Research

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9 pages, 199 KiB

Open AccessArticle

The Role of Age and Multimorbidity in Shaping Older African American Men’s Experiences with Patient–Provider Communication

by Ramona G. Perry, Jamie A. Mitchell, Jaclynn Hawkins and Vicki Johnson-Lawrence

Geriatrics 2018, 3(4), 74; https://doi.org/10.3390/geriatrics3040074 - 24 Oct 2018

Cited by 8 | Viewed by 5416

Abstract

This study investigated factors associated with older African American men’s unmet health communication needs in the context of patient–provider interactions. Responses to a health survey were analyzed for 430 African American men attending a Midwest community health fair. The outcome measure was the [...] Read more.

This study investigated factors associated with older African American men’s unmet health communication needs in the context of patient–provider interactions. Responses to a health survey were analyzed for 430 African American men attending a Midwest community health fair. The outcome measure was the extent to which men could get their health-related questions answered during recent medical visits. Men’s mean age was 54; 39% had one chronic condition and 22% had two or more comorbidities. The 53% who usually or always had their questions answered were older, had less comorbidity, higher educational attainment, higher annual incomes, were more likely to be married and have any type of insurance, and have a personal physician. Access to care was the primary factor in shaping men’s opportunities to ask health-related questions, and older multimorbid and low-income African American men may face increased barriers to healthcare access, and thus barriers to patient-centered care and communication. Full article

(This article belongs to the Special Issue Chronic Disease Self-Management in Older Adult Populations)

14 pages, 244 KiB

Open AccessFeature PaperArticle

Investigating the Enduring Impact of a Community-Based Health Education Program to Promote African American Elders’ Use of Technology Designed to Support Chronic Disease Self-Management

by Charles R. Senteio

Geriatrics 2018, 3(4), 70; https://doi.org/10.3390/geriatrics3040070 - 13 Oct 2018

Cited by 9 | Viewed by 6891

Abstract

Elders experience chronic disease disparities and barriers to access technology designed to support recommended self-management behaviors. Elders from racial minority groups are among those who experience particular disparities in chronic disease incidence, outcomes, and barriers to technology use. In order to investigate strategies [...] Read more.

Elders experience chronic disease disparities and barriers to access technology designed to support recommended self-management behaviors. Elders from racial minority groups are among those who experience particular disparities in chronic disease incidence, outcomes, and barriers to technology use. In order to investigate strategies to address barriers, the study team recruited elder African Americans with diabetes and young adults connected to the elders through naturally occurring familial or social networks. Participants attended a community-based health education session focused on enhancing self-efficacy for recommended self-management and using consumer-oriented technology accessible on their smartphones for self-management support. To assess enduring impact, the study team conducted a pilot study to investigate perceptions and use one month following the health education session. Both elders and young adults offered perspectives on what was effective in teaching elders how to use technology. Both age groups stressed that having patience was crucial, as is providing encouragement for the elders to try tasks on their own. Both elders and young adults also showed a statistically significant increase in aspirations to work together for additional intergenerational health and technology knowledge exchange. Several elder participants continued using technology that they first used during the session. This novel, pilot study describes how to promote self-management and technology use for individuals plagued by persistent chronic disease and technology use disparities. Full article

(This article belongs to the Special Issue Chronic Disease Self-Management in Older Adult Populations)

16 pages, 216 KiB

Open AccessArticle

The Situated Influence of Chronic Pain Perception on Chinese Older Adults’ Self-Management in Home Care

by Fang Liu and Min Tong

Geriatrics 2018, 3(4), 64; https://doi.org/10.3390/geriatrics3040064 - 28 Sep 2018

Cited by 5 | Viewed by 4691

Abstract

Background and objective: Worldwide, 26 million older adults die from chronic disease, and chronic pain is typically a part of the experience of chronic disease. This study explores the perception of chronic pain for home-dwelling Chinese older adults and its influence on (1) [...] Read more.

Background and objective: Worldwide, 26 million older adults die from chronic disease, and chronic pain is typically a part of the experience of chronic disease. This study explores the perception of chronic pain for home-dwelling Chinese older adults and its influence on (1) self-management ability and (2) management and reduction of chronic pain. Methods: Adopting a qualitative study design, we conducted in-depth interviews with 10 Chinese community-dwelling older adults who experience chronic pain. Half of our informants perceive chronic pain, whereas the other half, diagnosed with Alzheimer’s disease, do not report that they perceive chronic pain. Data were analyzed with inductive thematic analysis. Results: Chronic pain perception plays important roles in (1) defining the challenge of self-management, (2) connecting previous caretaking experience, (3) adjusting the identity of self-management, (4) acquiring support from important others and (5) re-planning self-management arrangements. Conclusion: Pain perception helps to motivate Chinese older adults to face health challenges and regain self-management capacity through adjustments in self-identity and care experience with the support of important others. Pain perception can consolidate the situation of independent living of older adults. It helps to motivate Chinese older adults to face health challenges and regain self-management capacity. Full article

