Self-management in older patients with chronic illness

Chronic illness causes the majority of disease burden and health costs in developed countries; however, this could be substantially reduced by optimal patient self-management. This study examined the levels of self-management in patients (n = 300) with chronic illness (chronic heart failure, chronic respiratory disease, Parkinson's disease and chronic schizophrenia) of moderate severity who had experienced an illness exacerbation in the last month. Patient's perceptions of self-efficacy in relation to their self-management and their sense of coherence were also assessed at baseline and 1 month later. No changes occurred in self-perceptions or self-management from baseline to follow-up. Patients at risk of poor self-management included people with low self-efficacy, poor sense of coherence, older age and a primary diagnosis of chronic schizophrenia. As self-efficacy is the only predictor known to be amenable to intervention, self-efficacy enhancing support should be promoted.     

Urinary incontinence in a community sample of older adults: prevalence and impact on quality of life

Purpose.?To measure the prevalence of urinary incontinence (UI) in a community-dwelling sample and the impact of self-reported UI on well-being and activity in older men and women.

Method.?Participants were older adults aged ≥65 years. Measures included the frequency of urgency incontinence, depression, positive and negative affect and social activity, independence in activities of daily living (IADL) and self-rated health. The data were collected by face to face interview (1994) and computer assisted telephone interviews (1996).

Results.?Of the 796 participants, 28%% experienced urgency incontinence and 21%% reported stress incontinence occasionally or often, with higher rates among women. The threshold for the impact on depression, negative affect and IADL was with occasional occurrence of urinary urgency incontinence. For positive affect and self-rated health, the threshold was experiencing urinary urgency incontinence often. The presence of urinary stress incontinence was associated with depression, IADL dependence, self-rated health and positive affect. Overall, women with incontinence had higher negative affect scores, but men with stress incontinence had higher scores than those without.

Conclusions.?The impact of incontinence highlights the need for more effective management of the condition. The threshold for the effects of urinary urgency incontinence on mental health and functionality is lower than for the effects on general health. There is a need to consider how older people judge the impact of UI in the design of targeted health promotion programmes.     

Self-care ability among home-dwelling older people in rural areas in southern Norway

Scand J Caring Sci; 2012; 26; 113–122
Self‐care ability among home‐dwelling older people in rural areas in southern Norway Introduction: The growing number of older people is assumed to represent many challenges in the future. Self‐care ability is a crucial health resource in older people and may be a decisive factor for older people managing daily life in their own homes. Studies have shown that self‐care ability is closely related to perceived health, sense of coherence and nutritional risk. Aim: The aim of this study was to describe self‐care ability among home‐dwelling older individuals living in rural areas in southern Norway and to relate the results to general living conditions, sense of coherence, screened nutritional state, perceived health, mental health and perceived life situation. Methods: A cross‐sectional survey was carried out in rural areas in five counties in 2010. A mailed questionnaire, containing background variables, health‐related questions and five instruments, was sent to a randomly selected sample of 3017 older people (65+ years), and 1050 respondents were included in the study. Data were analysed with statistical methods. Results: A total of 780 persons were found to have higher self‐care ability and 240 to have lower self‐care ability using the Self‐care Ability Scale for the Elderly. Self‐care ability was found to be closely related to health‐related issues, self‐care agency, sense of coherence, nutritional state and mental health, former profession, and type of dwelling. Predictors for high self‐care ability were to have higher self‐care agency, not receiving family help, having low risk for undernutrition, not perceiving helplessness, being able to prepare food, being active and having lower age. Conclusions: When self‐care ability is reduced in older people, caregivers have to be aware about how this can be expressed and also be aware of their responsibility for identifying and mapping needs for appropriate support and help, and preventing unnecessary and unwanted dependency.     

