Giulia Andrea Baldan, Irene Dello Iacono, Valentina Giurissevich, Davide Ausili, Ercole Vellone, Maddalena De Maria, Maria Matarese
{"title":"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","authors":"Giulia Andrea Baldan, Irene Dello Iacono, Valentina Giurissevich, Davide Ausili, Ercole Vellone, Maddalena De Maria, Maria Matarese","doi":"10.1111/jan.70246","DOIUrl":null,"url":null,"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 (<jats:italic>n</jats:italic> = 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.","PeriodicalId":54897,"journal":{"name":"Journal of Advanced Nursing","volume":"18 1","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Older Adults' Self‐Care and Family Caregiver Contribution in Multiple Chronic Conditions: A Dyadic Qualitative Study\",\"authors\":\"Giulia Andrea Baldan, Irene Dello Iacono, Valentina Giurissevich, Davide Ausili, Ercole Vellone, Maddalena De Maria, Maria Matarese\",\"doi\":\"10.1111/jan.70246\",\"DOIUrl\":null,\"url\":null,\"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 (<jats:italic>n</jats:italic> = 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.\",\"PeriodicalId\":54897,\"journal\":{\"name\":\"Journal of Advanced Nursing\",\"volume\":\"18 1\",\"pages\":\"\"},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2025-10-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Advanced Nursing\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/jan.70246\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"NURSING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Advanced Nursing","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/jan.70246","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NURSING","Score":null,"Total":0}
Older Adults' Self‐Care and Family Caregiver Contribution in Multiple Chronic Conditions: A Dyadic Qualitative Study
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.
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.