Abstract
BackgroundThe prevalence of multiple chronic conditions (MCC) among older persons is increasing worldwide and is associated with poor health status and high rates of healthcare utilization and costs. Current health and social services are not addressing the complex needs of this group or their family caregivers. A better understanding of the experience of MCC from multiple perspectives is needed to improve the approach to care for this vulnerable group. However, the experience of MCC has not been explored with a broad sample of community-living older adults, family caregivers and healthcare providers. The purpose of this study was to explore the experience of managing MCC in the community from the perspectives of older adults with MCC, family caregivers and healthcare providers working in a variety of settings.MethodsUsing Thorne’s interpretive description approach, semi-structured interviews (n = 130) were conducted in two Canadian provinces with 41 community-living older adults (aged 65 years and older) with three or more chronic conditions, 47 family caregivers (aged 18 years and older), and 42 healthcare providers working in various community settings. Healthcare providers represented various disciplines and settings. Interview transcripts were analyzed using Thorne’s interpretive description approach.ResultsParticipants described the experience of managing MCC as: (a) overwhelming, draining and complicated, (b) organizing pills and appointments, (c) being split into pieces, (d) doing what the doctor says, (e) relying on family and friends, and (f) having difficulty getting outside help. These themes resonated with the emotional impact of MCC for all three groups of participants and the heavy reliance on family caregivers to support care in the home.ConclusionsThe experience of managing MCC in the community was one of high complexity, where there was a large gap between the needs of older adults and caregivers and the ability of health and social care systems to meet those needs. Healthcare for MCC was experienced as piecemeal and fragmented with little focus on the person and family as a whole. These findings provide a foundation for the design of care processes to more optimally address the needs-service gap that is integral to the experience of managing MCC.
Highlights
The prevalence of multiple chronic conditions (MCC) among older persons is increasing worldwide and is associated with poor health status and high rates of healthcare utilization and costs
Healthcare providers (n = 42) were largely female (95.2%), educated at the Bachelor’s level (40.5%), and represented a variety of professional backgrounds, the most common being Registered Nurse (28.6%), Registered/Licensed Practical Nurse (16.7%) and Personal Support Worker/Healthcare Aide (14.3%) (Table 6)
This study provides a valuable understanding of the concept of need in the AHRQ MCCRN model [8]
Summary
The prevalence of multiple chronic conditions (MCC) among older persons is increasing worldwide and is associated with poor health status and high rates of healthcare utilization and costs. The experience of MCC has not been explored with a broad sample of communityliving older adults, family caregivers and healthcare providers. The prevalence of multiple chronic conditions (MCC), defined as having two or more chronic conditions, has increased worldwide over the past two decades [1, 2]. An important product of this work was the development of a conceptual model of the role of complexity in the care of persons with MCC [8] In this model, complexity is defined as the gap between an individual’s needs and the capacity of healthcare services to meet those needs [8]. This ecological model takes a holistic view of complexity, recognizing the influence of social support (e.g., family and other sources) as well as contextual factors (e.g., economic, social and physical) on the interaction between MCC-related needs and services
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