Time's up. descriptive epidemiology of multi-morbidity and time spent on health related activity by older Australians: a time use survey.

Tanisha Jowsey,Marjan Kljakovic,Rebecca Phillips,Laurann Yen,Ian S Mcrae,Lesley Jones,James Gillespie,Jose M Valderas,Paul Dugdale,Michelle Banfield,Robin Bunton

doi:10.1371/journal.pone.0059379

Abstract

Most Western health systems remain single illness orientated despite the growing prevalence of multi-morbidity. Identifying how much time people with multiple chronic conditions spend managing their health will help policy makers and health service providers make decisions about areas of patient need for support. This article presents findings from an Australian study concerning the time spent on health related activity by older adults (aged 50 years and over), most of whom had multiple chronic conditions. A recall questionnaire was developed, piloted, and adjusted. Sampling was undertaken through three bodies; the Lung Foundation Australia (COPD sub-sample), National Diabetes Services Scheme (Diabetes sub-sample) and National Seniors Australia (Seniors sub-sample). Questionnaires were mailed out during 2011 to 10,600 older adults living in Australia. 2540 survey responses were received and analysed. Descriptive analyses were completed to obtain median values for the hours spent on each activity per month. The mean number of chronic conditions was 3.7 in the COPD sub-sample, 3.4 in the Diabetes sub-sample and 2.0 in the NSA sub-sample. The study identified a clear trend of increased time use associated with increased number of chronic conditions. Median monthly time use was 5–16 hours per month overall for our three sub-samples. For respondents in the top decile with five or more chronic conditions the median time use was equivalent to two to three hours per day, and if exercise is included in the calculations, respondents spent from between five and eight hours per day: an amount similar to full-time work. Multi-morbidity imposes considerable time burdens on patients. Ageing is associated with increasing rates of multi-morbidity. Many older adults are facing high demands on their time to manage their health in the face of decreasing energy and mobility. Their time use must be considered in health service delivery and health system reform.

Highlights

Research on multi-morbidity has shown an increase in its prevalence over the last decade in Australia and elsewhere [2,3,4]
There is a gap in our knowledge of how people with multimorbid chronic conditions use time when undertaking health related activity (HRA)
Large surveys such as the American and Australian time use surveys provide limited detail about the time people spend on HRA

Summary

Introduction

Research on multi-morbidity (defined as the presence of two or more chronic conditions in an individual [1]) has shown an increase in its prevalence over the last decade in Australia and elsewhere [2,3,4]. There is a gap in our knowledge of how people with multimorbid chronic conditions (multi-morbidity hereafter) use time when undertaking health related activity (HRA). Drawing on the American Time Use Survey, he estimates that in 2007, Americans spent an average of 1.1 hours each week obtaining healthcare. This time, he argues, is an unseen cost in health care [15,16,17]. Other studies have measured the use of time as an unseen cost in health care [15,16,17] Large surveys such as the American and Australian time use surveys provide limited detail about the time people spend on HRA.

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Conclusion