(This article belongs to the Special Issue Chronic Disease Self-Management in Older Adult Populations)

13 pages, 568 KiB

Open AccessArticle

Effectiveness of a Community Health Worker-Led Diabetes Intervention among Older and Younger Latino Participants: Results from a Randomized Controlled Trial

by Barbara Mendez Campos, Edith C. Kieffer, Brandy Sinco, Gloria Palmisano, Michael S. Spencer and Gretchen A. Piatt

Geriatrics 2018, 3(3), 47; https://doi.org/10.3390/geriatrics3030047 - 02 Aug 2018

Cited by 13 | Viewed by 6067

Abstract

Diabetes management for older Latino adults is complex, given a higher incidence of multiple coexisting medical conditions and psychosocial barriers to self-management. Community health workers (CHWs) may be effective in reducing these barriers. The REACH Detroit CHW randomized controlled intervention studies with Latino/as [...] Read more.

Diabetes management for older Latino adults is complex, given a higher incidence of multiple coexisting medical conditions and psychosocial barriers to self-management. Community health workers (CHWs) may be effective in reducing these barriers. The REACH Detroit CHW randomized controlled intervention studies with Latino/as with diabetes found improvements in self-management behaviors and glucose control after participating in a CHW-led intervention. Using data from the REACH Detroit Partnership′s cohort 3, this study used descriptive statistics and multiple linear regression analyses to evaluate whether the six-month CHW intervention had a greater effect on older Latino/as (ages 55 and older) than younger participants between baseline and post-intervention follow-up at six months. There were significant intervention effects by age group that varied by outcome. Compared to a control group that received enhanced usual care, there were statistically significant intervention effects demonstrating greater self-efficacy scores 1.27 (0.23, 2.32); p < 0.05, and reductions in HbA1c 1.02 (−1.96, −0.07); p < 0.05, among older participants in the CHW intervention, and increases in diabetes support 0.74 (0.34, 1.13); p < 0.001; and understanding of diabetes management 0.39 (0.08, 0.70); p < 0.01 among younger participants. Full article

(This article belongs to the Special Issue Chronic Disease Self-Management in Older Adult Populations)

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14 pages, 492 KiB

Open AccessArticle

Illness Representation and Self-Care Ability in Older Adults with Chronic Disease

by Eleanor Rivera, Colleen Corte, Alana Steffen, Holli A. DeVon, Eileen G. Collins and Pamela J. McCabe

Geriatrics 2018, 3(3), 45; https://doi.org/10.3390/geriatrics3030045 - 31 Jul 2018

Cited by 19 | Viewed by 7278

Abstract

Chronic illness affects >50% of adults in the United States and accounts for >80% of healthcare spending. The purpose of this study was to determine whether beliefs about one’s chronic disease (illness representation) are associated with self-care activation, emergency department (ED) visits, or [...] Read more.

Chronic illness affects >50% of adults in the United States and accounts for >80% of healthcare spending. The purpose of this study was to determine whether beliefs about one’s chronic disease (illness representation) are associated with self-care activation, emergency department (ED) visits, or hospitalizations. Using a cross-sectional design, we recruited older adults with heart failure, chronic obstructive pulmonary disease (COPD), and chronic kidney disease. The Revised Illness Perception Questionnaire (IPQ-R) measured perceptions about disease. The Patient Activation Measure measured self-care activation. ED visits and hospitalizations were measured by self-report. IPQ-R scores were analyzed using latent profile analysis to identify subgroups. Participants included 187 adults (mean age 65 years, 54% female, 74% Black). We found three subgroups (stable, overwhelmed, and confident). Groups did not differ demographically or by disease. The stable group (few consequences, non-fluctuating pattern) had the fewest hospitalizations. The overwhelmed group (many consequences, fluctuating pattern, high negative emotion) had high hospitalizations and low self-care ability. The confident group (high disease control, well-understood) had the highest self-care ability, but also high hospitalizations. ED visits did not differ by group. We found three subgroups that differ in their illness representation and health outcomes. Findings suggest that assessing patients’ illness representations may have important implications for subgroup-specific interventions. Full article

(This article belongs to the Special Issue Chronic Disease Self-Management in Older Adult Populations)

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10 pages, 802 KiB

Open AccessArticle

Older African American Men’s Perspectives on Factors That Influence Type 2 Diabetes Self-Management and Peer-Led Interventions

by Jaclynn Hawkins, Jamie Mitchell, Gretchen Piatt and Deborah Ellis

Geriatrics 2018, 3(3), 38; https://doi.org/10.3390/geriatrics3030038 - 06 Jul 2018

Cited by 7 | Viewed by 5598

Abstract

Older African American men are at increased risk of Type 2 Diabetes (T2D) but demonstrate high rates of poor illness management. They also participate in interventions targeting illness management at extremely low rates and are at high risk for dropout from clinical trials. [...] Read more.

