Abstract
ABSTRACTThis study investigated the perceived value of informal and formal supports for older adults with multi-morbidity from the perspectives of patients, care-givers and family physicians. Semi-structured interviews were conducted with 27 patients, their informal care-givers and their family physicians in an urban academic family health team in Ontario. Analysis was conducted using a General Inductive Approach to facilitate identification of main themes and build a framework of perceived value of supports. Participant views converged on supports that facilitate patient independence and ease care-giver burden. However, important differences in participant perceptions arose regarding these priorities. Physicians and care-givers valued supports that facilitate health and safety while patients prioritised supports that enable self-efficacy and independence. While formal supports which eased care-giver burden were viewed positively by all members of the triad, many patients also rejected formal supports, citing that informal support from their care-giver was available. Such conflicts between patient, care-giver and physician-perceived value of supports may have important implications for consumer and care-giver willingness to accept formal supports when supports are available. These findings contribute to the broader literature on community-based care by incorporating the perspectives of patients, informal care-givers and family physicians to understand better the barriers and facilitators of uptake of supportive services that contribute to successful ageing at home.
Highlights
Global patterns of mortality and disease prevalence have shifted significantly from infectious diseases to chronic conditions with chronic diseases accounting for per cent of global mortality in recent years (World Health Organization ; Yach et al )
Multiple chronic conditions increase significantly with age and older adults with multiple chronic conditions are frequent users of health care and incur great health-care costs (Fortin et al ; Glynn et al ; König et al ; Lehnert et al ; Ward and Schiller ). This trend is apparent in the primary care setting where the prevalence of adult patients with multi-morbidity is higher than patients with isolated diseases (Fortin et al ; Rizza et al )
The interview guide was adapted from an instrument developed by the Bridgepoint Collaboratory for Research and Innovation and modified to include questions on care experiences, social support and the perceived value of different types of support, goals of care and frustrations experienced while managing multi-morbidity
Summary
Global patterns of mortality and disease prevalence have shifted significantly from infectious diseases to chronic conditions with chronic diseases accounting for per cent of global mortality in recent years (World Health Organization ; Yach et al ). Multiple chronic conditions increase significantly with age and older adults with multiple chronic conditions are frequent users of health care and incur great health-care costs (Fortin et al ; Glynn et al ; König et al ; Lehnert et al ; Ward and Schiller ). This trend is apparent in the primary care setting where the prevalence of adult patients with multi-morbidity is higher than patients with isolated diseases (Fortin et al ; Rizza et al ). This study distinguishes between formal (paid) support and informal (unpaid) support, and includes both in this analysis
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