A major concern to those who treat older patients is to develop self-management programs that can be used for those with several chronic illnesses. The goal of a study by Bayliss and coworkers was to identify barriers to self-management associated with lower perceived health status and, secondarily, with lower reported physical functioning for a population of seniors with multiple chronic conditions. They surveyed 352 health maintenance organization members aged 65 years or older with, at a minimum, coexisting diagnoses of diabetes, depression, and osteoarthritis. Validated questions were based on previous interviews that had elicited potential barriers to the self-management process for persons with multimorbidities. Associations between morbidity burden and potential barriers to self-management were analyzed. The response rate was 47%. Sixty-six percent of respondents were female; 55% were aged 65 to 74 years, and 45% were aged 75 years or older. Fifty percent reported fair or poor health. On average they each had 8.7 chronic diseases. In the analysis, higher level of morbidity, lower level of physical functioning, less knowledge about medical conditions, less social activity, persistent depressive symptoms, greater financial constraints, and male sex were associated with lower perceived health status. Potential barriers to self-management significantly associated with lower levels of physical functioning were higher level of morbidity, greater financial constraints, greater number of compound effects of conditions, persistent depressive symptoms, higher level of patient-clinician communication, and lower income.

VALUE OF STUDY TO READER: The study showed that in addition to morbidity burden, specific psychosocial factors were independently associated with lower reported health status and lower reported physical functioning in seniors with multiple physical disorders. These factors, suggested the authors, would be amenable to intervention to improve health outcomes. Changing these factors might be needed before self-management programs can be developed and tested for patients with multiple chronic conditions. In other cases, interventions for these issues might be included as components in an overall self-management program for use across chronic illnesses.

EA Bayliss et al. Barriers to Self-Management and Quality-of-Life Outcomes in Seniors With Multimorbidities. Annals of Family Medicine, 2007;5:395-402.