scholarly journals Home-Care Nurses’ Experiences of Caring for Older Adults With Type 2 Diabetes Mellitus and Urinary Incontinence: An Interpretive Description Study

2021 ◽  
Vol 7 ◽  
pp. 237796082110209
Author(s):  
Melissa Northwood ◽  
Jenny Ploeg ◽  
Maureen Markle-Reid ◽  
Diana Sherifali
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Urinary Incontinence ◽  
Home Care ◽  
System Integration ◽  
Chronic Conditions ◽  
Multiple Chronic Conditions ◽  
Interpretive Description ◽  
Care System ◽  
Home Care Nurses

Introduction A third of older adults with diabetes receiving home-care services have daily urinary incontinence. Despite this high prevalence of urinary incontinence, the condition is typically not recognized as a complication and thereby not detected or treated. Diabetes and urinary incontinence in older adults are associated with poorer functional status and lower quality of life. Home-care nurses have the potential to play an important role in supporting older adults in the management of these conditions. However, very little is known about home-care nurses’ care of this population. Objective The objective of this study was to explore how nurses care for older home-care clients with diabetes and incontinence. Methods This was an interpretive description study informed by a model of clinical complexity, and part of a convergent, mixed methods research study. Fifteen nurse participants were recruited from home-care programs in southern Ontario, Canada to participate in qualitative interviews. An interpretive description analytical process was used that involved constant comparative analysis and attention to commonalities and variance. Results The experiences of home-care nurses caring for this population is described in three themes and associated subthemes: (a) conducting a comprehensive nursing assessment with client and caregiver, (b) providing holistic treatment for multiple chronic conditions, and (c) collaborating with the interprofessional team. The provision of this care was hampered by a task-focused home-care system, limited opportunities to collaborate and communicate with other health-care providers, and the lack of health-care system integration between home care, primary care, and acute care. Conclusion The results suggest that nursing interventions for older adults with diabetes and incontinence should not only consider disease management of the individual conditions but pay attention to the broader social determinants of health in the context of multiple chronic conditions. Efforts to enhance health-care system integration would facilitate the provision of person-centred home care.

scholarly journals The Complexity of Living with Diabetes and Urinary Incontinence for Older Adults with Multiple Chronic Conditions Receiving Home Care Services: An Interpretive Description Study

2021 ◽  
Vol 8 ◽  
pp. 233339362199345
Author(s):  
Melissa Northwood ◽  
Jenny Ploeg ◽  
Maureen Markle-Reid ◽  
Diana Sherifali
Keyword(s):  
Older Adults ◽  
Urinary Incontinence ◽  
Home Care ◽  
Chronic Conditions ◽  
Self Care ◽  
Home Care Services ◽  
Experiential Knowledge ◽  
Multiple Chronic Conditions ◽  
Interpretive Description ◽  
Care Services

Over 40% of older adults with diabetes receiving home-care services experience urinary incontinence. However, experiential knowledge is lacking on how these older adults live with diabetes and incontinence. Interpretive description methodology was used to explore the experiences of 18 older adults with diabetes and urinary incontinence receiving home-care services in Ontario, Canada. Five themes emerged from the findings: (a) enduring urinary incontinence: “patch it in pads”; (b) struggling to manage diabetes, incontinence, and multiple chronic conditions: “a balancing act”; (c) covering the costs of care: “I can’t afford it”; (d) counting on a caregiver: “he does everything”; and (e) home-care services not meeting my needs: “it’s not individual.” These findings suggest that living with urinary incontinence and diabetes is a complex and challenging experience. This evidence could inform the provision of comprehensive home care to support self-care for this population.

