School of Nursing, Aging, Community and Health Research Unit, McMaster University, Hamilton, Ontario, Canada.
School of Nursing, Universita degli Studi di Milano-Bicocca, Milano, Lombardia, Italy.
BMJ Open. 2019 Mar 20;9(3):e023345. doi: 10.1136/bmjopen-2018-023345.
OBJECTIVES: The aim of the study was to understand the experiences of living with multiple chronic conditions (MCC) from the perspective of community-living older adults with MCC. DESIGN: A qualitative study using an interpretive description approach. SETTING: Participants were recruited from southern Ontario, Canada. PARTICIPANTS: 21 community-living, older adults (≥65 years) with an average of 7.4 chronic conditions including one of diabetes, dementia or stroke. METHODS: Data were collected through digitally-recorded, in-depth, semi-structured in-person interviews. Interview transcripts were analysed and coded using Thorne's interpretive description approach. RESULTS: Five themes were identified representing older adults' experiences of living with MCC: (a) trying to stay healthy while living with MCC, (b) depending on family caregivers for support with just about everything, (c) paying the high costs of living with MCC, (d) making healthcare decisions by proxy and (e) receiving healthcare services that do not address the complex needs of persons living with MCC. CONCLUSIONS: The experience of living with MCC in the community was complex and multi-faceted. The need for a person-centred and family-centred approach to care in the community, which includes the coordination of health and social services that are tailored to the needs of older adults and their informal caregivers, was underscored. Such an approach would facilitate improved information-sharing and discussion of care management options between health professionals and their patients, enable older adults with MCC to actively engage in priority-setting and decision-making and may result in improved health and quality of life for older adults with MCC.
目的:本研究旨在从患有多种慢性疾病(MCC)的社区居住老年患者的角度了解其患病体验。
设计:采用解释性描述方法的定性研究。
地点:参与者招募自加拿大安大略省南部。
参与者:21 名患有多种慢性疾病(≥65 岁)的社区居住老年患者,平均患有 7.4 种慢性疾病,其中包括糖尿病、痴呆症或中风中的一种。
方法:通过数字记录、深入的半结构化面对面访谈收集数据。使用 Thorne 的解释性描述方法对访谈记录进行分析和编码。
结果:确定了代表老年患者患有 MCC 后的体验的五个主题:(a)在患有 MCC 的同时努力保持健康,(b)在几乎所有事情上都依赖家庭护理者的支持,(c)承担 MCC 的高昂生活费用,(d)通过代理人做出医疗保健决策,(e)接受无法满足患有 MCC 的患者的复杂需求的医疗保健服务。
结论:在社区中患有 MCC 的体验是复杂和多方面的。强调需要采取以患者和家庭为中心的社区护理方法,包括协调针对老年患者及其非正式护理者的需求定制的卫生和社会服务。这种方法将促进卫生专业人员与其患者之间更好地共享信息和讨论护理管理方案,使患有 MCC 的老年患者能够积极参与优先事项的设定和决策,并可能改善患有 MCC 的老年患者的健康和生活质量。
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