DO MULTIPLE CHRONIC CONDITIONS INFLUENCE PERSONAL VIEWS ON THE AGEING PROCESS? A QUALITATIVE ANALYSIS

Objectives: For older persons with two or more chronic diseases (multiple chronic conditions) insight into what they perceive as important in their lives is essential when discussing preferences in the shared decision making process. The aims of this study were to 1) investigate the personal views on the ageing process communicated by older persons and 2) compare the personal views of older persons with and without multiple chronic conditions. Design: Using structured interviews participants were asked five questions about what they perceived as important in terms of ageing, worries, their future, healthy ageing and quality of life. Two independent researchers coded the data and performed content analyses. A stratified content analysis was performed to explore whether persons with and without multiple chronic conditions expressed different personal views with regard to the ageing process. Participants & setting: 547 community dwelling older persons aged 70 years and above. Results: The mean (SD) age was 78.9 (5.9) years, and 60.3% were female. Multiple chronic conditions were present in 72% of the study sample. There were no significant differences in demographic characteristics between persons with and without multiple chronic conditions . However persons with multiple chronic conditions more often had polypharmacy (43% vs 24%; p<0.001), more difficulties with (instrumental) activities of daily living (mean number of impairments 2.4 vs 0.8; p< 0.001) and reported more falls (35% vs 23% p = 0.01) than those without multiple chronic conditions. The qualitative analysis identified the following main themes: ageing was associated with acceptance of ageing, (further) deterioration and worries about limitations and family. A healthy lifestyle, keeping busy, maintaining social contacts and a positive attitude were considered prerequisites to healthy ageing. In 24 out of 28 sub-themes no significant differences were found between participants with and without multiple chronic conditions (MCC). Persons with multiple chronic conditions more often expressed that ageing for them meant having to cope with deterioration and limitations, they had more worries and feared more deteriorations compared to those without multiple chronic conditions. Also persons with multiple chronic conditions less often considered a positive attitude to life a prerequisite to healthy ageing. Conclusions: Acceptance of ageing, (further) deterioration and worries about limitations and family were important themes on the ageing process communicated by older persons. Overall, we found no major differences between persons with and without multiple chronic conditions. The results of this study may help raising awareness amongst health care professionals that eliciting and understanding an older persons’ views on the ageing process is an important first step in making health decisions that support older persons’ personal goals and expectations.

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Attitude towards ageing and perceived health status of community-dwelling older persons in a low resource setting: a rural-urban comparison

BMC Geriatrics ◽

10.1186/s12877-021-02394-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

E. O. Cadmus ◽

L. A. Adebusoye ◽

E. T. Owoaje

Keyword(s):

Older Persons ◽

Positive Attitude ◽

Community Dwelling ◽

Sub Saharan Africa ◽

Ageing Process ◽

Psychological Growth ◽

Targeted Interventions ◽

Self Rated Health ◽

Health Related ◽

Sub Saharan

Abstract Background Older person’s attitude to ageing is critical for their adjustment, acceptance of health-related behaviour, survival and choices. Their attitude influences how they cope with the challenges experienced while ageing, which affects their quality of life and health-related outcomes. Despite the increasing number of older persons in sub-Saharan Africa, there is limited information about their experience. This study examines the experience and attitude of older persons in Nigeria regarding the ageing process. Methods A descriptive cross-sectional study among older persons aged 60 years and above was carried out in a selected rural and an urban community in Oyo State, south-western Nigeria. The study participants were selected using a multi-stage sampling technique. Trained research assistants collected data with the aid of an interviewer-administered, semi-structured questionnaire. The Attitude to Ageing Questionnaire (AAQ) was used to measure participants’ perception of ageing in three domains (psychosocial loss, physical changes and psychological growth). Data were analysed using Stata version 14 at a level of significance p < 0.05. Results A total of 1,180 participants (588 rural vs. 592 urban) were recruited for the study. The mean age was 73.2 ± 9.3 years. The majority (69.7 %) were females and still working (50.5 %). Overall, urban-dwelling participants had a better attitude to the ageing process in all the domains compared with rural-dwelling participants (psychological growth 32.5 ± 3.4 vs. 32.4 ± 3.3, p = 0.30; physical change 27.5 ± 5.1 vs. 26.9 ± 5.0, p = 0.03; and psychosocial loss 25.3 ± 5.7 vs. 25.0 ± 5.3, p = 0.60). Among the rural and urban-dwelling participants, good self-rated health was significantly associated with a positive attitude to ageing across the domains. Conclusions Older persons residing in urban communities had higher positivity to ageing than their rural older counterparts. The common factor significantly associated with a positive attitude to ageing in both groups was good self-rated health. This information can be used for the planning of targeted interventions and informing policy formation for improved provisions for community-dwelling older persons in Nigeria and other sub-Saharan African countries.

