scholarly journals Rewards and Challenges in Caring for Older Adults with Multiple Chronic Conditions: Perspectives of Seniors’ Mental Health Case Managers

2018 ◽  
Vol 37 (1) ◽  
pp. 65-79 ◽  
Author(s):  
Andrew Perrella ◽  
Carrie McAiney ◽  
Jenny Ploeg
Author(s):  
Hankyung Jun ◽  
Emma Aguila

Older adults with multiple chronic conditions have a higher risk than those without multiple conditions of developing a mental health condition. Individuals with both physical and mental conditions face many substantial burdens. Many such individuals also belong to racial and ethnic minority groups. Private insurance coverage can reduce the risks of developing mental illnesses by increasing healthcare utilization and reducing psychological stress related to financial hardship. This study examines the association between private insurance and mental health (i.e., depressive symptoms and cognitive impairment) among older adults in the United States with multiple chronic conditions by race and ethnicity. We apply a multivariate logistic model with individual fixed-effects to 12 waves of the Health and Retirement Study. Among adults with multiple chronic conditions in late middle age nearing entry to Medicare and of all racial and ethnic groups, those without private insurance have a stronger probability of having depressive symptoms. Private insurance and Medicare can mediate the risk of cognitive impairment among non-Hispanic Whites with multiple chronic conditions and among Blacks regardless of the number of chronic conditions. Our study has implications for policies aiming to reduce disparities among individuals coping with multiple chronic conditions.


2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 827-827
Author(s):  
Jaime Hughes ◽  
Susan Hughes ◽  
Mina Raj ◽  
Janet Bettger

Abstract Behavior change is an inherent aspect of routine geriatric care. However, most research and clinical programs emphasis how to initiate behavior change with less emphasis placed on skills and strategies to maintain behaviors over time, including after an intervention has concluded. This presentation will provide an introduction to the symposium, including a review of prior work and our rationale for studying the critical yet overlooked construct of maintenance in older adults. Several key considerations in our work include the impact of multiple chronic conditions, declines in cognitive and functional capacity over time, changes in environmental context and/or social support, and sustainability of community and population-level programs and services.


2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S317-S318
Author(s):  
Jenny Ploeg ◽  
Marie-Lee Yous ◽  
Kimberly Fraser ◽  
Sinéad Dufour ◽  
Sharon Kaasalainen ◽  
...  

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.


2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Anita M Souza ◽  
Jenny Hsin-Chin Tsai ◽  
Kenneth C Pike ◽  
Francesca Martin ◽  
Susan M McCurry

Abstract Background and Objectives Formerly homeless older adults residing in Permanent Supportive Housing (PSH) represent an invisible subsector of two distinct, yet related populations: the homeless population and the elderly population. Little research is focused on the complex health concerns facing this aging population within the homelessness response system. Of particular concern is the identification and support of individuals with cognitive impairment and co-occurring chronic conditions. We collaborated with a leading housing services provider to develop a systematic screening system for case managers to capture the cognitive, physical, and psychosocial health of older adults served within homeless housing programs. Research Design and Methods PSH residents aged ≥50 years in four sites screened as being without cognitive impairment on the Mini-Cog were enrolled. A brief demographic survey and selected PROMIS measures were used to characterize participants’ demographics, cognition, global physical and mental health, physical functioning, self-efficacy for social interactions, and instrumental support. PSH case managers were trained to recruit participants and collect data. PROMIS scales were scored using the Health Measures Scoring Service. Descriptive statistics, correlations, and one sample t-tests were performed. Results Fifty-three residents (mean age = 60.8 years, range 50–76 years) participated. The majority self-identified as male and were military veterans; 60% reported having a history of two or more episodes of homelessness. All PROMIS scores were significantly (p < .05) lower than reference U.S. population means, with global mental health and cognition having the lowest scores. Discussion and Implications Self-reported cognitive functioning and global mental health were residents’ greatest concerns. Strengthening housing case manager capacity to assess residents’ cognitive and health status could increase support for older adults in PSH. It is feasible to train PSH staff to conduct structured interviews to identify resident cognitive and health needs to help support this “invisible” population to successfully age in place.


BMJ ◽  
2015 ◽  
pp. h4984 ◽  
Author(s):  
Mary E Tinetti ◽  
Gail McAvay ◽  
Mark Trentalange ◽  
Andrew B Cohen ◽  
Heather G Allore

2020 ◽  
Vol 10 ◽  
pp. 2235042X2098119
Author(s):  
Jenny Ploeg ◽  
Anna Garnett ◽  
Kimberly D Fraser ◽  
Lisa Garland Baird ◽  
Sharon Kaasalainen ◽  
...  

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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