Skip to main content
×
Home

Perceived value of support for older adults coping with multi-morbidity: patient, informal care-giver and family physician perspectives

  • GAYATHRI NAGANATHAN (a1), KERRY KULUSKI (a1) (a2), ASHLINDER GILL (a1), LIISA JAAKKIMAINEN (a3) (a4) (a5), ROSS UPSHUR (a2) (a3) (a5) (a6) and WALTER P. WODCHIS (a1) (a5) (a7)...
Abstract
ABSTRACT

This study investigated the perceived value of informal and formal supports for older adults with multi-morbidity from the perspectives of patients, care-givers and family physicians. Semi-structured interviews were conducted with 27 patients, their informal care-givers and their family physicians in an urban academic family health team in Ontario. Analysis was conducted using a General Inductive Approach to facilitate identification of main themes and build a framework of perceived value of supports. Participant views converged on supports that facilitate patient independence and ease care-giver burden. However, important differences in participant perceptions arose regarding these priorities. Physicians and care-givers valued supports that facilitate health and safety while patients prioritised supports that enable self-efficacy and independence. While formal supports which eased care-giver burden were viewed positively by all members of the triad, many patients also rejected formal supports, citing that informal support from their care-giver was available. Such conflicts between patient, care-giver and physician-perceived value of supports may have important implications for consumer and care-giver willingness to accept formal supports when supports are available. These findings contribute to the broader literature on community-based care by incorporating the perspectives of patients, informal care-givers and family physicians to understand better the barriers and facilitators of uptake of supportive services that contribute to successful ageing at home.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Perceived value of support for older adults coping with multi-morbidity: patient, informal care-giver and family physician perspectives
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Perceived value of support for older adults coping with multi-morbidity: patient, informal care-giver and family physician perspectives
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Perceived value of support for older adults coping with multi-morbidity: patient, informal care-giver and family physician perspectives
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Address for correspondence: Gayathri Naganathan, Institute of Health Policy, Management & Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON, Canada, M5T 3M6 E-mail: gayathri.naganathan@mail.utoronto.ca
References
Hide All
Alwin J., Oberg B. and Krevers B. 2010. Support/services among family caregivers of persons with dementia – perceived importance and services received. International Journal of Geriatric Psychiatry, 25, 3, 240–8.
Aronson J. 2004. ‘You need them to know your ways’: service users’ views about valued dimensions of home care. Home Health Care Services Quarterly, 22, 4, 8598.
Byrne K., Frazee K., Sims-Gould J. and Martin-Matthews A. 2012. Valuing the older person in the context of delivery and receipt of home support: client perspectives. Journal of Applied Gerontology, 31, 3, 377401.
Canadian Institute for Health Information 2011. Health Care in Canada, 2011: A Focus on Seniors and Aging. Canadian Institute for Health Information. Available online at https://secure.cihi.ca/free_products/HCIC_2011_seniors_report_en.pdf [Accessed 17 July 2014].
Canadian Institute for Health Information 2013. Home Care. Canadian Institute for Health Information. Available online at http://www.cihi.ca/CIHI-ext-portal/internet/EN/TabbedContent/types+of+care/community+care/home+care/cihi021338 [Accessed 24 July 2014].
Chan S., Hiebert D., Addario S. D. and Sherrell K. 2005. The Profile of Absolute and Relative Homelessness Among Immigrants, Refugees, and Refugee Claimants in the GVRD. MOSAIC, University of British Columbia. Available online at http://www.urbancentre.utoronto.ca/pdfs/elibrary/HLN-among-Immigrants-Vancou.pdf [Accessed 14 May 2014].
Chappell N. L. and Funk L. M. 2011. Social support, caregiving, and aging. Canadian Journal on Aging = La revue canadienne du vieillissement, 30, 3, 355–70.
Elwyn G., Frosch D., Thomson R., Joseph-Williams N., Lloyd A., Kinnersley P., Cording E., Tomson D., Dodd C., Rollnick S., Edwards A. and Barry M. 2012. Shared decision making: a model for clinical practice. Journal of General Internal Medicine, 27, 10, 1361–7.
