Barriers to self-management and quality-of-life outcomes in seniors with multimorbidities
Barriers to self-management and quality-of-life outcomes in seniors with multimorbidities
复制标题
DOI：
10.1370/afm.722
复制
发表时间：
2007-09-01
影响因子：
4.4
通讯作者：
Steiner, John F.
中科院分区：
文献类型：
--
作者：
Bayliss, Elizabeth A.;Ellis, Jennifer L.;Steiner, John F.
目的：患有多种慢性病的人必须整合自我管理任务，以便潜在地相互作用，以达到预期的临床效果。我们的目标是找出自我管理的障碍，这些障碍与自我感觉健康状况较低有关，其次是与患有多发性疾病的老年人报告的身体功能较低有关。方法我们对352名65岁或以上的健康维护组织成员进行了横断面电话调查，这些成员至少同时存在糖尿病、抑郁症和骨关节炎的诊断。验证性问题基于以前的定性访谈，这些访谈为患有多发性疾病的人引出了自我管理过程的潜在障碍。我们使用多元线性回归模型分析了发病率负担、自我管理的潜在障碍和两种结果之间的关系。66%的受访者是女性；55%的受访者年龄在65岁至74岁之间，45%的受访者年龄在75岁或以上。50%的人报告健康状况良好或较差。他们平均患有8.7种慢性病。在多因素分析中，较高的发病率、较低的身体功能水平、较少的医疗知识、较少的社会活动、持续的抑郁症状、较大的经济限制以及男性与较低的健康状况相关。自我管理的潜在障碍与较低的身体功能水平显著相关，包括较高的发病率水平、较大的经济限制、较多的条件复合效应、持续的抑郁症状、较高的患者-临床沟通水平和较低的收入。结论在患有多病的老年人中，除了发病率负担之外，特定的心理社会因素与较低的报告健康状况和较低的身体功能独立相关。许多因素都可以通过干预来改善健康结果。
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.