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Attitude towards ageing and perceived Health Status of Community-Dwelling Older Persons in a low resource setting: A rural-urban comparison

10.21203/rs.3.rs-42688/v1 ◽

2020 ◽

Author(s):

Eniola Olubukola Cadmus ◽

Lawrence Adekunle Adebusoye ◽

Eme Theodora Owoaje

Keyword(s):

Older Persons ◽

Positive Attitude ◽

Community Dwelling ◽

Sub Saharan Africa ◽

Ageing Process ◽

Physical Change ◽

Psychological Growth ◽

Targeted Interventions ◽

Self Rated Health ◽

Sub Saharan

Abstract Background: Ageing is a personal experience peculiar to each individual and is influenced by several demographic and social factors. Individuals, however, have different ways of coping with the challenges experienced during this process which affects their quality of life and health-related outcomes. Despite the increasing number of older persons in sub-Saharan Africa, there is limited information about their experience. This study examines the experience and attitude of older persons in Nigeria regarding the ageing processMethods: A descriptive cross-sectional study was carried out among older persons aged 60 years and above in a selected rural and an urban community in Oyo State, south-western Nigeria. Using a multistage sampling technique, data were collected with the aid of an interviewer-administered, semi-structured questionnaire. The Attitude to Ageing Questionnaire (AAQ) was used to measure participants' perception of ageing in three domains of psychosocial loss, physical changes and psychological growth. Data were analysed using Stata version 14 at a level of significance p<0.05. Results: A total of 1,180 participants (588 rural vs 592 urban) were recruited for the study. The mean age was 73.2 ±9.3 years. The majority (69.7%) were females and still working (50.5%) Overall, urban-dwelling participants had a better attitude to the ageing process in all the domains compared with rural-dwelling participants (psychological growth 32.5±3.4 vs 32.4±3.3, p=0.30; physical change 27.5±5.1 vs 26.9±5.0, p=0.03; and psychosocial loss 25.3±5.7 vs 25.0±5.3, p=0.60. The predictors for having a positive attitude to ageing especially among the urban-dwelling older persons were having a formal education, being employed and good self-rated health. While among the rural-dwelling older participants good self-rated health was the only predictor of having a positive attitude to ageing in the psychosocial loss and physical change domains. Conclusion: Older persons residing in urban communities had a better attitude to ageing process compared with their rural older counterparts. The common predictor of positive attitude to ageing in both groups was good self-rated health. This information can be used for the planning of targeted interventions and informing policy formation for improved provisions for community-dwelling older persons in Nigeria and other sub-Saharan African countries

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The complexity of caregiving for community-living older adults with multiple chronic conditions: A qualitative study

Journal of Comorbidity ◽

10.1177/2235042x20981190 ◽

2020 ◽

Vol 10 ◽

pp. 2235042X2098119

Author(s):

Jenny Ploeg ◽

Anna Garnett ◽

Kimberly D Fraser ◽

Lisa Garland Baird ◽

Sharon Kaasalainen ◽

...

