Chronic Illness Self-Management While Living Alone in Later Life : A Systematic Integrative Review

Increasing numbers of persons live with complex chronic medical needs and are at risk for poor health outcomes. These patients require unique self-management support, as they must manage many, often interacting, tasks. As part of a conference on Managing Complexity in Chronic Care sponsored by the Department of Veterans Affairs, a working group was convened to consider self-management issues specific to complex chronic care. In this paper, we assess gaps in current knowledge on self-management support relevant to this population, report on the recommendations of our working group, and discuss directions for future study. We conclude that this population requires specialized, multidimensional self-management support to achieve a range of patient-centred goals. New technologies and models of care delivery may provide opportunities to develop this support. Validation and quantification of these processes will require the development of performance measures that reflect the needs of this population, and research to prove effectiveness. Show more

The aim was to explore health in relation to the home as experienced by very old, single-living Swedish people. Applying a grounded theory approach, 40 men and women aged 80-89 were interviewed in their own homes. Data analysis revealed the main theme, "The home is the hub of health", comprising two categories, "The home as support for health", and "Having an inner driving force to maintain health". Health was described as being active and participating, and during the aging process the home became an increasingly important source of support. The older people were aware of their vulnerability, and knew that their life situation could change rapidly. Thus, health was always interpreted in relation to this. They had a strong inner driving force to maintain health, and within the home they challenged their capacity, and used different adaptive strategies targeting person-environment-activity transactions. Our findings imply the need for focusing on the opportunities for activity and participation in all interventions. They also challenge current national and international housing policy emphasizing the benefits of staying put, thus contributing to a more diverse view of what kind of housing arrangements are optimal for very old people. Show more