Living with chronic heart failure: a review of qualitative studies of older people

Title. Living with chronic heart failure: a review of qualitative studies of older people Aim. This paper is a report of a systematic review of qualitative studies of how older people live with chronic heart failure. Background. Chronic heart failure is a global epidemic mainly affecting an ageing population. Understanding how older people live with this disease is important to help promote their adjustment to the distressing illness experience. Data sources. Eligible studies published in 1997–2007 were identified from several databases (Medline, CINAHL, PsycINFO and Sociological Abstracts). A manual search was conducted of bibliographies of the identified studies and relevant journals. Review methods. Two researchers independently reviewed the studies and extracted the data. Key concepts from the papers were compared for similarities and differences. The transactional model of stress was used to guide data synthesis. Findings. Fourteen qualitative studies were identified. Most described the illness experiences of older people with chronic heart failure and associated coping strategies. There was some emerging work exploring the adjustment process. The findings indicated that living with chronic heart failure was characterized by distressing symptoms, compromised physical functioning, feelings of powerlessness and hopelessness, and social and role dysfunction. There were gender differences in the way the disease was conceived. Adjustment required patients to make sense of the illness experience, accept the prognosis, and get on with living with the condition. Conclusion. Empowering older people to manage chronic heart failure, instilling hope and bolstering support system are means of promoting successful adjustment to the disease. Further research needs to explore the cultural differences in the adjustment process.     

Older people living with chronic illness

This study aimed to gain a better understanding of what it is like for older people to live with chronic illness. A Phenomenological method was used. A purposive sampling strategy was used to recruit older people with chronic illness from one community in Nakhonratchasima province, Thailand. Semi-structured interview guides were used to explore the participants' experiences and perceptions. Data saturation was reached after 30 interviews were completed. The data was analyzed using thematic analysis. Four themes emerged from the data: 1) living a restricted life, 2) feeling overwhelmed, 3) understanding and accepting loss, and 4) being kind to oneself and learning to live with the disease. The findings may increase understanding about what older people with chronic illness experience. Health care providers can use this understanding to relate health care and guidance to their patients by incorporating cultural influences and religious/spiritual beliefs into the standardized care for this population.     

Disaster preparedness among vulnerable older adults with chronic diseases: Results from a cross‐sectional study in Incheon,Korea

About 80% of older adults have at least one chronic condition that makes them more vulnerable than healthy people during a disaster. This study examined the association of general health status and chronic disease status, respectively, with disaster preparedness among vulnerable older adults with chronic diseases. The 165 participants (100 females, 65 male) comprising the study population were taking a health course for chronic disease management at a public health center in Incheon, Korea from March to April 2012. A relatively small percentage of households had a complete set of disaster preparedness supplies, an emergency evacuation plan, and a three‐day supply of medications. Respondents with multiple chronic diseases were generally more likely to have a three‐day supply of medications in comparison with their healthier counterparts. To improve preparedness among vulnerable older adults, a “bottom up” assessment of directly canvassing the views of older people is necessary and should be transferred into practical conditions of disaster preparedness.     

Living with persistent pain: experiences of older people receiving home care

BACKGROUND: Although the topic of pain among older people has received increasing interest, little is still known about how pain is experienced or handled by those who no longer manage independently but depend on professionals for help with daily living. Developing pain management for older people requires such knowledge. AIM: To explore sense of self, sense of pain, daily living with pain, sense of others and ways of handling pain in older people with persistent pain. METHODS: Interviews with 90 older people receiving home care from nursing auxiliaries in their own homes or in sheltered accommodation were collected from January to June 2000. A typology of older people in persistent pain was developed. Activities for handling pain were examined using content analysis. FINDINGS: Respondents' experiences of themselves and their pain varied. Two groups of older people, considered as 'competent and proud' and 'confident and serene', expressed satisfaction in spite of pain, while the groups 'misunderstood and disappointed' and 'resigned and sad' expressed dissatisfaction. The most common strategies used were medication, rest, mobility, distracting activities and talking about pain. Respondents chose strategies by balancing the advantages of the activities against the disadvantages these brought for their daily living. CONCLUSION: This study indicates that characteristics of the older people, such as their way of experiencing themselves, how pain affects their daily life and how they perceive effects and side-effects of pain management are areas that need to be identified when staff assess pain and plan pain management. Caring for older people in pain could be improved by listening to and believing their complaints, evaluating effects and side-effects from medications and nonpharmacological pain management and by emphasising the importance of common everyday activities such as mobility and distraction to relieve pain.     

