Unlike the physician centered model the Orem self-care deficit model stresses patient participation in all phases of wellness. The end result is, of course, the development of a healthy lifestyle - one that is self-motivating (Steiger & Lipson, 1985). Further, self care regimens, according to authors such as Padula (1992) and Resnick and Daly (1998), are self-initiating, purposeful, and planned. The remainder of this report will, therefore, center around Orem's self care deficit model wherein the focus is on a patient's continued independence and proactive involvement in self-care.

             According to Orem (1995, 2003) an individual's health and well-being is a function of one's ability to meet one's health and developmental needs; and because everyone is responsible for their own life, all individuals are capable of fulfilling their goals and ambitions. Unfortunately, however, a web of influences can disrupt the positive flow of individual wellness. Such influencing factors are a professional lack of awareness by nurses of a patient's health beliefs, a lack of appreciation for a patient's cultural diversity, and the inability to listen to a patient's problems (physical and psychological), goals, desires, beliefs, practices, and worldviews. Although Orem is point specific with reference to health-promoting behavior she fell short of including a significant nursing characteristic that is vital in the facilitation of an elderly patient's self-care program, namely reflective thinking. Without reflective thinking a self-care program for the elderly can be fraught with unwanted influences and result in an elderly patient becoming depressive. Therefore, prior to a discussion on preventing depression amongst the elderly visa via self-care programming it is necessary to have a clear idea as to what constitutes reflective thinking and its relationship to self-care.

             With the ability to reflect, and armed with an appreciation and understanding of what constitutes self-care for the elderly, nurses can then begin to correct healthcare delivery systems that all too often promote and reinforce depression amongst the elderly.