Abstract
Chronic illness affects >50% of adults in the United States and accounts for >80% of healthcare spending. The purpose of this study was to determine whether beliefs about one’s chronic disease (illness representation) are associated with self-care activation, emergency department (ED) visits, or hospitalizations. Using a cross-sectional design, we recruited older adults with heart failure, chronic obstructive pulmonary disease (COPD), and chronic kidney disease. The Revised Illness Perception Questionnaire (IPQ-R) measured perceptions about disease. The Patient Activation Measure measured self-care activation. ED visits and hospitalizations were measured by self-report. IPQ-R scores were analyzed using latent profile analysis to identify subgroups. Participants included 187 adults (mean age 65 years, 54% female, 74% Black). We found three subgroups (stable, overwhelmed, and confident). Groups did not differ demographically or by disease. The stable group (few consequences, non-fluctuating pattern) had the fewest hospitalizations. The overwhelmed group (many consequences, fluctuating pattern, high negative emotion) had high hospitalizations and low self-care ability. The confident group (high disease control, well-understood) had the highest self-care ability, but also high hospitalizations. ED visits did not differ by group. We found three subgroups that differ in their illness representation and health outcomes. Findings suggest that assessing patients’ illness representations may have important implications for subgroup-specific interventions.
Highlights
Chronic disease is one of the most significant health care concerns in the United States
To select which disease populations we would use for this study, we consulted a list of 20 chronic conditions created by the Department of Health and
Five of the participants had a sufficient amount of missing data that not all the Illness Perception Questionnaire (IPQ-R) scale scores could be calculated; they were excluded from analysis
Summary
Chronic disease is one of the most significant health care concerns in the United States. 50% of adults have at least one chronic disease, and among adults aged 65 and older, the rate is above 90% [1,2]. Chronic diseases are a substantial source of morbidity and mortality, accounting for. 70% of deaths and more than 80% of all health care spending [3]. 80% of all inpatient hospital stays are attributed to chronic conditions, and per-person inpatient spending increases with the number of chronic conditions [2]. These trends are expected to increase over time [2]
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