The objectives of this synthesis are to highlight some of the evidence presented by the other articles in this issue and to discuss how this evidence can be used to design policies and deliver health care services which foster seniors' independence within a health reform context. This paper, therefore, first examines health reform and proceeds from there to discuss the key findings of the studies reported in this journal issue. The discussion then focusses on the importance of the evidence presented for policy making, planning and practice within the current context. Each section concludes by identifying the specific gaps in knowledge that require either additional literature reviews or further research.

Fostering independence amongst people over 65 years of age, over 80 per cent of whom have medical conditions, presents many challenges to policy personnel, program planners, and service providers, as physical, social, and psychological dimensions of independence must all be considered. This paper presents a systematic literature review and synthesis of 65 rigorous, comprehensive research papers selected from 238 published studies on care delivery approaches relevant to promoting the independence of older persons. This evidence suggests the merits of exercise and health promotion programs for all seniors, and in-home geriatric health care management and fall prevention programs for frail older persons. Findings also indicate the need for more attention to policy on assistive devices, and the need for more research on the effectiveness of public health programming, on strategies to enhance preventive medical care, and onpsychosocial factors which affect seniors' self-efficacy.