Models of mental health care for older adults: a review of the literature

Aim.  This paper reviews literature that draws on models of mental health care for older adults.
Background.  It is predicted that as a consequence of the aging of the population the incidence of mental health disorders, common in older populations, will also rise. Many such disorders can be successfully managed if detected early. Assessment and management requires collaboration between health professionals who are skilled and educated in the management of older adults with mental illness and the use of models of care appropriate to this population.
Results.  The paucity of research in this area is demonstrated.
Conclusion.  The need for mental health nurses to challenge current models of mental health care for older adults is identified so that they take on an expanded and developed specialist role in care of older adults with mental illness.     

Mental health and functional mental disorder in older adults

The available literature on mental health and older people tends to focus on dementia rather than functional illness, despite the greater prevalence of the latter. This review analyses articles published on mental health in nursing journals and considers their content. The author suggests that those working with older adults need to hear more about the experiences of those who suffer with mental health problems.     

Chronic illness self-management: locating the 'self'

AIM: In this paper, we present the findings of a recent research project in which we explored self- management with older people who were diagnosed with asthma. BACKGROUND: Asthma self-management literature has focused on the need for the patient to 'adhere' to prescribed therapies, in particular the taking of medications, monitoring of respiratory function or recognizing and avoiding triggers. METHOD: Data were generated during a period of 9 months from three sources; in-depth interviews with 24 older participants, an open-ended questionnaire and two mixed-gender participatory action research groups. FINDINGS: Based on current literature, our previous research findings which have 'unpacked' what is 'self'-management, and data generated in this project, we propose that three asthma management models are in operation: Medical Model of Self-management, Collaborative Model of Self-management and Self-Agency Model of Self-management. Locating the 'self' in self-management means acknowledging that many people living with a chronic condition are already self-determining and their expertise should be acknowledged as such. CONCLUSION: Health care professionals can best facilitate people toward self-agency by embracing new understandings of self-management in long-term illness. This process is enhanced when the expertise a person brings to the management of their condition is given the respect it deserves. There needs to be a focus on providing people with the means to grow and learn in a participative relationship that cannot be fully realized with 'off the shelf' self-management solutions.     

The self-management experience of people with mild to moderate chronic kidney disease.

This qualitative, exploratory study examined the self-management experiences of people with mild to moderate chronic kidney disease (CKD, Stages 1-3) to elicit participants' perceptions of health, kidney disease, and supports needed for self-management. Findings revealed a process of renegotiating life with chronic kidney disease, which encompassed Discovering Kidney Disease and Learning To Live With Kidney Disease. A number of themes were identified including searching for evidence, realizing kidney disease is forever, managing the illness, taking care of the self and the need for disease-specific information. The findings indicate participants with early CKD want to self-manage their illness in collaboration with health care providers. As well, people with early CKD need guidance and support from health professionals to successfully self-manage. Nephrology nurses are uniquely positioned to provide this support while collaborating with other care providers to facilitate self-management.     

Achieving self-management goals among low income older adults with functional limitations

Although self-management interventions can improve symptoms and disease among older adults, there is a dearth of literature on how self-management behaviors may improve factors related to the older adults’ physical function. To fill this gap in the literature, we describe the patient-directed self-management goals in nursing visits that relate to physical function as part of a multi-component program. We analyze the self-management goals and outcomes of 367 low- income older adults with functional limitations who participated in the CAPABLE program: a program to reduce the health effects of impaired physical function in low-income older adults. We focus on the following self-management goals that participants chose with the nurses: pain management, depressive symptoms, incontinence, fall prevention, and communication with healthcare providers. The majority of participants chose pain (50%) or fall prevention (51%) as goals and partially or fully met their goals. Improvements across these areas may lead to improved physical function.     

