Perceived challenges and priorities in co‐morbidity management of older patients with Type 2 diabetes

Abstract

Aims To explore older patients’ perceived impact of chronic co-morbid conditions on Type 2 diabetes self-management. Methods We used purposive sampling to select 32 mentally alert community-dwelling adults, aged 60 years or older, diagnosed with Type 2 diabetes and at least one other chronic health condition to participate in focus groups. We summarized the discussions following each focus group and identified codes to describe the overarching themes. Results We conducted eight 90-min focus groups, each consisting of two to six patients. Three themes emerged. (i) Diabetes complications as a motivator: managing co-morbid conditions made health an important focal point in the lives of older patients. Most patients acknowledged the positive effect complications had on their diabetes self-management by motivating them to pay greater attention to their diabetes to diminish the progression of these complications. (ii) Prioritizing health conditions: patients reported prioritizing health conditions and selectively attending to the management of those conditions based on perceived severity or importance. Further, many patients perceived some conditions as more serious than others and admitted to prioritizing another health condition over their diabetes. (iii) Emotional impact of co-morbidity management: patients described feeling frustrated, confused, and overwhelmed in response to conflicting treatment recommendations, particularly for diet, physical activity and medication regimens. Conclusions Complications and co-morbidities may have differential impacts on the diabetes self-management of older patients. Addressing the perceived impact of co-morbidity on diabetes self-management may improve patients’ outcomes; however, the most effective method of utilizing this information in clinical practice needs to be examined.

Digging Deeper: The Role of Qualitative Research in Behavioral Diabetes

“…In these qualitative studies, patients described a limited capacity to manage their multiple health conditions due to a diminished ability to recognize signs and symptoms of an exacerbating condition, difficulty managing complex medication regimens, and confusion resulting from conflicting self-care treatment recommendations [66][67][68]. Further, these studies found patients frequently prioritized the management of one health condition over another.…”

“…Several studies have explored the impact of multiple diabetes complications and comorbidities on patients' selfcare and quality of life [66][67][68]. In these qualitative studies, patients described a limited capacity to manage their multiple health conditions due to a diminished ability to recognize signs and symptoms of an exacerbating condition, difficulty managing complex medication regimens, and confusion resulting from conflicting self-care treatment recommendations [66][67][68].…”

Is Australian primary care practice equipped to provide multimorbidity care?

“…Multimorbidity, "the most common chronic condition experienced by adults", places significant demands on individuals, clinicians and the health system (25). Individuals must navigate an illness trajectory complicated by processes of adaption and re-adaption linked to each subsequent diagnosis (135,182,194 Research investigating the experience of managing multiple chronic conditions has grown in prominence in recent years, as an increasing number of largely qualitative studies have examined the challenges people face (133,135,(195)(196)(197)(198) Treatment burden arises from the need to learn about treatments, attend medical appointments, undergo tests or examinations, and adhere to complex medication and self-care regimens (95,199,201,202). For those managing multiple chronic conditions these demands are amplified in the face of unwanted complications and complexity (73,95,202,203).…”

“…Looking to simplify the complexity of managing multiple chronic conditions and the resulting treatment burdens, patients must frequently prioritise conditions, goals, medications and/or outcomes (28,73,93,133,135,189,196,206,(217)(218)(219)(220)(221)(222)(223).…”

“…A critical challenge to emerge from the multimorbidity literature is the need to acknowledge and incorporate patient preferences for care, particularly in relation to determining treatment and management priorities (28,73,93,133,135,189,196,(217)(218)(219)(220)(221)(222)(223). Individuals with multiple conditions are tasked with managing complex treatment regimens, complicated by conflicting conditions, medications, treatments and outcomes (201).…”