Epstein R. M. and Peters E. 2009. Beyond information: exploring patients’ preferences. JAMA: The Journal of the American Medical Association, 302, 2, 195–7.
Etters L., Goodall D. and Harrison B. E. 2008. Caregiver burden among dementia patient caregivers: a review of the literature. Journal of the American Academy of Nurse Practitioners, 20, 8, 423–8.
Fortin M., Bravo G., Hudon C., Vanasse A. and Lapointe L. 2005. Prevalence of multimorbidity among adults seen in family practice. Annals of Family Medicine, 3, 3, 223–8.
Geron S. M., Smith K., Tennstedt S., Jette A., Chassler D. and Kasten L. 2000. The home care satisfaction measure: a client-centered approach to assessing the satisfaction of frail older adults with home care services. Journals of Gerontology: Psychological Sciences and Social Sciences, 55B, 5, S25970.
Glynn L. G., Valderas J. M., Healy P., Burke E., Newell J., Gillespie P. and Murphy A. W. 2011. The prevalence of multimorbidity in primary care and its effect on health care utilization and cost. Family Practice, 28, 5, 516–23.
Green J. and Thorogood N. 2009. Qualitative Methods for Health Research. Second edition, Sage, Thousand Oaks, California.
Haapanen N., Miilunpalo S., Pasanen M., Oja P. and Vuori I. 1997. Agreement between questionnaire data and medical records of chronic diseases in middle-aged and elderly Finnish men and women. American Journal of Epidemiology, 145, 8, 762–9.
Iecovich E. and Biderman A. 2013. Concordance between self-reported and physician-reported chronic co-morbidity among disabled older adults. Canadian Journal on Aging = La revue canadienne du vieillissement, 32, 3, 287–97.
Institute for Patient- and Family-centered Care 2011. Advancing the Practice of Patient- and Family-Centered Care in Primary Care and Other Ambulatory Settings: How to Get Started. Institute for Patient- and Family-Centered Care. Available online at http://www.ipfcc.org/pdf/GettingStarted-AmbulatoryCare.pdf [Accessed 12 May 2014].
König H.-H., Leicht H., Bickel H., Fuchs A., Gensichen J., Maier W., Mergenthal K., Riedel-Heller S., Schäfer I., Schön G., Weyerer S., Wiese B., van den Bussche H., Scherer M. and Eckardt M. 2013. Effects of multiple chronic conditions on health care costs: an analysis based on an advanced tree-based regression model. BMC Health Services Research, 13, 219, 113.
Kriegsman D. M. W., Penninx B. W. J. H., van Eijk J. T. M., Boeke A. J. P. and Deeg D. J. H. 1996. Self-reports and general practitioner information on the presence of chronic diseases in community dwelling elderly: a study on the accuracy of patients’ self-reports and on determinants of inaccuracy. Journal of Clinical Epidemiology, 49, 12, 1407–17.
Kuluski K., Bensimon C., Alvaro C., Schaink A., Lyons R. and Tobias R. 2014. Life interrupted: a qualitative exploration of the impact of complex chronic disease on the daily lives of patients receiving complex continuing care. Illness, Crisis & Loss, 22, 2, 127–44.
Kuluski K., Gill A., Naganathan G., Upshur R., Jaakkimainen R. L. and Wodchis W. P. 2013 a. A qualitative descriptive study on the alignment of care goals between older persons with multi-morbidities, their family physicians and informal caregivers. BMC Family Practice, 14, 133, 110.
Kuluski K., Hoang S. N., Schaink A. K., Alvaro C., Lyons R. F., Tobias R. and Bensimon C. M. 2013 b. The care delivery experience of hospitalized patients with complex chronic disease. Health Expectations 16, 4, e111–23.
Kuluski K., Williams A. P., Laporte A. and Berta W. 2012. The role of community-based care capacity in shaping risk of long-term care facility placement. Healthcare Policy, 8, 1, 92105.
