Over two-thirds of older individuals live with multiple chronic conditions, yet chronic diseases are often studied in silos. Taking a lifespan approach to understanding the development of multiple chronic conditions in the older population helps to further elucidate opportunities for targeted interventions that address the complexities of multiple chronic conditions.
Methods
Semi-structured interviews were conducted with 38 older adults (age 64+) diagnosed with at least two chronic health conditions. Content analysis was used to build understanding of how older adults discuss the timing of diagnoses and subsequent self-management of multiple chronic conditions.
Results
Findings highlight the complex process by which illnesses unfold in the context of individuals’ lives and the subsequent engagement and/or disengagement in self-management behaviors. Two primary themes were evident regarding timing of illnesses: illnesses were experienced within the context of social life events and/or health events, and illnesses were not predominantly seen as connected to one another by patients. Self-management behaviors were described in response to onset of each illness.
Discussion
Findings provide insight into how older adults understand their experience of multiple chronic conditions and change in self-management behaviors over time. In order for practitioners to ignite behavioral changes, a person’s history and life experiences must be considered.
WardBSchillerJ.Prevalence of multiple chronic conditions among US adults: estimates from the National Health Interview Survey. Prev Chronic Dis. 2010;
10: E65.
6.
HughesLMcmurdoMGuthrieB.Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to people with multimorbidity. Age Ageing2012;
42: 62–69.
7.
The Institute of Medicine. Living well with chronic illness: a call for public health action. 2012.
Washington, DC:
The National Academies Press.
8.
HeyworthIHazellMLinehanM. et al.
How do common chronic conditions affect health-related quality of life?Br J Gen Pract2009;
59: 353–358.
9.
SaarniSSuvisaariJSintonenH. et al.
The health-related quality-of-life impact of chronic conditions varied with age in general population. J Clin Epidem2007;
60: 1288–1297.
10.
LaditkaJLaditkaS.Associations of multiple chronic health conditions with active life expectancy in the United States. Disabil Rehabil2016;
38: 354–361.
11.
HungerMThorandBSchunkM. et al.
Multimorbidity and health-related quality of life in the older population: results from the German KORA-Age study. Health Qual Life Outcomes2011;
9: 53.
12.
McDaidOHanlyMRichardsonK. et al.
The effect of multiple chronic conditions on self-rated health, disability and quality of life among the older populations of Northern Ireland and the Republic of Ireland: a comparison of two nationally representative cross-sectional surveys. BMJ Open2013;
3: e002571.
13.
RalphNMielenzTPartonH. et al.
Multiple chronic conditions and limitations in activities of daily living in a community-based sample of older adults in New York City, 2009. Prev Chronic Dis2013;
10: e130159.
14.
HeldFBlythFGnjidicD. et al.
Association rules analysis of comorbidity and multimorbidity: The Concord Health and Aging in Men Project. J Gerontol A Biol Sci Med Sci2016;
71: 625–631.
15.
VosRvan den AkkerMBoestenJ. et al.
Trajectories of multimorbidity: exploring patterns of multimorbidity in patients with more than ten chronic health problems in life course. BMC Fam Pract2015;
16: 2.
16.
Wilson-GendersonMHeidAPruchnoR.Onset of multiple chronic conditions and depressive symptoms: a life events perspective. Innovat Aging2017;
1: 1–10.
17.
WisterACoattaKSchuurmanN. et al.
A lifecourse model of multimorbidity resilience: theoretical and research developments. Int J Aging Hum Dev2016;
82: 290–313.
18.
BoydCLucasG.Patient-centered care for people living with multimorbidity. Curr Opin HIV AIDS2014;
9: 419–427.
19.
RobertoKGigliottiCHusserE.Older women’s experiences with multiple health conditions: daily challenges and care practices. Health Care WomenInt2005;
26: 672–692.
20.
SellsDSledgeWWielandM. et al.
Cascading crises, resilience and social support within the onset and development of multiple chronic conditions. Chronic Illn2009;
5: 92–102.
