Chronic disease management and dementia: a qualitative study of knowledge and needs of staff
Chelsea Baird A C , Marta H. Woolford A , Carmel Young A , Margaret Winbolt B and Joseph Ibrahim A C DA Department of Forensic Medicine, Monash University, Kavanagh Street, Southbank, Vic. 3006, Australia.
B Australian Centre for Evidence Based Aged Care, La Trobe University, Kingsbury Drive, Bundoora, Vic. 3086, Australia.
C Sub-Acute Service, Queen Elizabeth Centre, Ballarat Health Service, Ascot Street South, Ballarat, Vic. 3350, Australia.
D Corresponding author. Email: joseph.ibrahim@monash.edu
Australian Journal of Primary Health 25(4) 359-365 https://doi.org/10.1071/PY18197
Submitted: 17 December 2018 Accepted: 20 May 2019 Published: 30 August 2019
Abstract
Effective self-management is the cornerstone of chronic disease self-management. However, self-management of chronic disease in patients with comorbid dementia is particularly challenging. It is vital that clinicians, patients and carers work collaboratively to tailor self-management programs to each patient with dementia. This study aimed to identify barriers and facilitators of successful self-management in the context of cognitive impairment in order to optimise the capacity for self-management for persons with dementia (PWD). A qualitative study based on semistructured interviews was conducted in Victoria, Australia. Interviews were conducted with 12 people (employed in the ambulatory and dementia care sectors), representing six health services. Participants identified a healthcare system that is complex, not dementia friendly and not accommodating the needs of PWD who have comorbidities. Individual and systemic barriers contributed to ineffective self-management. Chronic disease support programs do not routinely undertake cognitive assessment or have guidelines for modified management approaches for those with cognitive impairment. Support needs to be long-term and requires a specialised skillset that recognises not only chronic disease management, but also the effect of cognition on self-management. Although formal guidelines are needed, care also needs to be tailored to individual cognitive abilities and deficits.
References
Agüero-Torres H, von Strauss E, Viitanen M, Winblad B, Fratiglioni L (2001) Institutionalization in the elderly: the role of chronic diseases and dementia. Cross-sectional and longitudinal data from a population-based study. Journal of Clinical Epidemiology 54, 795–801.| Institutionalization in the elderly: the role of chronic diseases and dementia. Cross-sectional and longitudinal data from a population-based study.Crossref | GoogleScholarGoogle Scholar | 11470388PubMed |
Baird C, Lovell J, Johnson M, Shiell K, Ibrahim JE (2017) The impact of cognitive impairment on self-management in chronic obstructive pulmonary disease: a systematic review. Respiratory Medicine 129, 130–139.
| The impact of cognitive impairment on self-management in chronic obstructive pulmonary disease: a systematic review.Crossref | GoogleScholarGoogle Scholar | 28732820PubMed |
Banerjee S (2015) Multimorbidity – older adults need health care that can count past one. Lancet 385, 587–589.
| Multimorbidity – older adults need health care that can count past one.Crossref | GoogleScholarGoogle Scholar | 25468155PubMed |
Braun V, Clark V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77–101.
| Using thematic analysis in psychology.Crossref | GoogleScholarGoogle Scholar |
Bunn F, Burn AM, Goodman C, Robinson L, Rait G, Norton S, Bennett H, Poole M, Schoeman J, Brayne C (2016) ‘Comorbidity and Dementia: A Mixed-Method Study on Improving Health Care for People with Dementia (CoDem).’ (NIHR Journals Library Health Services and Delivery Research: Southampton, UK)
Dodson JA, Truong TT, Towle VR, Kerins G, Chaudhry SI (2013) Cognitive impairment in older adults with heart failure: prevalence, documentation, and impact on outcomes. The American Journal of Medicine 126, 120–126.
| Cognitive impairment in older adults with heart failure: prevalence, documentation, and impact on outcomes.Crossref | GoogleScholarGoogle Scholar | 23331439PubMed |
Ibrahim JE, Anderson LJ, MacPhail A, Lovell JJ, Davis MC, Winbolt M (2017) Chronic disease self-management support for persons with dementia, in a clinical setting. Journal of Multidisciplinary Healthcare 10, 49–58.
| Chronic disease self-management support for persons with dementia, in a clinical setting.Crossref | GoogleScholarGoogle Scholar | 28182172PubMed |
Lorig KR, Holman HR (2003) Self-management education: history, definition, outcomes, and mechanisms. Annals of Behavioral Medicine 26, 1–7.
