title: Categorizing the effect of comorbidity: a qualitative study of individuals' experiences in a low-vision rehabilitation program.
abstract: OBJECTIVE
  To identify generalizable ways that comorbidity affects older adults' experiences in a health service program directed toward an index condition and to develop a framework to assist clinicians in approaching comorbidity in the design, delivery, and evaluation of such interventions.
  
  
  METHODS
  A qualitative data content analysis of interview transcripts to identify themes related to comorbidity.
  
  
  METHODS
  An outpatient low-vision rehabilitation program for macular disease.
  
  
  METHODS
  In 2007/08, 98 individuals undergoing low-vision rehabilitation and their companions provided 624 semistructured interviews that elicited perceptions about barriers and facilitators of successful program participation.
  
  
  RESULTS
  The interviews revealed five broad themes about comorbidity: (i) "good days, bad days," reflecting participants' fluctuating health status during the program because of concurrent medical problems; (ii) "communication barriers." which were sometimes due to participant impairments and sometimes situational; (iii) "overwhelmed," which encompassed pragmatic and emotional concerns of participants and caregivers; (iv) "delays," which referred to the tendency of comorbidities to delay progress in the program and to confer added inconvenience during lengthy appointments; and (v) value of companion involvement in overcoming some barriers imposed by comorbid conditions.
  
  
  CONCLUSIONS
  This study provides a taxonomy and conceptual framework for understanding consequences of comorbidity in the experience of individuals receiving a health service. If confirmed in individuals receiving interventions for other index diseases, the framework suggests actionable items to improve care and facilitate research involving older adults.
authors.affiliation: Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina, USA. heather.whitson@duke.edu
authors.forename: Heather E
authors.initials: HE
authors.lastname: Whitson
authors.forename: Karen
authors.initials: K
authors.lastname: Steinhauser
authors.forename: Natalie
authors.initials: N
authors.lastname: Ammarell
authors.forename: Diane
authors.initials: D
authors.lastname: Whitaker
authors.forename: Scott W
authors.initials: SW
authors.lastname: Cousins
authors.forename: Deidra
authors.initials: D
authors.lastname: Ansah
authors.forename: Linda L
authors.initials: LL
authors.lastname: Sanders
authors.forename: Harvey J
authors.initials: HJ
authors.lastname: Cohen
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D003144:Communication Barriers; D015897:Comorbidity; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008268:Macular Degeneration / Q000453:epidemiology* / Q000534:rehabilitation; D008297:Male; D009657:North Carolina; D009788:Occupational Therapy; D017060:Patient Satisfaction; D011446:Prospective Studies; D012656:Self-Help Devices; D015354:Vision, Low / Q000453:epidemiology* / Q000534:rehabilitation*
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