Keyword(s):

Older Adults ◽

Qualitative Study ◽

Chronic Conditions ◽

Social Inclusion ◽

Secondary Analysis ◽

Community Support ◽

Care Recipient ◽

Community Living ◽

Multiple Chronic Conditions ◽

Structured Interviews

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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Exploring Indicators of Use of Costly Health Services in Community-Dwelling Adults With Multiple Chronic Conditions

Professional Case Management ◽

10.1097/ncm.0000000000000076 ◽

2015 ◽

Vol 20 (1) ◽

pp. 12-13

Author(s):

&NA;

Keyword(s):

Health Services ◽

Chronic Conditions ◽

Community Dwelling ◽

Multiple Chronic Conditions

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

Alzheimer s & Dementia ◽

10.1002/alz.054751 ◽

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

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CARE OF CHILDREN WITH A CHRONIC CONDITION IN PRIMARY CARE: CHALLENGES TO THE HEALTHCARE MODEL

Texto & Contexto - Enfermagem ◽

10.1590/0104-0707201500003040014 ◽

2015 ◽

Vol 24 (4) ◽

pp. 1009-1017 ◽

Cited By ~ 11

Author(s):

Elysângela Dittz Duarte ◽

Kênia Lara Silva ◽

Tatiana Silva Tavares ◽

Corina Lemos Jamal Nishimoto ◽

Paloma Morais Silva ◽

...

Keyword(s):

Health Care ◽

Primary Health Care ◽

Health Care Professionals ◽

Chronic Conditions ◽

Structured Interviews ◽

Primary Health ◽

Healthcare Model ◽

Belo Horizonte ◽

The City ◽

Children With Chronic Conditions

ABSTRACT This is a qualitative study aiming to analyze the healthcare model for children with chronic conditions in Primary Health Care. The study subjects were nurses, nurse technicians and auxiliary nurses working in 16 basic health units in the city of Belo Horizonte, Minas Gerais. Data were collected through semi-structured interviews and later analyzed from the critical perspective, seeking to identify the common themes in the empirical material. Data revealed how primary health care professionals identified and reached children with chronic conditions, as well as how they presented the care actions performed. However, the development of a model of care for children with chronic conditions in primary health that considers their specific health needs constitutes a challenge.

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ProACT - A Digital Platform to Support Self-Management of Multiple Chronic Conditions: Findings in Relation to Engagement during a one-year Proof-of-Concept Trial (Preprint)

10.2196/preprints.22672 ◽

2020 ◽

Author(s):

Julie Doyle ◽

Emma Murphy ◽

Shane Gavin ◽

Alessandra Pascale ◽

Stephane Deparis ◽

...

Keyword(s):

Older Adults ◽

Chronic Conditions ◽

Digital Health ◽

Self Management ◽

Multiple Chronic Conditions ◽

User Engagement ◽

Proof Of Concept ◽

Structured Interviews ◽

Health Technologies ◽

Care Approach

BACKGROUND Self-management, a core activity for older adults living with multiple chronic conditions (multimorbidity), is challenging, requiring the person to engage in multiple tasks such as symptom monitoring, recognition of exacerbations, medication adherence and inter-stakeholder communication. A digital, integrated care approach is a critical part of the solution, however, there is a dearth of literature on this topic. Furthermore, there is little research on older adults’ acceptability, usage and experiences of engaging with digital health technologies, particularly over long periods of time. OBJECTIVE The objectives were to (1) co-design and develop a digital health platform, called ProACT, to facilitate older adults self-managing multimorbidity, with support from their care network (CN); (2) evaluate end user engagement and experiences with the platform through a 12-month trial. METHODS The ProACT digital health platfrom is presented. The platform was evaluated in a year-long proof-of-concept (PoC) action research trial with 120 older persons with multimorbidity (PwMs) in Ireland and Belgium. Alongside the technology, participants had access to a clinical triage service responding to symptom alerts, and a technical helpdesk. Interactions with the platform during the PoC trial were logged to determine engagement, semi-structured interviews were conducted with participants and analysed using inductive thematic analysis methods, while usability and user burden were examined using validated questionnaires. RESULTS This article presents the ProACT platform and its components, along with findings on engagement with the platform and its usability. Of the 120 participants who took part, 24 withdrew before the end of the study while three passed away. The remaining 93 participants actively used the platform until the end of the trial, on average taking two or three health readings daily over the course of the trial, in Ireland and Belgium respectively. Participants reported ProACT to be usable and of low burden. Findings from interviews outline that participants experienced multiple benefits as a result of using ProACT, including improved self-management, improved health and wellbeing and support from the triage service. For those who withdrew, barriers to engagement were poor health and frustration when technology didn’t work as expected. CONCLUSIONS This is the first study to present findings from a longitudinal study of older adults using digital health technology to self-manage multiple chronic conditions. Our findings show that older adults sustained engagement with the technology and found it usable. Potential reasons for this include a strong focus on user-centred design and engagement throughout the project lifecycle, resulting in a platform that met user needs, as well as the integration of behavior change techniques and personal analytics into the platform. The provision of triage and technical support services alongside the platform during the trial were also important facilitators of engagement. INTERNATIONAL REGISTERED REPORT RR2-10.2196/preprints.22125

