Flourishing refers to the experience of a life going well. It is a way to describe optimal life functioning, in spite of chronic disease and psychical bodily deterioration. It focuses on adaptation to age-related changes and reduction of abilities, but also the positive gains and strengths associated with old age. To flourish means to proactively and reactively respond and interact with what comes our way, by selecting goals that fit the issues we deal with, and then optimize our engagement in the selected goals, and in this process compensate and maintain a certain quality of life that is possible in the face of loss and decline.
Integrated Care Models
Older adults with multiple chronic conditions can benefit greatly from integrated care coordination models, where the aim is to coordinate services across the health care and social service sectors for the main goal of supporting flourishing and quality of life. These holistic models of care focus on all the determinants of health, namely biological, psychological, individual health behaviors, health services, environmental, and social. These comprehensive models understand the hierarchy of needs within an individual and focus first on meeting basic psychological (eg. food, shelter, clothing) and safety (eg. personal security, health, employment) needs, before addressing higher needs of belonging, esteem and self-actualization.
The Flourish Index
The Flourish Index is a set of evidence-based, quality of life indicators across the six determinants of health that can be used to track flourishing within an individual. In terms of biological determinants, the Index tracks ability to perform activities of daily living with or without the support of caregiver, self-evaluation of health, muscle strength and balance problems. In terms of psychological determinants, the Index focuses on tracking happiness, satisfaction with life, social support, loneliness, depression, and stress, among others. Individual health behaviors determinants focus on healthy behaviors, specifically eating, exercise, smoking, drinking and drug habits. Health services determinants focus on access issues related to a regular source of care, medication, dental care, mental health services, medication management as well as overall satisfaction with health care. Environmental determinants focus on the safety and hygiene of the home environment. Social determinants focus on socio-economic indicators, eg. economic stability, education, basic food access, transportation access and caregiver access.
Comprehensive care coordination models can use the Flourish Index to track the progress of their patients in terms of all the indicators noted above. The Index can serve as a motivation tool for older adults to show them how they score overall on a combination of quality of life indicators and then to work with them to improve their overall score. This provides the opportunity for older adults to reframe their ability to flourish, despite the chronic conditions they may struggle with.