Engaging in Coordination of Health and Disability Services as Described by Older Adults: Processes and Influential Factors.
OBJECTIVE
There is little consensus on the definition and design of effective care coordination for older adults with chronic conditions, and the majority of care coordination models minimize the role and voice of older patients. Our objectives are to examine how older adults perceive and engage in the process of care coordination of health and disability support services and the factors that influence their engagement.


METHODS
Thirty-seven older adults with chronic conditions and 9 geriatric case managers participated in semistructured interviews that focused on older adults' experiences with self-managing and coordinating their health and support services. Interview data were systematically analyzed for themes.


RESULTS
The interview data revealed that involving older adults in care coordination is a complex, multistage process, conceptualized as making self-health assessments, making informed decisions about care, and executing and coordinating care. The findings indicate that a number of factors facilitate older adults' decision and capacity to become involved in the coordination of their care, including their perceptions about how their condition impacted their everyday lives, and availability of intrinsic resources, tangible resources, and social network. Low perceptions of control over health and lack of such resources constrain their involvement.


CONCLUSIONS
Practitioners may facilitate older adults' involvement in care coordination by using language with older patients that emphasizes psychosocial experiences in addition to medical symptomatology. They may also provide targeted support for patients with limited facilitating factors to promote involvement at multiple stages of the care coordination process.
School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami. nruggian@fiu.edu.
Nicole
N
Ruggiano
School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami.
Natalia
N
Shtompel
Austin Health Clinical School of Nursing, La Trobe University, Melbourne, Australia. Department of Nursing, University of Umeå, Sweden.
David
D
Edvardsson
D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000458:organization & administration*; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D005853:Geriatrics / Q000458:organization & administration*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D012648:Self Care / Q000379:methods*; D012647:Self-Assessment; D014481:United States
Care coordination; Chronic illness; Disability; Health care systems and management; Home and community-based services; Person-centered care