Back to the beginning: Perceptions of older Singaporean couples living alone

Singapore has an aging population that is projected to increase by 32% in 2100. The majority of older couples live alone. “Aging in Place” is an initiative that is widely promoted by the government, in which older people are supported to live in their own homes. In this qualitative study, we explored the perceptions of older people living with their spouse in Singapore. Fifteen community‐dwelling older participants were interviewed. Four themes emerged from the thematic analysis: (i) maintaining health and mobility; (2) maintaining relationships with spouse; (iii) maintaining relationship with others; and (iv) living the last leg of the race. The older people living on their own were generally content about maintaining their interdependence and complementary roles. Insights gathered from this study have relevance to implementation of the Aging‐in‐Place policy to ensure that older people receive the support they need to maintain their physical and psychosocial well‐being while living on their own.     

Treatment adherence of youth and young adults with and without a chronic illness

The present study was undertaken to explore the psychosocial functioning of young people with chronic illness, their beliefs about treatment adherence, difficulties with adherence and concerns about living with their illness. A small correlational study was undertaken to compare the psychosocial functioning of young people, with and without chronic illness, aged between 12 and 24 years. Subjects were recruited from a metropolitan teaching hospital. Group 1 included 44 young people with chronic illness; Group 2 included 41 young people without chronic illness. Both groups were divided on the basis of age: younger (12-18 years, n = 24); older (19-24 years, n = 61) and sex (female = 43; male = 42). Subjects completed the Achenbach self-report questionnaire as a measure of psychosocial functioning, and a second questionnaire constructed for this study to explore treatment adherence. Psychosocial functioning scores were found to be similar on the majority of subscales. Young women with chronic illness were, however, found to have significantly higher internalizing scores than young women without chronic illness. A significant negative relationship was found for the chronic illness group between internalizing scores and treatment adherence. The findings highlight potential areas of difficulty in psychosocial functioning of some young people with chronic illness. They also suggest the existence of a subgroup of young people with chronic illness who experience more problems than their peers. More research is needed to generate evidence about this possible subgroup to determine predictors of psychosocial functioning and test the timing and efficacy of psychosocial interventions.     

Identification and characteristics of older homeless African American women

More older African American women are homeless, with this issue receiving little research attention. An exploratory study examined demographics and health characteristics of 100 women. Their mean age was 52.55 years (SD = 3.57) and ranged from 50 to 74 years. Most were unmarried, homeless more than three months, reported more than two diagnoses, and self-rated their health as fair or good. Length of time homeless did not significantly influence self-reported health. Medical diagnoses increased with time homeless, and rates of some chronic diseases were higher than domiciled African American elders 60 years of age and over Nearly half (48.5%) of women who were homeless more than 12 months reported emotional/mental illness.     

Hardiness, self-care practices and perceived health status in older adults

The purpose of this study was to examine the relationship among hardiness, self-care practices and perceived health status in older adults A random sample of older adults ( n = 72) was selected from the population of a small north-eastern town in the United States Self-report data were obtained on the Health-Related Hardiness Scale as a measure of hardness, the Personal Lifestyle Questionnaire as a measure of self-care practices and the Visual Analogue Scale as a measure of perceived health status It was hypothesized that older adults who had higher levels of hardness and self-care practices would have a higher perceived health status and that hardness and self-care practices combined would explain more of the variance in perceived health status than either variable taken individually Statistical analyses supported the three hypotheses The obtained significant correlation between hardness and perceived health status was –068( P <0 001) (hardiness negatively scored) For self-care practices and perceived health status, the correlation was 0 46 ( P < 0 001) The illness index, income and living circumstance accounted for 46% of the variance in perceived health status scores Hardness and self-care practices accounted for an additional 10% of the variance in perceived health status once these demographic and illness variables were controlled Implications for nursing practice, education and research are discussed Recommendations included replication of the study with a larger, more heterogeneous population Suggestions for further investigation of the relationship between resistance resources such as hardness and self-care practices and health status are presented     

Effects of self-management support programmes on activities of daily living of older adults: A systematic review