Kwag K. H., Martin P., Russell D., Franke W. and Kohut M. 2011. The impact of perceived stress, social support, and home-based physical activity on mental health among older adults. International Journal of Aging and Human Development, 72, 2, 137–54.
Kwan B. M., Dimidjian S. and Rizvi S. L. 2010. Treatment preference, engagement, and clinical improvement in pharmacotherapy versus psychotherapy for depression. Behaviour Research and Therapy, 48, 8, 799804.
Lehnert T., Heider D., Leicht H., Heinrich S., Corrieri S., Luppa M., Riedel-Heller S. and König H.-H. 2011. Review: health care utilization and costs of elderly persons with multiple chronic conditions. Medical Care Research and Review, 68, 4, 387420.
Lilly M. B., Robinson C., Holtzman S. and Bottorff J. L. 2012. Can we move beyond burden and burnout to support the health and wellness of family caregivers to persons with dementia? Evidence from British Columbia, Canada. Health & Social Care in the Community, 20, 1, 103–12.
Lopez R. P., Mazor K. M., Mitchell S. L. and Givens J. L. 2013. What is family-centered care for nursing home residents with advanced dementia? American Journal of Alzheimer's Disease and Other Dementias, 28, 8, 763–68.
Maier H. and Klumb P. L. 2005. Social participation and survival at older ages: is the effect driven by activity content or context? European Journal of Ageing, 2, 1, 31–9.
Martin-Matthews A. and Sims-Gould J. 2008. Employers, home support workers and elderly clients: identifying key issues in delivery and receipt of home support. Healthcare Quarterly, 11, 4, 6975.
Martin-Matthews A., Sims-Gould J. and Tong C. E. 2013. Canada's complex and fractionalized home care context: perspectives of workers, elderly clients, family carers, and home care managers. Canadian Review of Social Policy, 2013, 68/69, 5574.
Maslow A. H. 1943. A theory of human motivation. Psychological Review, 50, 4, 370–96.
Mercer K. 2008. Facilitating organizational mergers: amalgamation of community care access centres. Journal of Health Services Research & Policy, 13, supplement 1, 4651.
Ministry of Health and Long-term Care 2006. CCAC Home Care Services. In CCAC Client Services Policy Manual. Ministry of Health and Long-term Care, Toronto, 121.
Ministry of Health and Long-term Care 2010. Aging at Home Strategy. Ministry of Health and Long-term Care. Available online at http://news.ontario.ca/mohltc/en/2010/08/aging-at-home-strategy.html [Accessed 20 August 2014].
Money A. G., Barnett J., Kuljis J. and Lucas J. 2013. Patient perceptions of epinephrine auto-injectors: exploring barriers to use. Scandinavian Journal of Caring Sciences, 27, 2, 335–44.
Okura Y., Urban L. H., Mahoney D. W., Jacobsen S. J. and Rodeheffer R. J. 2004. Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure. Journal of Clinical Epidemiology, 57, 10, 1096–103.
Ontario Medical Association 2010. Patient-Centred Care. Ontario Medical Review, June, 3449.
Qian H., Li G.-b., Chen H.-x. and Zhang D.-l. 2011. An exploratory research of patient perceived value in China. Journal of Medical Marketing: Device, Diagnostic and Pharmaceutical Marketing, 11, 4, 277–83.
Rizza A., Kaplan V., Senn O., Rosemann T., Bhend H. and Tandjung R. 2012. Age- and gender-related prevalence of multimorbidity in primary care: the Swiss FIRE project. BMC Family Practice, 13, 113, 19.
Schultz H., Westberg S. M., de Oliveira D. R. and Brummel A. 2012. Patient-perceived value of Medication Therapy Management (MTM) services: a series of focus groups. Innovations in Pharmacy, 3, 4, 18.
Shier G., Ginsburg M., Howell J., Volland P. and Golden R. 2013. Strong social support services, such as transportation and help for caregivers, can lead to lower health care use and costs. Health Affairs (Project Hope), 32, 3, 544–51.
