Decision-making and cancer screening: A qualitative study of older adults with multiple chronic conditions

Background: Older adults with multiple chronic conditions (MCC) rely heavily on caregivers for assistance with care. However, we know little about their psychosocial experiences and their needs for support in managing MCC. The purpose of this study was to explore the experiences of caregivers of older adults living in the community with MCC. Methods: This qualitative study was a secondary analysis of previously collected data from caregivers in Ontario and Alberta, Canada. Participants included caregivers of older adults (65 years and older) with three or more chronic conditions. Data were collected through in-depth, semi-structured interviews. Interview transcripts were coded and analyzed using Thorne’s interpretive description approach. Results: Most of the 47 caregiver participants were female (76.6%), aged 65 years of age or older (61.7%), married (87.2%) and were spouses to the care recipient (68.1%). Caregivers’ experiences of caring for community-living older adults with MCC were complex and included: (a) dealing with the demands of caregiving; (b) prioritizing chronic conditions; (c) living with my own health limitations; (d) feeling socially isolated and constrained; (e) remaining committed to caring; and (f) reaping the rewards of caregiving. Conclusions: Healthcare providers can play key roles in supporting caregivers of older adults with MCC by providing education and support on managing MCC, actively engaging them in goal setting and care planning, and linking them to appropriate community health and social support services. Communities can create environments that support caregivers in areas such as social participation, social inclusion, and community support and health services.

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EFFECTS OF A SHARED DECISION MAKING INTERVENTION FOR OLDER ADULTS WITH CHRONIC CONDITIONS: AN OBSERVATIONAL STUDY

Innovation in Aging ◽

10.1093/geroni/igz038.1090 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S296-S297

Author(s):

Ruth E Pel-Littel ◽

Bianca Buurman ◽

Marjolein van de Pol ◽

Linda Tulner ◽

Mirella Minkman ◽

...

Keyword(s):

Older Adults ◽

Decision Making ◽

Observational Study ◽

Shared Decision Making ◽

Chronic Conditions ◽

Decisional Conflict ◽

Future Research ◽

Multiple Chronic Conditions ◽

Shared Decision ◽

Perceived Involvement

Abstract Shared decision making (SDM) in older patients is more complex when multiple chronic conditions (MCC) have to be taken into account. The aim of this research is to explore the effect of the evidence based implementation intervention SDMMCC on (1) the preferred and perceived participation (2) decisional conflict and (3) actual SDM during consultations. 216 outpatients participated in a video observational study. The intervention existed of a SDM training for geriatricians and a preparatory tool for patients. Consultations were videotaped and coded with the OPTIONMCC. Pre- and post-consultation questionnaires were completed. Participation was measured by the Patients’ perceived Involvement in Care Scale (PICS). Decisional conflict was measured by the Decisional Conflict Scale (DCS). The patients mean age was 77 years, 56% was female. The preparatory tool was completed by 56 older adults (52%), of which 64% rated the tool as positive. The preparatory tool was used in 12% of the consultations. The mean overall OPTIONMCC score showed no significant changes on the level of SDM(39.3 vs 39.3 P0.98), however there were significant improvements on discussing goals and options on sub-items of the scale. There were no significant differences found in the match on preferred and perceived participation (86.5% vs 85.0% P 0.595) or in decisional conflict (22.7 vs 22.9 P0.630). The limited use of the preparatory tool could have biased the effect of the intervention. In future research more attention must be paid towards the implementation of preparatory tools, not only among patients but also among geriatricians.

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Managing multiple chronic conditions in the community: a Canadian qualitative study of the experiences of older adults, family caregivers and healthcare providers

BMC Geriatrics ◽

10.1186/s12877-017-0431-6 ◽

2017 ◽

Vol 17 (1) ◽

Cited By ~ 47

Author(s):

Jenny Ploeg ◽

Nancy Matthew-Maich ◽

Kimberly Fraser ◽

Sinéad Dufour ◽

Carrie McAiney ◽

...

Keyword(s):

Older Adults ◽

Qualitative Study ◽

Family Caregivers ◽

Chronic Conditions ◽

Healthcare Providers ◽

Multiple Chronic Conditions

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A Web-Based Intervention to Help Caregivers of Older Adults With Dementia and Multiple Chronic Conditions: Qualitative Study

JMIR Aging ◽

10.2196/aging.8475 ◽

2018 ◽

Vol 1 (1) ◽

pp. e2 ◽

Cited By ~ 11

Author(s):

Jenny Ploeg ◽

Carrie McAiney ◽

Wendy Duggleby ◽

Tracey Chambers ◽

Annie Lam ◽

...

Keyword(s):

Older Adults ◽

Qualitative Study ◽

Chronic Conditions ◽

Multiple Chronic Conditions ◽

Web Based

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A Canadian qualitative study exploring the diversity of the experience of family caregivers of older adults with multiple chronic conditions using a social location perspective

International Journal for Equity in Health ◽

10.1186/s12939-016-0328-6 ◽

2016 ◽

Vol 15 (1) ◽

Cited By ~ 25

Author(s):

Allison Williams ◽

Bharati Sethi ◽

Wendy Duggleby ◽

Jenny Ploeg ◽

Maureen Markle-Reid ◽

...

Keyword(s):

Older Adults ◽

Qualitative Study ◽

Family Caregivers ◽

Chronic Conditions ◽

Multiple Chronic Conditions ◽

Social Location

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Using Big Data for Clinical Decision Making

Innovation in Aging ◽

10.1093/geroni/igaa057.563 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 174-174

Author(s):

Diana Woods ◽

Maria Yefimova

Keyword(s):

Older Adults ◽

Decision Making ◽

Chronic Conditions ◽

Clinical Decision Making ◽

Clinical Decision ◽

Sensor Data ◽

Innovative Technology ◽

Multiple Chronic Conditions ◽

Daily Routine ◽

Frail Older Adults

Abstract The current workforce is ill prepared for the rise in Americans 65 and older from 46.3 million in 2010 to 98.2 million by 2050, a national increase of 112.2 % accompanied by increasing chronic conditions. The increase in older Americans, the prevalence of those with dementia, accompanied by behavioral symptoms of dementia (BSD) is increasing. Innovative technology may alert health providers to early signs of decline in frail older adults with multiple chronic conditions. Remote monitoring in the home and community living spaces can address complex care needs for older adults. Monitoring may identify and predict deviations in a person’s daily routine that herald a change in a chronic condition. We present two examples that can potentially assist in clinical decision making. The first exemplar used 24/7 sensor data to identify changes, potentially clinically significant, such that early intervention may prevent hospitalizations; the second exemplar presents the use of pattern recognition software (THEME TM) for temporal pattern analysis, to identify and quantify behavior patterns with regard to intensity, frequency and complexity, such that interventions may be individually tailored and timed. Clinical researchers and technology developers need to collaborate early in the process to consider the sources and frequency of clinical measures for meaningful predictions. One major challenge lies in the interpretation of the vast amounts of within individual data. Our insights strive to improve future interdisciplinary development of monitoring systems to support aging in place and support clinical decisions for timely and effective care for frail older adults.

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