scholarly journals Development & Testing of a Comprehensive Digital Self-Care Support System for Older Adults With Chronic Conditions

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 633-633
Author(s):  
Priya Nambisan ◽  
Kurt Stange ◽  
Kalle Lyytinen ◽  
Eva Kahana ◽  
Edmund Duthie ◽  
...  
Keyword(s):  
Older Adults ◽  
Support System ◽  
Low Income ◽  
Chronic Conditions ◽  
Self Care ◽  
Community Dwelling ◽  
Multiple Chronic Conditions ◽  
Phase 3 ◽  
Phase Study ◽  
Care Support

Abstract This 3-phase study involves the conceptualization and design, development and usability testing of a Comprehensive Digital Self-care Support System (CDSSS) named myHESTIA for older adults with multiple chronic conditions (MCC). The objective of this study was to test whether a CDSSS can be developed for those who are dealing with MCC and whether such a system that is specifically developed for older adult patients will enable daily capture of self-care data. Participants for this 3-phase study included: 10 older adults (age>60) and 10 caregivers in Phase 1; 15 Geriatrics clinicians and 25 community-dwelling low-income older adults in Phase 2; and, 10 older adults (age>60) with MCC in Phase 3. Agile method of system development was used for the design and development of the system. The first two phases involved collecting data for designing and developing myHESTIA. The third phase involved small group usability and feasibility testing, in which the participants used myHESTIA trackers for 4 weeks. Results from phase 3 shows daily inputs were possible and the self-reported data shows that it was not at all difficult for older adults to track their symptoms daily. User experience data (n=10) shows overall positive experience along pragmatic (5.8 out of 7), hedonic (4.6 out of 7), sociability (5.5 out of 7) and usability (6.3 out of 7) experience dimensions. Finally, all the participants (n=10) who completed the phase 3 study reported intention to continue using myHESTIA. Results indicate that it is feasible to design a CDSSS for older adults with MCC.

scholarly journals IMPLEMENTATION OF PATIENT PRIORITIES CARE WITHIN A VA GERIATRICS CLINIC

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S774-S774
Author(s):  
Jennifer Freytag ◽  
Lilian Dindo ◽  
Angela Catic ◽  
Aanand Naik ◽  
Mary Tinetti
Keyword(s):  
Older Adults ◽  
Social Interactions ◽  
Medical Records ◽  
Social Engagement ◽  
Chronic Conditions ◽  
Self Care ◽  
Routine Care ◽  
Mean Difference ◽  
Multiple Chronic Conditions ◽  
Geriatric Clinic

Abstract Patient Priorities Care (PPC) is an approach to decision-making for older adults with multiple chronic conditions (MCC). PPC trains facilitators to have structured conversations with patients to identify their priorities (the outcomes that matter most given what care they are willing/able to do or receive). Clinicians then align care to achieve patient priorities rather than focusing on multiple single-disease guidelines. We piloted PPC in a VA geriatrics clinic and compared it to usual care (UC) for multimorbid adults. This retrospective cohort study (n=36 PPC, 36 UC) describes changes made by clinicians after Veterans with MCC had facilitated conversations in a VA geriatric clinic. UC Veterans were matched by prognosis, same primary clinician, and timeframe. Coders used a standardized rubric to assess documented care within medical records. Changes to care examined include medications added/removed, referrals made/avoided, self-care recommendations, and recommendations for social engagement. Although PPC and UC patients were seen by the same clinicians, patients receiving PPC had fewer added medications (mean difference -.47, t(70)=-1.99, p=.05); received more recommendations for self-care aligned with priorities (mean difference .25, t(69)=2.14, p=.003); received more recommended consultations with desired care, including podiatry, transportation, and dermatology (mean difference .55, t(70)=2.06, p=.01), and more recommendations for care and services to facilitate social interactions (p<.0001). PPC produced documented changes in care that better align with patient priorities within the routine care workflow of a busy geriatrics clinic. Our results provide evidence that structured priorities conversations change the way clinicians provide care for older adults with MCC.

scholarly journals Association between patterns of multiple chronic conditions and cognitive impairment in community‐dwelling older adults in Taiwan

2021 ◽  
Vol 17 (S10) ◽  
Author(s):  
Pei‐Iun Hsieh ◽  
Yen‐Ching Chen ◽  
Jeng‐Min Chiou ◽  
Ta‐Fu Chen ◽  
Su‐Ling Yeh ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Chronic Conditions ◽  
Community Dwelling ◽  
Multiple Chronic Conditions ◽  
Community Dwelling Older Adults

scholarly journals Illness perceptions and health outcomes among community-dwelling older adults with multiple chronic conditions

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 615-616
Author(s):  
Ayo Bankole
Keyword(s):  
Older Adults ◽  
Health Outcomes ◽  
Chronic Conditions ◽  
Illness Perceptions ◽  
Community Dwelling ◽  
Multiple Chronic Conditions ◽  
Targeted Interventions ◽  
Self Rated Health ◽  
The Past ◽  
The Relationship

