Influences of Transportation on Health Decision-Making and Self-Management Behaviors among Older Adults with Chronic Conditions.

Although transportation has been established as a facilitator/barrier to health self-management, little is known about how the context of transportation shapes health self-management behaviors and decision-making among older adults with chronic conditions. This study interviewed 37 older adults with chronic conditions in Florida to examine their perspectives about how transportation influences their chronic care self-management. The data were systematically analyzed for themes. The thematic findings revealed how transportation intersected with participants' everyday experiences with chronic health self-management, how they evaluated transportation as part of the process of making decisions about health, and how creative problem-solving about transportation became an additional health self-management activity for addressing their complex needs. These findings suggest that the context of transportation goes beyond a basic facilitator/barrier for health and enhance our understanding about how transportation services and policies may be changed to better address the needs of older adults with chronic conditions.

"If I Don't Like the Way I Feel With a Certain Drug, I'll Tell Them.": Older Adults' Experiences With Self-Determination and Health Self-Advocacy.

Health self-advocacy is associated with positive health outcomes, though existing research indicates that older adults may be at a disadvantage when self-advocating within the health care and disability support systems. This study examined perceptions of older adults' health self-advocacy behaviors and the context under which they self-advocate for their chronic conditions. The study involved in-depth interviews with 37 older adults with chronic illnesses and disabilities and 9 geriatric case managers in South and Central Florida. Data were systematically analyzed for themes. Thematic findings revealed that concerns over quality of life is the most common motivator for older adults to engage in health self-advocacy and that self-advocacy involves gathering information to prepare for decision-making and confronting providers about the information gathered. The findings suggest that providers may help facilitate self-determination by framing health communication within the context of quality of life.

Applying Erikson's wisdom to self-management practices of older adults: findings from two field studies.

According to Erik Erikson's theory on the stages of human development, achieving wisdom later in life involves revisiting previous crises and renewing psychosocial accomplishments. However, few studies have used Erikson's theory as a framework for examining how older adults self-manage physical and mental health changes that commonly occur later in life. This article presents findings from two qualitative studies that demonstrate how older adults apply wisdom in new domains. Specifically, it was found that older adults (1) reasserted autonomy by initiating creative problem solving and (2) applied skills gained from productive activities earlier in life to new health-related problems that arise later in life. These findings highlight the importance of engaging older adults to repurpose their life skills and thus reapply wisdom to new areas of their lives. Implications for practice are discussed.

Engaging in Coordination of Health and Disability Services as Described by Older Adults: Processes and Influential Factors.

PURPOSE OF THE STUDY: 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. DESIGN AND 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. IMPLICATIONS: 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.

Negative feelings and help seeking among older adults with chronic conditions.

Older adults with chronic conditions are at greater risk of negative affect, though few studies have focused on older adults' perspectives on how chronic conditions affect their mental well-being. This study involved in-depth interviews that explored how older adults describe their feelings about chronic conditions, the context within which they experience these feelings, and their experiences with help-seeking for negative feelings. Participants reported that older adults experience a range of negative feelings related to their conditions and are only comfortable talking to people who understand their everyday experiences with managing chronic conditions. The findings have implications for health self-management.