving UHC with support from the European Union, the Grand Duchy of Luxembourg, Irish Aid, the French Ministry for Europe and Foreign Affairs, the Government of Japan - Ministry of Health, Labour and Welfare, the United Kingdom - Foreign, Commonwealth & Development Office, Belgium, Canada, and Germany. None.

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