Older Adults' Self‐Care and Family Caregiver Contribution in Multiple Chronic Conditions: A Dyadic Qualitative Study

IF 3.4 3区 医学 Q1 NURSING
Giulia Andrea Baldan, Irene Dello Iacono, Valentina Giurissevich, Davide Ausili, Ercole Vellone, Maddalena De Maria, Maria Matarese
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引用次数: 0

Abstract

AimsTo explore how older adult‐family caregiver dyads jointly manage multiple chronic conditions. Specifically, it investigates how dyads (i) prioritise chronic diseases, (ii) make and negotiate decisions related to self‐care and (iii) define and distribute self‐care tasks and caregiver contributions.DesignA qualitative descriptive study using dyadic data collection and analysis.MethodsSemi‐structured interviews were conducted separately with chronically ill older adults and their family caregivers between July and December 2024. A hybrid inductive‐deductive content analysis was applied. Dyadic analysis compared intra‐dyad perspectives to identify patterns of agreement and disagreement.ResultsThirty‐four dyads (n = 68 participants) were interviewed. Older adults had a mean age of 80.09 years (SD = 6.95) and were affected by a median of four chronic conditions. Family caregivers had a mean age of 51.71 years (SD = 14.59), with most being the older adults' children (66.67%) and women (82.35%). Five categories, comprising 25 subcategories, were derived from the data. Disease prioritisation varied within dyads: older adults often focused on conditions with the most disabling symptoms, while caregivers emphasised those with higher risks of complication. Decision‐making roles ranged from older adult‐led to caregiver‐led to shared. Care organisation followed three models: collaborative, older adult‐directed, or caregiver‐directed. Challenges in managing diseases included treatment adherence, care coordination, emotional burden and addressing multiple symptoms simultaneously. Role distribution in disease management and decision‐making was complex and occasionally misaligned, sometimes resulting in conflict. Collaborative dyads reported greater adaptability and balance, while incongruent dyads experienced relational and organisational strain.ConclusionManaging multiple chronic conditions in older adults is a relational process shaped by interpersonal dynamics and shared responsibilities with family caregivers. Recognising dyadic relational patterns is essential for designing targeted educational interventions. Nurses should incorporate dyadic assessments into routine care to improve outcomes for older adults and reduce caregiver burden.Implications for the Profession and/or Patient CareThis study highlights the importance of viewing chronic disease management as a dyadic process, rather than an individual task, involving both the older adult and the family caregiver. Tailored strategies that account for the relational dynamics within dyads, such as decision‐making roles and care task distribution, are essential for effective chronic disease management.Reporting MethodConsolidated criteria for reporting qualitative studies (COREQ).Patient or Public ContributionNone.
老年人自我照顾和家庭照顾对多种慢性疾病的贡献:一项二元定性研究
目的探讨老年人-家庭照顾者如何共同管理多种慢性疾病。具体来说,它调查了二人组如何(i)优先考虑慢性疾病,(ii)制定和协商与自我保健有关的决策,以及(iii)定义和分配自我保健任务和照顾者的贡献。设计使用二元数据收集和分析的定性描述性研究。方法于2024年7月至12月对慢性疾病老年人及其家庭照顾者进行半结构化访谈。采用混合归纳-演绎含量分析。二元分析比较了内部二元视角,以确定一致和不一致的模式。结果共采访了34对夫妇(n = 68名参与者)。老年人的平均年龄为80.09岁(SD = 6.95),受四种慢性疾病的中位数影响。家庭照顾者平均年龄为51.71岁(SD = 14.59),以老年人子女(66.67%)和女性(82.35%)居多。从数据中得出五个类别,包括25个小类别。两代人对疾病的优先顺序各不相同:老年人通常关注具有最严重致残症状的疾病,而护理人员则强调那些并发症风险较高的疾病。决策角色从老年人主导到照顾者主导再到共同主导。护理组织遵循三种模式:协作、老年人指导或护理人员指导。疾病管理方面的挑战包括治疗依从性、护理协调、情绪负担和同时处理多种症状。疾病管理和决策中的角色分配是复杂的,有时会错位,有时会导致冲突。合作型二人组表现出更强的适应性和平衡性,而不协调型二人组则经历了关系和组织压力。结论老年人多重慢性疾病的管理是一个由人际动态和与家庭照顾者共同承担责任形成的关系过程。识别二元关系模式对于设计有针对性的教育干预措施至关重要。护士应将二元评估纳入日常护理,以改善老年人的预后,减轻护理人员的负担。对专业和/或患者护理的启示本研究强调了将慢性疾病管理视为一个二元过程的重要性,而不是一个涉及老年人和家庭护理者的个人任务。量身定制的策略,考虑到二联体内部的关系动态,如决策角色和护理任务分配,对于有效的慢性疾病管理至关重要。报告方法定性研究报告的综合标准(COREQ)。患者或公众贡献无。
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来源期刊
CiteScore
6.40
自引率
7.90%
发文量
369
审稿时长
3 months
期刊介绍: The Journal of Advanced Nursing (JAN) contributes to the advancement of evidence-based nursing, midwifery and healthcare by disseminating high quality research and scholarship of contemporary relevance and with potential to advance knowledge for practice, education, management or policy. All JAN papers are required to have a sound scientific, evidential, theoretical or philosophical base and to be critical, questioning and scholarly in approach. As an international journal, JAN promotes diversity of research and scholarship in terms of culture, paradigm and healthcare context. For JAN’s worldwide readership, authors are expected to make clear the wider international relevance of their work and to demonstrate sensitivity to cultural considerations and differences.
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