BackgroundThe ability of older adults to carry out activities of daily living and to adapt and to manage their own life decreases due to deterioration of their physical and cognitive condition. Nurses and other health care professionals should support the self-management ability of older adults to prevent activities of daily living dependence and increase the ability to adapt and to self-manage the consequences of living with a chronic condition.ObjectiveTo gain insight into the evidence of the effects of self-management support programmes on the activities of daily living of older adults living at home.DesignA systematic literature review of original research publications.Data sourcesSearches were performed in PubMed, CINAHL, PsychInfo, EMBASE and the Cochrane Central Register of Controlled Trials (in February 2016). No limitations were applied regarding date of publication, language or country.Review methodsPublications were eligible for this review on condition that they described a self-management support programme directed at adults of on average 65 years or older, and living in the community; used a randomized control group design; and presented information about the effects on activities of daily living. The methodological quality of the included studies was independently assessed by the authors using the quality criteria for reviews of the Cochrane Effective Practice and Organisation of Care Review Group. A best evidence synthesis was performed using guidelines provided by the Cochrane Collaboration Back Review Group.ResultsA total of 6246 potentially relevant references were found. After screening the references, 12 studies with a randomized controlled trial design were included. The methodological assessment of the 12 studies indicated variations in the risk of bias from low (n = 1) to unclear (n = 3) and high (n = 8). Although there was considerable variation in study population, intervention characteristics and measurement instruments used, most studies (n = 11) showed effects of self-management support programmes on the activities of daily living of older adults.ConclusionsThere is a moderate level of evidence that self-management support programmes with a multi-component structure, containing disease-specific information, education of knowledge and skills and, in particular, individually tailored coaching, improve the activities of daily living of older adults.Further research is required to gain insight into the most appropriate context and approach of self-management support interventions targeting activities of daily living of older adults living in the community.     

Protocol for a randomised controlled trial of chronic disease self-management support for older Australians with multiple chronic diseases

The prevalence of older Australians with multiple chronic diseases is increasing and now accounts for a large proportion of total health care utilisation. Chronic disease self-management support (CDSMS) has become a core service component of many community based health programs because it is considered a useful tool in improving population health outcomes and reducing the financial burden of chronic disease care. However, the evidence base to justify these support programs is limited, particularly for older people with multiple chronic diseases. We describe an ongoing trial examining the effectiveness of a particular CDSMS approach called the Flinders Program. The Flinders Program is a clinician-led generic self-management intervention that provides a set of tools and a structured process that enables health workers and patients to collaboratively assess self-management behaviours, identify problems, set goals, and develop individual care plans covering key self-care, medical, psychosocial and carer issues. A sample of 252 older Australians that have two or more chronic conditions will be randomly assigned to receive either CDSMS or an attention control intervention (health information only) for 6 months. Outcomes will be assessed using self-reported health measures taken at baseline and post-intervention. This project will be the first comprehensive evaluation of CDSMS in this population. Findings are expected to guide consumers, clinicians and policymakers in the use of CDSMS, as well as facilitate prioritisation of public monies towards evidence-based services.     

Depressive symptomatology among Turkish older adults with low incomes in a rural community sample

Aims and objectives. To identify the characteristics that are associated with depressive symptomatology among Turkish older adults with low income. Background. Depression is a major threat to mental health in older people, but little is known about older adults with low income at risk for depressive symptomatology in Turkey. Design. This was a cross‐sectional study, based in one area of Istanbul. Methods. The sample included 132 older adults in a rural setting living in Istanbul, Turkey. The participants were 55 years of age or older and chosen from among older adults with low income. Data were collected through a structured interview conducted in the homes of the participants. Results. High depressive symptoms (Geriatric Depression Scale ≥11) were reported by 50% of the participants. Compared with non‐depressed individuals, those with depressive symptomatology were more likely to be women, widowed, lack health insurance and to live alone. Depressed participants significantly more often reported chronic health conditions compared to non‐depressed participants (OR = 4·11, 95% CI = 1·35, 12·57). Overall well‐being scores were significantly higher in men and in the non‐depressed group. The result of the Pearson correlation provided support for the association between depression scores and overall well‐being scores (r = ?0·60). Conclusions. Depressive symptomatology is prevalent within Turkish older adults with low income. Further research is needed to examine potential risk factors associated with depressive symptomatology for this population. Relevance to clinical practice. Findings may assist health care professionals in assessing high‐risk older people who could benefit from interventions aimed at minimizing depressive symptoms.