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The goal of this investigation was to assess service use, self-management strategies, and health status of older adults (60+ years) with perceived need who sought assistance from the Virginia Medicaid Elderly and Disabled Consumer-Direction (EDCD) waiver services. A sequential explanatory mixed method design was used to address the overall research question: How do older adults manage unmet needs? Using health services data from two independent State agencies, regression techniques were used to examine predictors of service use, hospitalization, and mortality among 1,008 individuals. A purposive subsample of eight rural-dwelling waiver-ineligible individuals was identified for follow-up semi-structured telephone interviews to explore self-management strategies for confronting functional care needs. Waiver-ineligible individuals were at risk for hospitalization and mortality; rural-dwelling individuals were more likely to be waiver-ineligible and had increased risk of mortality. Analysis of interviews revealed individuals had ongoing unmet needs and relied on family and community services and used internal and external strategies to manage them; plans were not in place should their health continued to decline. For this group of near-risk older adults who are waiver-ineligible and do not have financial means to pay for more help, accessible preventive services are necessary to reduce risk of adverse health outcomes. Policymakers are encouraged to advocate for preventive services that assist individuals before care needs become unmanageable. Agencies responsible for service delivery need to target efforts toward this group, particularly those residing in rural areas. Researchers must continue forging partnerships that permit use of health services data to identify when and how older adults use services, and explore how self-management strategies influence health and functioning over time. / Ph. D.

Bakgrund: Diabetes mellitus typ 2 är en kronisk sjukdom som karaktäriseras av högt blodsocker då patienten inte bildar tillräckligt med insulin och/eller är insulinresistent. Diabetes mellitus typ 2 är vanligaste diabetesförekomsten och omkring 463 miljoner människor med diabetes. Förhöjt blodsocker riskerar tillkomst av komplikationer som försämrar hälsotillståndet och livskvalitén hos patienten. Livsstilsförändringar är grunden för diabetesbehandling där kostrestriktioner och fysisk aktivitet är viktiga åtgärder.   Syfte: Syftet var att belysa patienters erfarenheter av egenvård vid diabetes typ 2.   Metod: Litteraturöversikt där databaserna Cinahl samt PubMed användes för att sammanställa åtta vetenskapliga artiklar. Artiklarna har analyserats, sammanställts och sedan presenterats med nya kategorier enligt metod av Friberg.    Resultat: Litteraturstudien visade att det var utmanande att förändra sin livsstil och att detta krävde en strategi. Omgivningen var viktig för egenvårdens framgång, och kunde både hjälpa och stjälpa egenvården. Olika insikter som tydliggjorde behovet av egenvård motiverade också till egenvård. Det var också utmanande att utföra adekvat egenvård eller att veta vad som är adekvat egenvård i olika situationer. Sjuksköterskan hade en viktig uppgift att utbilda patienten och fungerade dessutom som en diskussionspartner.   Konklusion: Varje individ har olika erfarenheter av egenvård och därmed unika behov vilket sjuksköterskan bör ta i beaktande i vården av patienter med diabetes typ 2. / Background: Diabetes type 2 is characterised by high blood glucose due to insufficient insulin production and/or are insulin resistant. Diabetes mellitus type 2 are the common type of diabetes and approximately 463 million people live with the disease. Increased blood glucose levels are associated with complications which may reduce state of health and quality of life. Lifestyle changes are basis for treatment where diet restrictions and physical activity are important interventions   Aim: The aim was to describe patients’ experiences of self-care in type 2 diabetes   Methods: A literature review using databases CINAHL and PubMed finding eight scientific articles which has been analyzed, compiled and presented with new categories according to method by Friberg.   Result: The literature review showed that it was challenging to change your lifestyle, and it required strategy. Other people was a significant factor for self-care, both good and bad. It also showed that there were realizations that motivated to self-care, and that it was challenging knowing and performing adequate self-care. The nurse had an important role to educate patients and also worked as a discussion partner.    Conclusion: Each individual has different experiences of self-care and thus unique needs, which the nurse should take into account in the care of patients with type 2 diabetes.

Yes / Introduction: Many older people live with both multiple long‐term conditions and frailty; thus, they manage complex medicines regimens and are at heightened risk of the consequences of medicines errors. Research to enhance how people manage medicines has focused on adherence to regimens rather than on the wider skills necessary to safely manage medicines, and the older population living with frailty and managing multiple medicines at home has been under‐explored. This study, therefore, examines in depth how older people with mild to moderate frailty manage their polypharmacy regimens at home. Methods: Between June 2021 and February 2022, 32 patients aged 65 years or older with mild or moderate frailty and taking five or more medicines were recruited from 10 medical practices in the North of England, United Kingdom, and the CARE 75+ research cohort. Semi‐structured interviews were conducted face to face, by telephone or online. The interviews were recorded, transcribed verbatim and analysed using reflexive thematic analysis. Findings: Five themes were developed: (1) Managing many medicines is a skilled job I didn't apply for; (2) Medicines keep me going, but what happened to my life?; (3) Managing medicines in an unclear system; (4) Support with medicines that makes my work easier; and (5) My medicines are familiar to me—there is nothing else I need (or want) to know. While navigating fragmented care, patients were expected to fit new medicines routines into their lives and keep on top of their medicines supply. Sometimes, they felt let down by a system that created new obstacles instead of supporting their complex daily work. Conclusion: Frail older patients, who are at heightened risk of the impact of medicines errors, are expected to perform complex work to safely self‐manage multiple medicines at home. Such a workload needs to be acknowledged, and more needs to be done to prepare people in order to avoid harm from medicines. Patient and Public Involvement: An older person managing multiple medicines at home was a core member of the research team. An advisory group of older patients and family members advised the study and was involved in the first stages of data analysis. This influenced how data were coded and themes shaped. / National Institute for Health and Care Research (NIHR). Grant Number: NIHR201056. National Institute for Health and Care Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre.

