Personalised care for long-term conditions

 Living with multiple conditions

Mary, aged 76, has diabetes, arthritis, and macular degeneration, and she’s feeling low. She recently lost her husband, Frank, who died after a long period of dementia. She cared for him devotedly for many years, but this occupied most of her time and energy and took a heavy toll on her health and wellbeing.

Mary’s GP reminds her to attend the local diabetes clinic. The specialist nurses are concerned about her test results and urge her to try to eat a healthier diet and take more exercise. Mary nods, but in her heart knows that this advice will be difficult to follow. Her knees are painful, her eyesight is deteriorating, the local shops don’t sell much in the way of healthy food, and she doesn’t feel confident to travel far on her own.

As populations age, increasing numbers of people live with ...

Games of uncertainty: the participation of older patients with multimorbidity in care planning meetings – a qualitative study

Active patients lie at the heart of integrated care. Although interventions to increase the participation of older patients in care planning are being implemented in several countries, there is a lack of knowledge about the interactions involved and how they are experienced by older patients with multimorbidity. We explore this issue in the context of care-planning meetings within Norwegian municipal health services.

Managing clinical uncertainty in older people towards the end of life: a systematic review of person-centred tools

Older people with multi-morbidities commonly experience an uncertain illness trajectory. Clinical uncertainty is challenging to manage, with risk of poor outcomes. Person-centred care is essential to align care and treatment with patient priorities and wishes. Use of evidence-based tools may support person-centred management of clinical uncertainty. We aimed to develop a logic model of person-centred evidence-based tools to manage clinical uncertainty in older people.