scholarly journals HEALTHCARE PROVIDERS’ EXPERIENCES IN CARING FOR OLDER ADULTS WITH MULTIPLE CHRONIC CONDITIONS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S317-S318
Author(s):  
Jenny Ploeg ◽  
Marie-Lee Yous ◽  
Kimberly Fraser ◽  
Sinéad Dufour ◽  
Sharon Kaasalainen ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Home Care ◽  
Family Caregivers ◽  
Chronic Conditions ◽  
Care Delivery ◽  
Healthcare Providers ◽  
Multiple Chronic Conditions ◽  
Team Approach ◽  
Personal Support

Abstract The management of multiple chronic conditions (MCC) in older adults living in the community is complex. Little is known about the experiences of interdisciplinary primary care and home providers who care for this vulnerable group. The aim of this study was to explore the experiences of healthcare providers in managing the care of community-living older adults with MCC and to highlight their recommendations for improving care delivery for this group. A qualitative interpretive description design was used. A total of 42 healthcare providers from two provinces in Canada participated in semi-structured interviews. Participants represented diverse disciplines (e.g., physicians, nurses, social workers, personal support workers) and settings (e.g., primary care and home care). Thematic analysis was used to analyze interview data. The experiences of healthcare providers managing care for older adults with MCC were organized into six major themes: (1) managing complexity associated with MCC, (2) implementing person-centred care, (3), involving and supporting family caregivers, (4) using a team approach for holistic care delivery, (5) encountering rewards and challenges in caring for older adults with MCC, and (6) recommending ways to address the challenges of the healthcare system. Healthcare providers highlighted the need for a more comprehensive integrated system of care to improve care management for older adults with MCC and their family caregivers. Specifically, they suggested increased care coordination, more comprehensive primary care visits with an interprofessional team, and increased home care support.

scholarly journals A Web-Based eHealth Intervention to Improve the Quality of Life of Older Adults With Multiple Chronic Conditions: Protocol for a Randomized Controlled Trial

10.2196/25175 ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. e25175
Author(s):  
David H Gustafson Sr ◽  
Marie-Louise Mares ◽  
Darcie C Johnston ◽  
Jane E Mahoney ◽  
Randall T Brown ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Primary Care ◽  
Health Care ◽  
Chronic Conditions ◽  
Health Care Use ◽  
Multiple Chronic Conditions ◽  
Secondary Outcomes ◽  
Ehealth Intervention

Background Multiple chronic conditions (MCCs) are common among older adults and expensive to manage. Two-thirds of Medicare beneficiaries have multiple conditions (eg, diabetes and osteoarthritis) and account for more than 90% of Medicare spending. Patients with MCCs also experience lower quality of life and worse medical and psychiatric outcomes than patients without MCCs. In primary care settings, where MCCs are generally treated, care often focuses on laboratory results and medication management, and not quality of life, due in part to time constraints. eHealth systems, which have been shown to improve multiple outcomes, may be able to fill the gap, supplementing primary care and improving these patients’ lives. Objective This study aims to assess the effects of ElderTree (ET), an eHealth intervention for older adults with MCCs, on quality of life and related measures. Methods In this unblinded study, 346 adults aged 65 years and older with at least 3 of 5 targeted high-risk chronic conditions (hypertension, hyperlipidemia, diabetes, osteoarthritis, and BMI ≥30 kg/m2) were recruited from primary care clinics and randomized in a ratio of 1:1 to one of 2 conditions: usual care (UC) plus laptop computer, internet service, and ET or a control consisting of UC plus laptop and internet but no ET. Patients with ET have access for 12 months and will be followed up for an additional 6 months, for a total of 18 months. The primary outcomes of this study are the differences between the 2 groups with regard to measures of quality of life, psychological well-being, and loneliness. The secondary outcomes are between-group differences in laboratory scores, falls, symptom distress, medication adherence, and crisis and long-term health care use. We will also examine the mediators and moderators of the effects of ET. At baseline and months 6, 12, and 18, patients complete written surveys comprising validated scales selected for good psychometric properties with similar populations; laboratory data are collected from eHealth records; health care use and chronic conditions are collected from health records and patient surveys; and ET use data are collected continuously in system logs. We will use general linear models and linear mixed models to evaluate primary and secondary outcomes over time, with treatment condition as a between-subjects factor. Separate analyses will be conducted for outcomes that are noncontinuous or not correlated with other outcomes. Results Recruitment was conducted from January 2018 to December 2019, and 346 participants were recruited. The intervention period will end in June 2021. Conclusions With self-management and motivational strategies, health tracking, educational tools, and peer community and support, ET may help improve outcomes for patients coping with ongoing, complex MCCs. In addition, it may relieve some stress on the primary care system, with potential cost implications. Trial Registration ClinicalTrials.gov NCT03387735; https://www.clinicaltrials.gov/ct2/show/NCT03387735. International Registered Report Identifier (IRRID) DERR1-10.2196/25175

