Self management support amongst older adults: the availability, impact and potential of locally based services and resources

Background Supporting the self management of Long Term Conditions (LTCs) is becoming a key issue for older people as the proportion of older people in the population increases and as any added years are not necessarily healthy ones. For older people, local resources and support services may be of particular importance. Aim To investigate the self management experiences and expectations of older people, and to compare these against the availability of support from locally based services within four areas of England. Method Within each area we carried out the following work a) Mapped the socio-demographic, health status and service organisation; b) Questionnaire survey to a random sample of 625 older people to explore LTC prevalence, general health, patient activation, demographics and service use; c) Qualitative studies of service providers and commissioners to explore their experiences of providing support and of older people and carers to explore their experiences of obtaining support. Results The questionnaire survey response rate was 40%. The prevalence of LTCs was 65% with arthritis being the most prevalent condition (53%). Those with multiple LTCs had decreased confidence in self management and therefore sought help from a wider range of sources. Influences on people's support needs included: expectations of health in later life; beliefs about responsibility for health and beliefs about self care versus self management. When there was mutual trust GPs were most effective at providing patients with self management support. Pharmacists were also valued due to the large number of medications taken by many of those with LTCs; improving medicines management was considered to be particularly important for older people. Participants were reluctant to obtain support from social services and were often unaware of the voluntary sector support available. Across all interview groups (service providers, commissioners, older people and carers) there was no consensus regarding the value of the Expert Patients Programme. Conclusions Older people's perceptions and everyday practices should be taken into account when developing new policy initiatives and services to increase their relevance. We found that deprivation was associated with serious difficulties in promoting, providing and accessing self management support. At the same time, in areas with high levels of social and ethnic diversity there was often a wide range of small scale services available. Better coordination between services is needed, which underlines the importance of joint health and social care commissioning and cross sector working. General Practice may be particularly relevant in developing this coordination as they are considered by older people to be key to their care and self management