21.
WillettWKoplanJNugentR, et al. Prevention of chronic disease by means of diet and lifestyle changes. In: Jamison DT, Breman JG, Measham AR, et al. (eds) Disease control priorities in developing countries. 2nd ed. Chapter 44. Washington, DC: World Bank, 2006, http://www.ncbi.nlm.nih.gov/books/NBK11795/
22.
GoedeckeJMicklesfieldL.The effect of exercise on obesity, body fat distribution and risk for type 2 diabetes. Med Sport Sci2014;
60: 82–93.
23.
HaskelW.Cardiovascular disease prevention and lifestyle interventions: effectiveness and efficacy. J Cardiovasc Nurs2003;
18: 245–255.
24.
KroghJNordentoftMSterneJ. et al.
The effect of exercise in clinically depressed adults: systematic review and meta-analysis.J Clin Psychiatry2011;
72: 529–538.
25.
U.S.Department of health and human services. Multiple chronic conditions—a strategic framework: Optimum health and quality of life for individuals with multiple chronic conditions.
Washington, DC: US Department of Healht and Human Services. 2010.
26.
PorterTSandersTRichardsonJ. et al.
Living with multimorbidity: medical and lay healthcare approaches. Int J Clin Rheumatol2015;
10: 111–119.
27.
TaylorAPriceJGillT. et al.
Multimorbidity – not just an older person’s issue: results from an Australian biomedical study. BMC Public Health2010;
10: 718.
28.
LiddyCBlazkhoVMillK.Challenges of self-management when living with multiple chronic conditions. Can Fam Phys2014;
60: 1123–1133.
29.
BoeckxstaensPDe SutterAVaesB. et al.
Should we keep on measuring multimorbidity?J Clin Epidemiol2016;
71: 113–114.
30.
BowerPHarknessEMacdonaldW. et al.
Illness representations in patients with multimorbid long-term conditions: qualitative study. Psychol Health2012;
27: 1211–1226.
31.
FixGCohnESolomonJ. et al.
The role of comorbidities in patients’ hypertension self-management. Chronic Illn2014;
10: 81–92.
32.
McSharryJBishopFMoss-MorrisR. et al.
The chicken and egg thing’: cognitive representations and self-management of multimorbidity in people with diabetes and depression. Psychol Health2013;
28: 103–119.
33.
GraneheimULundmanB.Qualitative content analysis in nursing research: concepts, procedures and measure to achieve trustworthiness. Nurse Educ Today2004;
24: 105–112.
34.
GlaserB.The constant comparative method of qualitative analysis. Social Probl1965;
12: 436–445.
35.
MarksL.A pragmatic, step-by-step guide for qualitative methods: capturing the disaster and long-term recovery stories of Katrina and Rita. Curr Psychol2015;
34: 494–505.
36.
BoydCKentD.Evidence-based medicine and the hard problem of multimorbidity. J Gen Intern Med2014;
29: 553–553.
37.
LeventhalHPhillipsLBurnsE.Modelling management of chronic illness in everyday life: a common-sense approach. Psychol Topics2016;
25: 1–18.
38.
ShawSHuebnerCArminJ. et al.
The role of culture in health literacy and chronic disease screening and management. J Immigr Minor Health2009;
11: 460–467.
39.
GallantM.The influence of social support on chronic illness self-management: a review and directions for research. Health Educ Behav2003;
30: 170–195.
40.
PruchnoRWilson-GendersonMHeidA.Multiple chronic conditions and depression in community dwelling older adults. J Gerontol A Biol Sci Med Sci2016;
71: 910–915.
41.
BoydCFortinM.Future of multimorbidty research: how should understanding of multimorbidity inform health system design?Public Health Rev2010;
33: 451–474.
42.
BoydCBoultCShadmiE. et al.
Guided care for multimorbid older adults. Gerontologist2007;
47: 697–704.
43.
RubakSSanboekALouritzenT. et al.
Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract2005;
55: 305–312.