scholarly journals Outcome Goals and Health Care Preferences of Older Adults With Multiple Chronic Conditions

2021 ◽  
Vol 4 (3) ◽  
pp. e211271 ◽  
Author(s):  
Mary E. Tinetti ◽  
Darcé M. Costello ◽  
Aanand D. Naik ◽  
Claire Davenport ◽  
Kizzy Hernandez-Bigos ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Chronic Conditions ◽  
Multiple Chronic Conditions ◽  
Outcome Goals ◽  
Health Care Preferences

scholarly journals Research Priorities to Advance the Health and Health Care of Older Adults with Multiple Chronic Conditions

2017 ◽  
Vol 65 (7) ◽  
pp. 1549-1553 ◽  
Author(s):  
Mayra Tisminetzky ◽  
Elizabeth A. Bayliss ◽  
Jay S. Magaziner ◽  
Heather G. Allore ◽  
Kathryn Anzuoni ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Chronic Conditions ◽  
Research Priorities ◽  
Multiple Chronic Conditions

The Challenge of Comprehensive Care

2015 ◽  
Vol 8 (1) ◽  
pp. 84-86
Author(s):  
Dawn Bucher
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Nurse Practitioners ◽  
Chronic Conditions ◽  
Nursing Practice ◽  
Comprehensive Care ◽  
Multiple Chronic Conditions ◽  
Independent Practice ◽  
Doctor Of Nursing Practice ◽  
Care System

Adults are living longer with multiple chronic conditions. There are many challenges to providing comprehensive care to patients around the country in today’s system. This article, although personal, discusses some challenges seen by the writer but witnessed by many. It also looks at some challenges nurse practitioners have when practicing in multiple states across the country. Lastly, I offer my opinion on certification as a Diplomate of Comprehensive Care for all Doctor of Nursing Practice clinicians who provide comprehensive care in independent practice settings. It is time to provide safe, quality, comprehensive care to our patients in a reputable health care system.

scholarly journals Chronic disease burden predicts food insecurity among older adults

2018 ◽  
Vol 21 (9) ◽  
pp. 1737-1742 ◽  
Author(s):  
Jane Jih ◽  
Irena Stijacic-Cenzer ◽  
Hilary K Seligman ◽  
W John Boscardin ◽  
Tung T Nguyen ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Chronic Disease ◽  
Food Insecurity ◽  
Chronic Conditions ◽  
Disease Burden ◽  
Health Care Expenditures ◽  
Multiple Chronic Conditions ◽  
Increased Risk ◽  
Chronic Disease Burden

