Barriers to Self-Management and Quality-of-Life Outcomes in Seniors With Multimorbidities

Abstract

PURPOSE Persons with multiple chronic diseases must integrate self-management tasks for potentially interacting conditions to attain desired clinical outcomes. Our goal was to identify barriers to self-management that were associated with lower perceived health status and, secondarily, with lower reported physical functioning for a population of seniors with multimorbidities. METHODSWe conducted a cross-sectional telephone survey of 352 health maintenance organization members aged 65 years or older with, at a minimum, coexisting diagnoses of diabetes, depression, and osteoarthritis. Validated questions were based on previous qualitative interviews that had elicited potential barriers to the self-management process for persons with multimorbidities. We analyzed associations between morbidity burden, potential barriers to self-management, and the 2 outcomes using multivariate linear regression modeling. RESULTSOur response rate was 47%. Sixty-six percent of respondents were female; 55% were aged 65 to 74 years, and 45% were aged 75 years or older. Fifty percent reported fair or poor health. On average they had 8.7 chronic diseases. In multivariate analysis, higher level of morbidity, lower level of physical functioning, less knowledge about medical conditions, less social activity, persistent depressive symptoms, greater fi nancial constraints, and male sex were associated with lower perceived health status. Potential barriers to self-management signifi cantly associated with lower levels of physical functioning were higher level of morbidity, greater fi nancial constraints, greater number of compound effects of conditions, persistent depressive symptoms, higher level of patient-clinician communication, and lower income.CONCLUSIONS In addition to morbidity burden, specifi c psychosocial factors are independently associated with lower reported health status and lower reported physical functioning in seniors with multimorbidities. Many factors are amenable to intervention to improve health outcomes. INTRODUCTIONO ptimal health outcomes for persons with chronic diseases depend heavily on medical self-management. [1][2][3][4][5] This process is complex for persons with multimorbidities who must integrate self-management tasks for coexisting and often interacting diseases. Improvements in medical self-management processes correlate with improved health outcomes in studies of single diseases and studies of populations with a variety of chronic illnesses.3,6-8 Conversely, barriers to medical self-management negatively affect disease-specifi c outcomes, mortality, and quality of life.9-11 Identifying barriers is a fi rst step in collaborating with patients to improve medical self-management.Previous investigations of barriers to medical self-management have been 396SENIOR S' BA R R IER S TO SEL F -M A NAGEMENT largely disease specifi c. [12][13][14][15][16][17] Barriers reported in these investigations have included inadequate social support, diffi culties with time management, troubled emotional state, low self...

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