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

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 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.

Estimating the Prevalence of Knee Pain and the Association between Illness Perception Profiles and Self-Management Strategies in the Frederiksberg Cohort of Elderly Individuals with Knee Pain: A Cross-Sectional Study

“…Both studies found that clusters where patients perceived their pain as having most consequences for their lives had more primary care visits. Riviera et al [ 67 ] identified three clusters based on 187 patients with heart failure, chronic obstructive pulmonary disease (COPD), and chronic kidney disease. The cluster perceiving the illness to have few consequences and a non-fluctuating pattern had the fewest hospitalizations while both the cluster perceiving many consequences to their illness and the cluster perceiving a high disease control and understanding of their illness had many hospitalizations.…”

Effects of illness representation‐focused patient education on illness representations and self‐care in patients with heart failure: A randomised clinical trial

“…The concept of illness representations is derived from the common-sense model postulating that when facing a health threat, an individual produces illness representations to cope and form strategies, appraises the effectiveness of the strategies, and then adjusts the coping strategies and feedback to evaluate the threat perception (Leventhal et al, 2011). Previous studies have confirmed that illness representations not only are substantially associated with perceived general health in patients with HF (Lerdal, Hofoss, Gay, & Fagermoen, 2019) but also can affect adherence to health-related behaviours, such as following medical plans, participating in dietary modifications (Jones, Smith, & Llewellyn, 2016) and self-care activation (Rivera et al, 2018). However, Albert et al (2014) found that patients with acute decompensated HF had inaccurate HF beliefs and poor self-care adherence in the two weeks before seeking emergency department care.…”

“…They further suggested the needs for predischarge HF education targeting the improvement of illness representations and self-care behaviours. However, the self-care education should be tailored based on the patient's specific illness representation to make it more meaningful to the patient (Rivera et al, 2018).…”

Zone Tool: Improving Self-Care and Self-Efficacy among Patients with Chronic Kidney Disease

“…Further, it leads to patient's gratification, empowering, self-control and improving the whole patient's quality of life. [4,6,7] To improve self-care management among adult and geriatric patients with chronic illness; self-efficacy should be investigated in order to be developed. Self-efficacy is described as the belief of the individual in his/her potentials to accomplish own goals and reach the desired targets.…”

“…It is the main and considerable power for assessing and managing chronic health conditions. Further, it is the key to psychological and physiological development which leads to coping with environments and performing healthy behaviors [7,8,9]. Patients with high self-efficacy have an elevated trust in their potentials to do complicated tasks and cope with any disease challenges.…”