Abstract Illness perceptions (IP) has been associated with self-management and health outcomes in individuals with chronic diseases such as heart disease and diabetes; however, there is less research on the relationship between IP and health outcomes in individuals with multiple chronic conditions (MCC). Older adults with MCC are more likely to experience poor outcomes such as hospitalizations and poor self-rated health yet, there is less understanding of the processes associated with these outcomes. The purpose of this study was to (1) explore the relationship between IP and self-rated health among older adults with MCC (2) explore the relationship between IP and the number of hospitalization within the past year among older adults with MCC. Understanding these relationships may be instrumental to designing targeted interventions to improve health outcomes for this population. 116 participants (ages 65-90) completed the illness perception of multimorbidity scale, modified general health subscale of the SF-36 questionnaire, and self-reported number of hospitalizations within the past year. Ordinal logistic regression was used for analysis. Older adults who reported negative IP were likely to report worse self-rated health and this relationship remained significant after controlling for age and number of chronic conditions {-0.032 (95% CI (-0.050 to 0.014) p< 0.05}. There was no significant relationship between IP and the number of hospitalization within the past year. The study results study suggest that IP is associated with self-rated health in older adults with MCC. IP may be useful to design targeted interventions to improve self-rated health in this population.

scholarly journals Emergency Department and Inpatient Utilization among U.S. Older Adults with Multiple Chronic Conditions: A Post-Reform Update

2020 ◽  
Author(s):  
SangNam Ahn ◽  
Mustafa Hussein ◽  
Asos Mahmood ◽  
Matthew Lee Smith
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Low Income ◽  
Chronic Conditions ◽  
Medical Expenditure Panel Survey ◽  
Medical Expenditure ◽  
Multiple Chronic Conditions ◽  
Medicare Beneficiaries ◽  
Percentage Points ◽  
Ed Visits

Abstract Background. The Affordable Care Act (ACA) was enacted to enhance access to care primarily among nonelderly and low-income populations; however, several provisions addressed key determinants of emergency department (ED) and inpatient visits among Medicare beneficiaries over age 65 years. We take stock of the overall changes in these visits among older Medicare beneficiaries, focusing on those with multiple chronic conditions (MCCs), and provide a nationally representative post-reform update. Methods. We analyzed a sample of 32,919 older adults (65+) on Medicare from the 2006-2015 Medical Expenditure Panel Survey (MEPS). Using a survey-weighted two-part model, we examined changes in ED visits, inpatient visits, and length of stay (LOS) by MCC status, before (2006-2010), during (2011-2013), and after the ACA (2014-2015). Results. Prior to the ACA, 18.1% of Medicare older adults had ≥1 ED visit, whereas 17.1% had ≥1 inpatient visits, with an average of 5.1 nights/visit. Following ACA reforms, among those with 2+ chronic conditions, the rate of ever having an ED visit increased by 4.3 percentage points [95% confidence intervals [CI]: 2.5, 6.1, p < 0.01], whereas the rate of inpatient visits decreased by 1.4 percentage points [95%CI: -2.9, 0.2, p < 0.1], after multivariable adjustment. Conclusions. We found sizable increases in ED visits and nontrivial decreases in inpatient visits among older Medicare beneficiaries with MCCs, underscoring the continuing need for improving access to and quality of care among older adults with MCCs to decrease reliance on the ED and reduce preventable hospitalizations.

scholarly journals Self-Management of Multiple Chronic Conditions by Community-Dwelling Older Adults: A Concept Analysis

2018 ◽  
Vol 4 ◽  
pp. 237796081775247 ◽  
Author(s):  
Anna Garnett ◽  
Jenny Ploeg ◽  
Maureen Markle-Reid ◽  
Patricia H. Strachan
Keyword(s):  
Older Adults ◽  
Disease Management ◽  
Chronic Conditions ◽  
Concept Analysis ◽  
Community Dwelling ◽  
Self Management ◽  
Multiple Chronic Conditions ◽  
Complex Process ◽  
Health And Disease ◽  
Community Dwelling Older Adults

The proportion of the aging population living with multiple chronic conditions (MCC) is increasing. Self-management is valuable in helping individuals manage MCC. The purpose of this study was to conduct a concept analysis of self-management in community-dwelling older adults with MCC using Walker and Avant’s method. The review included 30 articles published between 2000 and 2017. The following attributes were identified: (a) using financial resources for chronic disease management, (b) acquiring health- and disease-related education, (c) making use of ongoing social supports, (d) responding positively to health changes, (e) ongoing engagement with the health system, and (f) actively participating in sustained disease management. Self-management is a complex process; the presence of these attributes increases the likelihood that an older adult will be successful in managing the symptoms of MCC.

Depression and self‐care in older adults with multiple chronic conditions: A multivariate analysis

2020 ◽  
Vol 76 (7) ◽  
pp. 1668-1678 ◽  
Author(s):  
Paolo Iovino ◽  
Maddalena De Maria ◽  
Maria Matarese ◽  
Ercole Vellone ◽  
Davide Ausili ◽  
...  
Keyword(s):  
Older Adults ◽  
Multivariate Analysis ◽  
Chronic Conditions ◽  
Self Care ◽  
Multiple Chronic Conditions
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