Managing multiple morbidity in mid-life: a qualitative study of attitudes to drug use

Townsend, Anne; Hunt, Kate; Wyke, Sally

doi:10.1136/bmj.327.7419.837

Cited by 154 publications

(175 citation statements)

References 12 publications

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“…10,20,21 We separately examined older adults' preferences for participating in health care decisions with doctors and family and close friends using the following categories: Bmaking decisions independently, with or without advice^, Bshare decisions^and Bleave decisions up to them.^Finally, we developed questions to assess older adults' perspectives on their experiences managing their health, drawing on prior work to articulate disease-specific treatment burden. 6,7,[22][23][24] We constructed a summary measure that identified participants who reported that one or more of four individual experiences relating to treatment burden occur Bsometimes^or Boften.Ĉ ovariates We examine older adults' age, gender, educational attainment, self-rated health, numbers of chronic medical conditions, selfreported hospitalization in the prior year, and sensory impairment. Depressive symptoms were measured using established cut-points of the PHQ-2.…”

Section: Study Outcomesmentioning

confidence: 99%

A Look at Person-Centered and Family-Centered Care Among Older Adults: Results from a National Survey

Wolff

Boyd

2015

J GEN INTERN MED

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BACKGROUND:Person-centered and family-centered care represents the pinnacle of health care quality, but delivering it is challenging, as is assessing whether it has occurred. Prior studies portray older adults as passive in health decisions and burdened by care-but emphasize age-based differences or focus on vulnerable subgroups. OBJECTIVES: We aimed to examine domains of person-centered and family-centered care among older adults and whether the social context in which older adults manage their health relates to preferences for participating in health decisions and experiences with care. DESIGN AND PARTICIPANTS: This was an observational study of a nationally representative survey of adults aged 65+ years, conducted in concert with the 2012 National Health and Aging Trends Study (n=2040). MAIN MEASURES: Approach to managing health (selfmanage, co-manage, delegate); preferences for making health care decisions with: (1) doctors, (2) family/close friends; and experiences with care pertaining to treatment burden were measured. KEY RESULTS: Approximately two-thirds of older adults self-manage (69.4 %) and one-third comanage (19.6 %) or delegate (11.0 %) health care activities. The majority prefer an independent or shared role when making health decisions with doctors (84.7 %) and family/close friends (95.9 %). Nearly four in ten older adults (37.9 %) experience treatment burden-that managing health care activities are sometimes or often hard for either them or their family/close friends, that health care activities get delayed or don't get done, or that they are cumulatively too much to do. Relative to older adults who self-manage, those who delegate health care activities are more likely to prefer to share or leave health decisions to doctors (aOR=1.79 (95 % CI, 1.37-2.33) and family/close friends (aOR=3.12 (95 % CI, 2.23-4.36), and are more likely to experience treatment burden (aOR= 2.37 (95 % CI, 1.61-3.47). CONCLUSIONS: Attaining person-centered and familycentered care will require strategies that respect diverse decision-making preferences, minimize treatment burden, and support the broader social context in which older adults manage their health.

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Section: Study Outcomesmentioning

confidence: 99%

A Look at Person-Centered and Family-Centered Care Among Older Adults: Results from a National Survey

Wolff

Boyd

2015

J GEN INTERN MED

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“…The efficacy of anti-depressants for mild depression has been questioned (Moncrieff & Kirsch, 2005) and they are not recommended to be used routinely by people with persistent sub-threshold depressive symptoms or mild depression in the first instance (NICE, 2010). There is also a range of side effects (Demyttenaere, 2003), many people do not like taking medicines (Maxwell, 2005;Givens et al, 2006;Townsend, Hunt, & Wyke, 2003;Kessing, Vibe Hansen, Demyttenaere, & Bech, 2005) and early drop-out rates in clinical trials vary from 12% to 40% (Cipriani et al, 2009;Kirsch et al, 2008). Psychological therapies are resource intensive, and may require cognitive capabilities a person with depression cannot attain.…”

Section: Introductionmentioning

confidence: 99%

Walking for depression or depressive symptoms: A systematic review and meta-analysis

