Self-Care of Older Patients Affected by at Least Two Chronic Conditions Between Heart Failure, Diabetes Mellitus and Chronic Obstructive Pulmonary Disease: A Comparative Study.

Abstract

Aims: This study aims to describe disease-specific self-care behaviours in patients with heart failure (HF), diabetes mellitus (DM) and chronic obstructive pulmonary disease (COPD) in various combinations; to compare these self-care behaviours within patient groups; and to evaluate differences across these groups.

Design: Cross-sectional study.

Methods: A total sample of 1079 older patients was recruited from outpatient clinics and home settings. Eligible patients were aged ≥ 65 years and had a diagnosis of HF and/or DM, and/or COPD, along with at least one additional chronic condition. Data were collected using validated tools: the Self-Care of Heart Failure Index, Self-Care of Diabetes Inventory and Self-Care of Chronic Obstructive Pulmonary Disease Inventory. Descriptive statistics were used to analyse disease-specific self-care behaviours. Group comparisons were performed using Student's t-test and univariate, followed by multivariate analyses of variance.

Results: The analysis focused on a subset of 223 patients who had a combination of at least two chronic conditions between HF, DM and/or COPD. The mean age of participants was 77.3 (SD 7.5) years, with a majority being female (53.4%). Self-care maintenance, monitoring and management for HF and COPD were found to be inadequate across all patient groups. Adequate self-care was only observed in DM management among those with HF and DM and in DM maintenance for those with DM and COPD treated with insulin. Significant differences in all self-care dimensions were observed across groups, particularly in patients managing all three conditions (HF, DM and COPD).

Conclusions: The findings provide valuable insights into the complexities of self-care in patients with multiple chronic conditions, underscoring the need for tailored, integrated and patient-centred interventions. Healthcare strategies should focus on enhancing patient education and developing personalised approaches to improve health outcomes and quality of life in this population.

Reporting method: All the authors have adhered to the EQUATOR guidelines STROBE Statement.

Patient or public contribution: A convenience sample of patients was recruited in outpatient clinics and their homes. Data were collected between March 2017 and August 2022, by face-to-face during routine outpatient visits or directly at the patient's home.