title: Managing multiple chronic conditions in the community: a Canadian qualitative study of the experiences of older adults, family caregivers and healthcare providers.
abstract: The prevalence of multiple chronic conditions (MCC) among older persons is increasing worldwide and is associated with poor health status and high rates of healthcare utilization and costs. Current health and social services are not addressing the complex needs of this group or their family caregivers. A better understanding of the experience of MCC from multiple perspectives is needed to improve the approach to care for this vulnerable group. However, the experience of MCC has not been explored with a broad sample of community-living older adults, family caregivers and healthcare providers. The purpose of this study was to explore the experience of managing MCC in the community from the perspectives of older adults with MCC, family caregivers and healthcare providers working in a variety of settings.
  
  
  
  Using Thorne's interpretive description approach, semi-structured interviews (n = 130) were conducted in two Canadian provinces with 41 community-living older adults (aged 65 years and older) with three or more chronic conditions, 47 family caregivers (aged 18 years and older), and 42 healthcare providers working in various community settings. Healthcare providers represented various disciplines and settings. Interview transcripts were analyzed using Thorne's interpretive description approach.
  
  
  
  Participants described the experience of managing MCC as: (a) overwhelming, draining and complicated, (b) organizing pills and appointments, (c) being split into pieces, (d) doing what the doctor says, (e) relying on family and friends, and (f) having difficulty getting outside help. These themes resonated with the emotional impact of MCC for all three groups of participants and the heavy reliance on family caregivers to support care in the home.
  
  
  
  The experience of managing MCC in the community was one of high complexity, where there was a large gap between the needs of older adults and caregivers and the ability of health and social care systems to meet those needs. Healthcare for MCC was experienced as piecemeal and fragmented with little focus on the person and family as a whole. These findings provide a foundation for the design of care processes to more optimally address the needs-service gap that is integral to the experience of managing MCC.
authors.affiliation: Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main Street West, HSc3N25C, Hamilton, ON, L8S 4K1, Canada. ploegj@mcmaster.ca.|Department of Health, Aging and Society, McMaster University, 1280 Main Street West, HSc3N25C, Hamilton, ON, L8S 4K1, Canada. ploegj@mcmaster.ca.
authors.forename: Jenny
authors.identifier: 0000-0001-8168-8449
authors.initials: J
authors.lastname: Ploeg
authors.affiliation: Health Science Research and Innovation, School of Nursing, Mohawk College of Applied Arts and Technology, 1400 Main Street West, IAHS - 354, Hamilton, ON, L8S 1C7, Canada.
authors.forename: Nancy
authors.initials: N
authors.lastname: Matthew-Maich
authors.affiliation: Faculty of Nursing, University of Alberta, 5-185 Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Fraser
authors.affiliation: School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, 1400 Main Street West, IAHS Rm 403, Hamilton, ON, L8S 4K1, Canada.
authors.forename: Sinéad
authors.initials: S
authors.lastname: Dufour
authors.affiliation: Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, St. Joseph's Healthcare Hamilton, West 5th Campus, 100 West 5th Street, Room G102, Hamilton, ON, L8N 3K7, Canada.
authors.forename: Carrie
authors.initials: C
authors.lastname: McAiney
authors.affiliation: School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
authors.forename: Sharon
authors.initials: S
authors.lastname: Kaasalainen
authors.affiliation: Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main Street West, HSc3N25C, Hamilton, ON, L8S 4K1, Canada.|Aging, Chronic Disease and Health Promotion Interventions, 1280 Main Street West, HSc3N25B, Hamilton, ON, L8S 4K1, Canada.|Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, 1280 Main Street West, HSc3N25B, Hamilton, ON, L8S 4K1, Canada.
authors.forename: Maureen
authors.initials: M
authors.lastname: Markle-Reid
authors.affiliation: Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, M.33 1 Bridgepoint Drive, Toronto, ON, M4M 2B5, Canada.|Bridgepoint Collaboratory for Research and Innovation, Sinai Health System, AM.33 1 Bridgepoint Drive, Toronto, ON, M4M 2B5, Canada.
authors.forename: Ross
authors.initials: R
authors.lastname: Upshur
authors.affiliation: School of Nursing and Department of Family Medicine, Health TAPESTRY, McMaster University, 1280 Main Street West, David Braley Health Science Centre, 5th Floor, Hamilton, ON, L9S 4K1, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Cleghorn
authors.affiliation: McMaster University, Main West Medical Group, 1685 Main Street West, Hamilton, ON, L8S 1G5, Canada.
authors.forename: Anna
authors.initials: A
authors.lastname: Emili
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D017028:Caregivers / Q000523:psychology*; D002908:Chronic Disease; D019468:Disease Management; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D057187:Independent Living / Q000523:psychology*; D008297:Male; D000071069:Multiple Chronic Conditions / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D036301:Qualitative Research
keywords: Caregivers; Healthcare providers; Home care; Multimorbidity; Older persons; Primary care; Qualitative research