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eHealth Technologies, Multimorbidity, and the Office Visit: Qualitative Interview Study on the Perspectives of Physicians and Nurses (Preprint)

10.2196/preprints.8983 ◽

2017 ◽

Author(s):

Graham G Macdonald ◽

Anne F Townsend ◽

Paul Adam ◽

Linda C Li ◽

Sheila Kerr ◽

...

Keyword(s):

Information And Communication Technologies ◽

Health Care Professionals ◽

Chronic Conditions ◽

Health Sector ◽

Office Visit ◽

Best Interests ◽

Multiple Chronic Conditions ◽

Management Support ◽

Web Based ◽

Qualitative Interview Study

BACKGROUND eHealth is a broad term referring to the application of information and communication technologies in the health sector, ranging from health records to telemedicine and multiple forms of health education and digital tools. By providing increased and anytime access to information, opportunities to exchange experiences with others, and self-management support, eHealth has been heralded as transformational. It has created a group of informed, engaged, and empowered patients as partners, equipped to take part in shared decision making and effectively self-manage chronic illness. Less attention has been given to health care professionals’ (HCPs) experiences of the role of eHealth in patient encounters. OBJECTIVE The objective of this study was to examine HCPs’ perspectives on how eHealth affects their relationships with patients living with multiple chronic conditions, as well as its ethical and practical ramifications. METHODS We interviewed HCPs about their experiences with eHealth and its impact on the office visit. Eligible participants needed to report a caseload of ≥25% of patients with multimorbidity to address issues of managing complex chronic conditions and coordination of care. We used a semistructured discussion guide for in-depth interviews, and follow-up interviews served to clarify and expand upon initial discussions. Constant comparisons and a narrative approach guided the analyses, and a relational ethics conceptual lens was applied to the data to identify emergent themes. RESULTS A total of 12 physicians and nurses (6 male, 6 female; median years of practice=13) participated. eHealth tools most frequently described were Web-based educational resources for patients and Web-based resources for HCPs such as curated scientific summaries on diagnostic criteria, clinical therapies, and dosage calculators. Analysis centered on a grand theme of the two-way conversation between HCPs and patients, which addresses a general recentering of the ethical relationship between HCPs and patients around engagement. Subthemes explain the evolution of the two-way conversation, and having, using, and supporting the two-way conversation with patients, primarily as this relates to achieving adherence and health outcomes. CONCLUSIONS Emerging ethical concerns were related to the ambiguity of the ideal of empowered patients and the ways in which health professionals described enacting those ideals in practice, showing how the cultural shift toward truly mutually respectful and collaborative practice is in transition. HCPs aim to act in the best interests of their patients; the challenge is to benefit from emergent technologies that may enhance patient-HCP interactions and effective care, while abiding by regulations, dealing with the strictures of the technology itself, and managing changing demands on their time.

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