Sims-Gould J. and Martin-Matthews A. 2010. We share the care: family caregivers’ experiences of their older relative receiving home support services. Health & Social Care in the Community, 18, 4, 415–23.
Sinha S. K. 2013. Living Longer, Living Well: Highlights and Key Recommendations from the Report Submitted to the Minister of Health and Long-term Care and the Minister Responsible for Seniors on Recommendations to Inform a Seniors Strategy for Ontario. Ontario Ministry of Health and Long-term Care. Available online at http://www.health.gov.on.ca/en/common/ministry/publications/reports/seniors_strategy/docs/seniors_strategy.pdf [Accessed 5 July 2014].
Surbone A., Baider L. and Kagawa-Singer M. 2010. Cultural competence in the practice of patient–family-centered geriatric oncology. Journal of Geriatric Oncology, 1, 2, 45–7.
Thomas D. R. 2006. A general inductive approach for analyzing qualitative evaluation data. American Journal of Evaluation, 27, 2, 237–46.
Tomaka J., Thompson S. and Palacios R. 2006. The relation of social isolation, loneliness, and social support to disease outcomes among the elderly. Journal of Aging and Health, 18, 3, 359–84.
Toronto Transit Commission 2015. Wheel-Trans. Toronto Transit Commission. Available online at https://ttc.ca/WheelTrans/index.jsp [Accessed 23 February 2015].
United Nations Department of Economic and Social Affairs, Population Division 2013. World Population Ageing 2013. United Nations. Available online at http://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2013.pdf [Accessed 28 April 2014].
Ward B. W. and Schiller J. S. 2013. Prevalence of multiple chronic conditions among US adults: estimates from the National Health Interview Survey, 2010. Preventing Chronic Disease, 10, E65.
Warner L. M., Ziegelmann J. P., Schüz B., Wurm S., Tesch-Römer C. and Schwarzer R. 2011. Maintaining autonomy despite multimorbidity: self-efficacy and the two faces of social support. European Journal of Ageing, 8, 1, 312.
Watsford C. and Rickwood D. 2014. Young people's expectations, preferences, and experiences of therapy: effects on clinical outcome, service use, and help-seeking intentions. Clinical Psychologist, 18, 1, 4351.
Williams A. P., Challis D., Deber R., Watkins J., Kuluski K., Lum J. M. and Daub S. 2009 a. Balancing institutional and community-based care: why some older persons can age successfully at home while others require residential long-term care. Longwoods Review, 7, 1, 95105.
Williams A. P., Lum J. M., Deber R., Montgomery R., Kuluski K., Peckham A., Watkins J., Williams A., Ying A. and Zhu L. 2009 b. Aging at home: integrating community-based care for older persons. Healthcare Papers, 10, 1, 821.
World Health Organization 2011. Global Status Report on Noncommunicable Diseases 2010. World Health Organization. Available online at http://www.who.int/nmh/publications/ncd_report_full_en.pdf [Accessed 18 August 2014].
Yach D., Hawkes C., Gould C. L. and Hofman K. J. 2004. The global burden of chronic diseases: overcoming impediments to prevention and control. JAMA: The Journal of the American Medical Association, 291, 21, 2616–22.
Yu J. 2011. Home care utilization patterns among the elderly population: a case study of Ontario, Canada . Queen's University. Available online at http://hdl.handle.net/1974/6523 [Accessed 18 August 2014].
Zhu S., Hu J. and Efird J. T. 2012. Role of social support in cognitive function among elders. Journal of Clinical Nursing, 21, 15/16, 2118–25.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Ageing & Society
  • ISSN: 0144-686X
  • EISSN: 1469-1779
  • URL: /core/journals/ageing-and-society
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Full text views

Total number of HTML views: 38
Total number of PDF views: 350 *
Loading metrics...

Abstract views

Total abstract views: 534 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 21st November 2017. This data will be updated every 24 hours.