| Self-management education: history, definition, outcomes, and mechanisms.Crossref | GoogleScholarGoogle Scholar | 12867348PubMed |
Melis RJ, Marengoni A, Rizzuto D, Teerenstra S, Kivipelto M, Angleman SB, Fratiglioni L (2013) The influence of multimorbidity on clinical progression of dementia in a population-based cohort. PLoS One 8, e84014
| The influence of multimorbidity on clinical progression of dementia in a population-based cohort.Crossref | GoogleScholarGoogle Scholar | 24386324PubMed |
Munshi MN (2017) Cognitive dysfunction in older adults with diabetes: what a clinician needs to know. Diabetes Care 40, 461–467.
| Cognitive dysfunction in older adults with diabetes: what a clinician needs to know.Crossref | GoogleScholarGoogle Scholar | 28325796PubMed |
Mutasingwa DR, Ge H, Upshur REG (2011) How applicable are clinical practice guidelines to elderly patients with comorbidities? Canadian Family Physician Medecin de Famille Canadien 57, e253–e262.
Ott A, Stolk RP, van Harskamp F, Pols HA, Hofman A, Breteler MM (1999) Diabetes mellitus and the risk of dementia: the Rotterdam Study. Neurology 53, 1937–1942.
| Diabetes mellitus and the risk of dementia: the Rotterdam Study.Crossref | GoogleScholarGoogle Scholar | 10599761PubMed |
Rawlings AM, Sharrett AR, Schneider ALC, Coresh J, Albert M, Couper D, Griswold M, Gottesman RF, Wagenknecht LE, Windham BG, Selvin E (2014) Diabetes in midlife and cognitive change over 20 years: a cohort study. Annals of Internal Medicine 161, 785–793.
| Diabetes in midlife and cognitive change over 20 years: a cohort study.Crossref | GoogleScholarGoogle Scholar | 25437406PubMed |
Rusanen M, Ngandu T, Laatikainen T, Tuomilehto J, Soininen H, Kivipelto M (2013) Chronic obstructive pulmonary disease and asthma and the risk of mild cognitive impairment and dementia: a population based CAIDE study. Current Alzheimer Research 10, 549–555.
| Chronic obstructive pulmonary disease and asthma and the risk of mild cognitive impairment and dementia: a population based CAIDE study.Crossref | GoogleScholarGoogle Scholar | 23566344PubMed |
Santos T, Lovell J, Shiell K, Johnson M, Ibrahim JE (2018) The impact of cognitive impairment in dementia on self-care domains in diabetes: a systematic search and narrative review. Diabetes/Metabolism Research and Reviews 34, e3013
| The impact of cognitive impairment in dementia on self-care domains in diabetes: a systematic search and narrative review.Crossref | GoogleScholarGoogle Scholar | 29707902PubMed |
Schubert CC, Boustani M, Callahan CM, Perkins AJ, Carney CP, Fox C, Unverzagt F, Hui S, Hendrie HC (2006) Comorbidity profile of dementia patients in primary care: are they sicker? Journal of the American Geriatrics Society 54, 104–109.
| Comorbidity profile of dementia patients in primary care: are they sicker?Crossref | GoogleScholarGoogle Scholar | 16420205PubMed |
Smith JA, Osborn M (2015) Interpretative phenomenological analysis as a useful methodology for research on the lived experience of pain. British Journal of Pain 9, 41–42.
| Interpretative phenomenological analysis as a useful methodology for research on the lived experience of pain.Crossref | GoogleScholarGoogle Scholar | 26516556PubMed |
Stampfer MJ (2006) Cardiovascular disease and Alzheimer’s disease: common links. Journal of Internal Medicine 260, 211–223.
| Cardiovascular disease and Alzheimer’s disease: common links.Crossref | GoogleScholarGoogle Scholar | 16918818PubMed |
Tong A, Sainsbury P, Craig J (2007) Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care 19, 349–357.
| Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.Crossref | GoogleScholarGoogle Scholar | 17872937PubMed |
Victorian Government Department of Human Services (2008) Health independence programs guidelines. (Victorian Government Department of Human Services: Melbourne, Vic., Australia) Available at https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/rehabilitation-complex-care/health-independence-program [Verified 12 July 2018]
Vitry AI, Zhang Y (2008) Quality of Australian clinical guidelines and relevance to the care of older people with multiple comorbid conditions. Medical Journal of Australia 189, 360–365.
Wolters FJ, Segufa RA, Darweesh SKL, Bos D, Ikram MA, Sabayan B, Hofman A, Sedaghat S (2018) Coronary heart disease, heart failure, and the risk of dementia: a systematic review and meta-analysis. Alzheimer’s & Dementia 14, 1493–1504.
| Coronary heart disease, heart failure, and the risk of dementia: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar |
World Health Organization (WHO) (2018) Chronic Diseases and Health Promotion. (WHO: Geneva, Switzerland) Available at http://www.who.int/chp/about/integrated_cd/en/ [Verified 20 April 2019]
