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. 2007 Sep-Oct;5(5):395-402.
doi: 10.1370/afm.722.

Barriers to self-management and quality-of-life outcomes in seniors with multimorbidities

Elizabeth A Bayliss  1 , Jennifer L Ellis, John F Steiner
Affiliations

Barriers to self-management and quality-of-life outcomes in seniors with multimorbidities

Elizabeth A Bayliss et al. Ann Fam Med. 2007 Sep-Oct.

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.

Methods: We 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.

Results: Our 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 financial constraints, and male sex were associated with lower perceived health status. Potential barriers to self-management significantly associated with lower levels of physical functioning were higher level of morbidity, greater financial 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, specific 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.

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Figures

Figure 1.
Figure 1.
How barriers may affect health outcomes.
See this image and copyright information in PMC

References

    1. Essential Elements of Self-Management Interventions. The Robert Wood Johnson Foundations, The Center for the Advancement of the Health; 2004.
    1. Clark NM. Management of chronic disease by patients. Annu Rev Public Health. 2003;24:289–313. - PubMed
    1. Lorig KR, Sobel DS, Ritter PL, Laurent D, Hobbs M. Effect of a self-management program on patients with chronic disease. Eff Clin Pract. 2001;4(6):256–262. - PubMed
    1. Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff (Millwood). 2001;20(6):64–78. - PubMed
    1. Glasgow RE, Funnell MM, Bonomi AE, Davis C, Beckham V, Wagner EH. Self-management aspects of the improving chronic illness care breakthrough series: implementation with diabetes and heart failure teams. Ann Behav Med. 2002;24(2):80–87. - PubMed

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