AbstractObjectiveIncreased out-of-pocket health-care expenditures may exert budget pressure on low-income households that leads to food insecurity. The objective of the present study was to examine whether older adults with higher chronic disease burden are at increased risk of food insecurity.DesignSecondary analysis of the 2013 Health and Retirement Study (HRS) Health Care and Nutrition Study (HCNS) linked to the 2012 nationally representative HRS.SettingUSA.SubjectsRespondents of the 2013 HRS HCNS with household incomes <300 % of the federal poverty line (n 3552). Chronic disease burden was categorized by number of concurrent chronic conditions (0–1, 2–4, ≥5 conditions), with multiple chronic conditions (MCC) defined as ≥2 conditions.ResultsThe prevalence of food insecurity was 27·8 %. Compared with those having 0–1 conditions, respondents with MCC were significantly more likely to report food insecurity, with the adjusted odds ratio for those with 2–4 conditions being 2·12 (95 % CI 1·45, 3·09) and for those with ≥5 conditions being 3·64 (95 % CI 2·47, 5·37).ConclusionsA heavy chronic disease burden likely exerts substantial pressure on the household budgets of older adults, creating an increased risk for food insecurity. Given the high prevalence of food insecurity among older adults, screening those with MCC for food insecurity in the clinical setting may be warranted in order to refer to community food resources.

scholarly journals Transition Experiences of Caregivers of Older Adults With Dementia and Multiple Chronic Conditions: An Interpretive Description Study

2020 ◽  
Vol 6 ◽  
pp. 237796082093429
Author(s):  
Annie Lam ◽  
Jenny Ploeg ◽  
Sandra L. Carroll ◽  
Wendy Duggleby ◽  
Carrie McAiney ◽  
...  
Keyword(s):  
Health Care ◽  
Family Caregivers ◽  
Health Care Providers ◽  
Social Life ◽  
Chronic Conditions ◽  
Community Dwelling ◽  
Multiple Chronic Conditions ◽  
Interpretive Description ◽  
Care Providers ◽  
Transition Experiences

Introduction Family caregivers provide most of the care for older persons living with dementia (PLWD) and multiple chronic conditions (MCCs) in the community. Caregivers experience transitions, such as changes to their health, roles, and responsibilities, during the process of caring. Transitions encompass a time when caregivers undergo stressful responses to change. However, we know little about the transition experiences of caregivers of persons living with both dementia and MCCs. Objective This qualitative study explored the transition experiences of caregivers of PLWD within the context of MCCs, from the perspective of both caregivers and practitioners. The research question was the following: What are the transition experiences of family caregivers in providing care to older PLWD and MCCs living in the community? Methods This study was conducted using an interpretive description approach. Semistructured interviews were conducted with 19 caregivers of older community-dwelling PLWD and MCCs and 7 health-care providers working with caregivers in Ontario, Canada. Concurrent data collection and inductive data analysis were used. Results Caregivers of older PLWD and MCCs experienced four key transitions: (a) taking on responsibility for managing multiple complex conditions, (b) my health is getting worse, (c) caregiving now defines my social life, and (d) expecting that things will change. Findings highlight how the coexistence of MCCs with dementia complicates caregiver transitions and the importance of social networks for facilitating transitions. Conclusion The study provided insight on the transition experiences of caregivers of older PLWD and MCCs. MCCs increased the care load and further complicated caregivers’ transition experiences. Health-care providers, such as nurses, can play important roles in supporting caregivers during these transitions and engage them as partners in care.

Chronic disease management and the home-care alternative in Ontario, Canada

2009 ◽  
Vol 22 (3) ◽  
pp. 136-139 ◽  
Author(s):  
Peter Tsasis
Keyword(s):  
Health Care ◽  
Chronic Disease ◽  
Disease Management ◽  
Home Care ◽  
Health Care System ◽  
System Integration ◽  
Health Care Policy ◽  
Chronic Disease Management ◽  
Public Health Care ◽  
Care System

The pressure on our health-care system to deliver efficient, quality and cost-effective care is increasing. The debate on its sustainability is also expanding. These challenges can be managed with revisions to our health-care policy frameworks governing how and what public health-care services are delivered. Chronic disease management and home care can together ease many of the present and future pressures facing the health-care system. However, the current level of investment and the present policy are not effectively supporting movement in this direction. Updating the Canada Health Act to reflect the realities of our health-care system, and developing policies to support the areas of interdisciplinary teamwork and system integration are needed to facilitate chronic disease management and home care in Canada. This article lays out the challenges, highlights the impending issues and suggests a framework for moving forward.

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