Self-management in older adults: how to delineate self-management ability, self-management behavior, and self-management support?

Abstract

4Background: Self-management is a key element in person-centered and integrated care. It involves 5 several related concepts, such as self-management ability, behavior, and support. These concepts are 6 poorly delineated. The aim of this study was to examine hypothesized associations between self-7 management ability, behavior, and support in older adults (taking their frailty and complexity of care 8 needs into account) and to examine underlying aspects of these concepts, if these hypotheses lack 9 support. 10 Methods: Cross-sectional data from the Embrace study, a stratified randomized controlled trial, 11 evaluating person-centered and integrated care in Dutch community-living older adults, were used. 12 Participants (n=537) were aged 75 and older, assigned to health-related risk profiles based on self-13 reported frailty and complexity of care needs. Ability was assessed with the Self-Management Ability 14 Scale, behavior with the Partner in Health Scale for Older Adults, and support with the Patient 15 Assessment of Integrated Elderly Care. 16Results: Ability and behavior were positively associated for participants with the risk profiles 17 "Robust" and "Complex care needs" (betas are 0.38 and 0.46). Coping (an aspect of behavior) turned 18 out to be a key element for participants with risk profiles "Robust" and "Complex care needs" (betas 19 ranging from 0.13 to 0.45). Support was associated with aspects of behavior, varying per risk profile. 20 Conclusion:We found no associations for self-management on the conceptual level, but the aspect 21 coping did appear to play a major role. Improving coping strategies of older adults may be a 22 promising way of enhancing self-management ability, and of reducing the need for self-management 23 support. 24 25 2 Keywords: Self-management ability, self-management behavior, self-management support, 26 older adults, person-centered care, integrated care. 27 3 BACKGROUND 28Self-management, a concept frequently used by policymakers and researchers, is a key element in 29 person-centered and integrated care [1,2]. Enhancing self-management may be a relatively low-cost 30 way of improving health outcomes in older adults and in patients with chronic conditions [3]. "Self-31 management" is a term that is often used in connection with an individual's level of health (which 32 has been shown to be associated with their level of self-management) [5][6][7][8]. However, self-33 management is also essential for maintaining the well-being of older adults, regardless of their health 34 status. This is in line with the theory of self-management of well-being [4]. The theory states that 35 successful aging can only be achieved through sustainable well-being, which is based on the use of 36 self-management abilities. 37Self-management involves concepts such as self-management ability (i.e. the ability to manage 38 one's internal and external key resources), self-management behavior (i.e. applying self-39 management abilities), and self-management support (i.e. the care and educati...