Ruggiano Nicole, Shtompel Natalia, Edvardsson David
School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami.
Austin Health Clinical School of Nursing, La Trobe University, Melbourne, Australia. Department of Nursing, University of Umeå, Sweden.
Gerontologist. 2015 Dec;55(6):1015-25. doi: 10.1093/geront/gnt208. Epub 2014 Jan 28.
There is little consensus on the definition and design of effective care coordination for older adults with chronic conditions, and the majority of care coordination models minimize the role and voice of older patients. Our objectives are to examine how older adults perceive and engage in the process of care coordination of health and disability support services and the factors that influence their engagement.
Thirty-seven older adults with chronic conditions and 9 geriatric case managers participated in semistructured interviews that focused on older adults' experiences with self-managing and coordinating their health and support services. Interview data were systematically analyzed for themes.
The interview data revealed that involving older adults in care coordination is a complex, multistage process, conceptualized as making self-health assessments, making informed decisions about care, and executing and coordinating care. The findings indicate that a number of factors facilitate older adults' decision and capacity to become involved in the coordination of their care, including their perceptions about how their condition impacted their everyday lives, and availability of intrinsic resources, tangible resources, and social network. Low perceptions of control over health and lack of such resources constrain their involvement.
Practitioners may facilitate older adults' involvement in care coordination by using language with older patients that emphasizes psychosocial experiences in addition to medical symptomatology. They may also provide targeted support for patients with limited facilitating factors to promote involvement at multiple stages of the care coordination process.
对于患有慢性病的老年人有效护理协调的定义和设计，目前几乎没有共识，并且大多数护理协调模式都将老年患者的作用和声音最小化。我们的目标是研究老年人如何看待健康与残疾支持服务的护理协调过程并参与其中，以及影响他们参与的因素。
37名患有慢性病的老年人和9名老年病例管理人员参与了半结构化访谈，访谈重点是老年人自我管理和协调其健康及支持服务的经历。对访谈数据进行系统分析以找出主题。
访谈数据显示，让老年人参与护理协调是一个复杂的多阶段过程，可概念化为进行自我健康评估、对护理做出明智决策以及执行和协调护理。研究结果表明，一些因素促进了老年人参与护理协调的决策和能力，包括他们对自身状况如何影响日常生活的认知，以及内在资源、有形资源和社会网络的可用性。对健康控制感低以及缺乏此类资源会限制他们的参与。
从业者可以通过与老年患者使用强调心理社会经历以及医学症状的语言，来促进老年人参与护理协调。他们还可以为促进因素有限的患者提供有针对性的支持，以促进其在护理协调过程的多个阶段的参与。
