I sympathize with Cyndy Irvine's discomfort and applaud her for writing about her experience ("Best for Mr. Miller," Reflections, October 2007). Her poignant description raises a host of issues that we as professionals and members of society are ill-equipped to address. Mr. Miller's life had shrunk to little more than familiar surroundings and his dog, and while this small existence may not represent a good quality of life, he preferred it to the institutional setting that took away what little he had.

The traditional medical model directs at-risk older adults to medical care and institutionalization and subverts the quality of a person's life and self-determination in the name of (presumed) safety and longevity. In contrast, an interdisciplinary model of gerontology would incorporate autonomy, advocacy, social support, and functional status. Specifically, what does this individual want, and what is meaningful to him? Who is this person's advocate? Is there a way to provide meals and trips to the physician without sacrificing independence? How can we improve and maintain his functioning? While long-term institutional care has its place, there are other options to consider. As our aging population grows, we need to support a social and political agenda that demands more training for professionals and promotes community-based services and supportive housing.

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Jeanne St. Pierre, MN, RN, APRN, BC

Muncie, IN