Robertson

Jepson

et al. 2012

Mental Health and Physical Activity

201

121

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Problem: Depression is a common disorder worldwide. Most patients are treated within primary care and antidepressant treatment is not recommended for people with mild depression. Physical activity has been shown to alleviate depression but it is not known whether the less vigorous activity of walking -a potentially widely acceptable and safe intervention -confers such benefit.Method: Eleven databases were systematically searched for randomised controlled trials of walking as a treatment intervention for depression, from database inception until January 2012.Meta-analyses were carried out on all trials eligible for inclusion and on sub-groups of outdoor, indoor and group walking.Results: Of the 14,672 articles retrieved, eight trials met the inclusion criteria. The pooled standardised mean difference (effect size) was -0.86 [-1.12, -0.61] showing that walking has a statistically significant, large effect on symptoms of depression. However, there was considerable heterogeneity amongst the interventions and research populations and it is uncertain whether the results can be generalised to specific populations such as primary care patients.Conclusions: Walking has a statistically significant, large effect on the symptoms of depression in some populations, but the current evidence base from randomised, controlled trials is limited.Thus, while walking is a promising treatment for depression or depressive symptoms with few, if any, contraindications, further investigations to establish the frequency, intensity, duration and type(s) of effective walking interventions particularly in primary care populations would be beneficial for providing further recommendations to clinical practitioners.Keywords: depression, physical activity, walking, systematic review, meta-analysis 2 IntroductionDepression is an illness or mood disorder with a variety of symptoms, the most defining being an inexplicable, enduring feeling of sadness (loss of positive affect). It is categorised as mild, moderate or severe depending upon the number and severity of the symptoms (WHO, 2010). It is a common mental health problem, estimated in 2000 to be the fourth leading cause of disease burden worldwide (WHO, 2003;Ustun, Ayuso-Mateos, Chatterji, Mathers, & Murray, 2004). It causes a level of morbidity comparable to or worse than other common chronic diseases such as asthma and diabetes (Moussavi et al., 2007). In the UK over 75% of patients with depression are treated solely within primary care (NICE, 2010) where prevalence is estimated at 7% (Ostler et al., 2001).Depression is commonly treated with anti-depressant medications, psychological therapies or a combination of both. The efficacy of anti-depressants for mild depression has been questioned (Moncrieff & Kirsch, 2005) and they are not recommended to be used routinely by people with persistent sub-threshold depressive symptoms or mild depression in the first instance (NICE, 2010). There is also a range of side effects (Demyttenaere, 2003), many people do not like taking medicines (Ma...

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“…9 Qualitative work has established that the main issues affecting patients with multimorbidity include loss of function, multiple medicine use, and negative effects on wellbeing, relationships, and coordination of care. 10,11 In addition, patients with multimorbidity often know a lot about managing their conditions and are actively engaged in self-management. However, they also have an interest in, and require support from, an enabling multidisciplinary health professional team.…”

Section: Introductionmentioning

confidence: 99%

GPs' and pharmacists' experiences of managing multimorbidity: a ‘Pandora's box’

2010

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Multimorbidity is defined as the occurrence of two or more chronic diseases in one individual. Patients with multimorbidity generally have poorer health and functioning and higher rates of attendance in primary care and specialty settings. AimTo explore the views and attitudes of GPs and pharmacists managing patients with multimorbidity in primary care. Design of studyQualitative study using focus groups. SettingPrimary care in Ireland. MethodThree focus groups were held in total, involving 13 GPs and seven pharmacists. Focus groups were recorded, transcribed, and analysed using the 'framework' approach. ResultsThe predominant themes to emerge from the focus groups were: 1) the concept of multimorbidity and the link to polypharmacy and ageing; 2) health systems issues relating to lack to time, inter-professional communication difficulties, and fragmentation of care; 3) individual issues from clinicians relating to professional roles, clinical uncertainty, and avoidance; 4) patient issues; and 5) potential management solutions. ConclusionThis study provides information on the significant impact of multimorbidity from a professional perspective. It highlights potential elements of an intervention that could be designed and tested to achieve improvements in the management of multimorbidity, outcomes for individuals affected, and the experiences of those providing healthcare.

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Managing multiple morbidity in mid-life: a qualitative study of attitudes to drug use

Cited by 154 publications

References 12 publications

A Look at Person-Centered and Family-Centered Care Among Older Adults: Results from a National Survey

A Look at Person-Centered and Family-Centered Care Among Older Adults: Results from a National Survey

Walking for depression or depressive symptoms: A systematic review and meta-analysis

GPs' and pharmacists' experiences of managing multimorbidity: a ‘Pandora's box’

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