Older African American men are at increased risk of Type 2 Diabetes (T2D) but demonstrate high rates of poor illness management. They also participate in interventions targeting illness management at extremely low rates and are at high risk for dropout from clinical trials. One modifiable factor that has been identified in the literature that contributes to these disparities is health beliefs particular to men. Yet, despite the fact that illness management interventions have been developed to meet the needs of African Americans, none have followed recommendations to use gender-sensitive programming to meet the needs of men. The primary aim of this study was to advance our understanding of the intersection of age, race/ethnicity and gender on T2D self-management among older African American men, and to explore their preferences for a peer-led T2D self-management intervention. Two focus groups were conducted with older African American men (n = 12) over a 6-month period. Sessions lasted 90 min, were audiotaped, and analyzed using thematic content analysis techniques. The most prominent themes included: (a) the influence of gendered values and beliefs on health behavior; (b) quantity and quality of patient-provider communication; (c) social and structural barriers to T2D self-management; and (d) preferences for peer-led T2D self-management interventions. Results suggest that these themes may be particularly salient for T2D self-management in older African American men, and that this population may be receptive to a peer-led T2D self-management intervention. Full article

(This article belongs to the Special Issue Chronic Disease Self-Management in Older Adult Populations)

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12 pages, 213 KiB

Open AccessArticle

Organizational Readiness to Implement the Chronic Disease Self-Management Program in Dialysis Facilities

by Tiffany R. Washington, Tandrea S. Hilliard, Chivon A. Mingo, Rasheeda K. Hall, Matthew Lee Smith and Janice I. Lea

Geriatrics 2018, 3(2), 31; https://doi.org/10.3390/geriatrics3020031 - 14 Jun 2018

Cited by 4 | Viewed by 5403

Abstract

A gap exists between the development and uptake of evidence-based health promotion programs in health care settings. One reason for this gap is lack of attention to organizational readiness. The objective of this study was to assess organizational readiness to implement the Chronic [...] Read more.

A gap exists between the development and uptake of evidence-based health promotion programs in health care settings. One reason for this gap is lack of attention to organizational readiness. The objective of this study was to assess organizational readiness to implement the Chronic Disease Self-Management Program in dialysis facilities. Survey data were collected from dialysis staff using a semi-structured Organizational Readiness for Implementing Change questionnaire. Change efficacy and change commitment scale ratings were all above 3.0, indicating a moderate level of readiness among staff. Profession and level of education were significantly associated with mean change efficacy scale ratings. Textual data revealed benefits to patients, implementation barriers and facilitators, and the influence of facility environment and culture. The findings of the current study suggest that additional efforts to advance the implementation of evidence-based health promotion programs in dialysis facilities are needed. Full article

(This article belongs to the Special Issue Chronic Disease Self-Management in Older Adult Populations)

Review

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14 pages, 269 KiB

Open AccessReview

Chronic Kidney Disease and Older African American Adults: How Embodiment Influences Self-Management

by Tyrone C. Hamler, Vivian J. Miller and Sonya Petrakovitz

Geriatrics 2018, 3(3), 52; https://doi.org/10.3390/geriatrics3030052 - 16 Aug 2018

Cited by 9 | Viewed by 6398

Abstract

Patients living with chronic kidney disease (CKD) must balance the medical management of their kidney disease and other chronic conditions with their daily lives, including managing the emotional and psychosocial consequences of living with a chronic disease. Self-management is critical to managing chronic [...] Read more.

Patients living with chronic kidney disease (CKD) must balance the medical management of their kidney disease and other chronic conditions with their daily lives, including managing the emotional and psychosocial consequences of living with a chronic disease. Self-management is critical to managing chronic kidney disease, as treatment consists of a complex regimen of medications, dosages, and treatments. This is a particularly important issue for older African American adults who will comprise a significant portion of the older adult population in the coming years. Yet current conceptualizations of self-management behaviors cannot adequately address the needs of this population. Embodiment theory provides a novel perspective that considers how social factors and experiences are embodied within decision-making processes regarding self-management care among older African Americans. This paper will explore how embodiment theory can aid in shifting the conceptualization of self-management from a model of individual choice, to a framework that cannot separate lived experiences of social, political, and racial factors from clinical understandings of self-management behaviors. This shift in the conceptualization of self-management is particularly important to consider for CKD management because the profound illness burdens require significant self-management and care coordination skills. Full article

(This article belongs to the Special Issue Chronic Disease Self-Management in Older Adult Populations)

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