Yes / In the United Kingdom, stroke is the most significant cause of adult disability. Stroke survivors are frequently left with physical and psychological changes that can profoundly affect their functional ability, independence, and social participation. Research suggests that long-term, intense, task- and context-specific rehabilitation that is goal-oriented and environmentally enriched improves function, independence, and quality of life after a stroke. It is recommended that rehabilitation should continue until maximum recovery has been achieved. However, the increasing demand on services and financial constraints means that needs cannot be met through traditional face-to-face delivery of rehabilitation. Using a participatory design methodology, we developed an information communication technology–enhanced Personalized Self-Managed rehabilitation System (PSMrS) for stroke survivors with integrated insole sensor technology within an “intelligent shoe.”. The intervention model was based around a rehabilitation paradigm underpinned by theories of motor relearning and neuroplastic adaptation, motivational feedback, self-efficacy, and knowledge transfer. To understand the conditions under which this technology-based rehabilitation solution would most likely have an impact on the motor behavior of the user, what would work for whom, in what context, and how. We were interested in what aspects of the system would work best to facilitate the motor behavior change associated with self-managed rehabilitation and which user characteristics and circumstances of use could promote improved functional outcomes. Methods: We used a Realist Evaluation (RE) framework to evaluate the final prototype PSMrS with the assumption that the intervention consists of a series of configurations that include the Context of use, the underlying Mechanisms of change and the potential Outcomes or impacts (CMOs). We developed the CMOs from literature reviews and engagement with clinicians, users, and caregivers during a series of focus groups and home visits. These CMOs were then tested in five in-depth case studies with stroke survivors and their caregivers. Results: While two new propositions emerged, the second importantly related to the self-management aspects of the system. The study revealed that the system should also encourage independent use and the setting of personalized goals or activities. Conclusions: Information communication technology that purports to support the self-management of stroke rehabilitation should give significant consideration to the need for motivational feedback that provides quantitative, reliable, accurate, context-specific, and culturally sensitive information about the achievement of personalized goal-based activities.

Yes / People with dementia or mild cognitive impairment (MCI) and their family carers face challenges in managing medicines. How medicines self-management could be supported for this population is unclear. This review identifies interventions to improve medicines self-management for people with dementia, MCI and their family carers, and which core components of medicines self-management they address. Methods A database search was conducted for studies with all research designs and ongoing citation searches from inception to December 2021. Selection criteria included community dwelling people with dementia and MCI and their family carers, and interventions with a minimum of one medicine self-management component. Exclusion criteria were wrong population, not focusing on medicines management, incorrect medicines self-management components, not in English and wrong study design. Results are presented and analysed through narrative synthesis. The review is registered [PROSPERO (CRD42020213302)]. Quality assessment was carried out independently applying the QATSDD quality assessment tool. Results Thirteen interventions were identified. Interventions primarily addressed adherence. A limited number focused on a wider range of medicine self-management components. Complex psychosocial interventions with frequent visits considered the person’s knowledge and understanding, supply management, monitoring effects and side-effects and communicating with healthcare professionals; and addressed more resilience capabilities. However, these interventions were delivered to family carers alone. None of the interventions described patient and public involvement. Conclusion Interventions, and measures to assess self-management, need to be developed which address all components of medicines self-management, to better meet the needs for people with dementia and MCI and their family carers.

Thesis (M.A. (Psychology)) -- University of Limpopo, 2000 / Refer to document

Individuals’ self-management styles are crucial for how they manage to live with illness. Commonly investigated factors include social support, self-efficacy, health beliefs, and demographics. There is a gap in the literature with regard to in-depth studies of how those factors actually influence an individual’s self-management.   The aim of this thesis was to investigate the underlying mechanisms of self-management from the perspective of individuals living with chronic illness.   Interviews were conducted with 47 individuals with various chronic illnesses, some of them repeatedly over two and a half years (a total of 107 interviews). The material was analysed with; constructive grounded theory, content analysis, phenomenography, and interpretive description.   The Self-management Support Model identified aspects that influenced participants’ self-management: economic and social situation, social support, views and perspectives on illness, attribution of responsibility, and ability to integrate self-management into an overall life situation. For example, individuals with a life-oriented or disease-oriented perspective on illness prioritized different aspects of self-management. People who attributed internal responsibility performed a more complex self-management regimen than individuals who attributed external responsibility. In conclusion, individuals who were creative and resourceful had a better chance of tailoring a self-management regimen that suited them well. People in more disadvantaged positions (e.g., financial strain, limited support, or severe intrusive illness) experienced difficulty in finding a method of self-management that fit their life situation.   These findings can inspire healthcare providers to initiate a reflective dialogue about self-management with their patients. / Exploring individuals’ conceptions as a way to understand self-management among people living with long term medical conditions

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