| The global epidemic of chronic disease has become a public health issue and created a huge burden on health care systems and societies. Older population is highly susceptible to chronic disease. The high prevalence of chronic disease among older adults results in a series of physical, psychosocial and financial consequences in this patient group. In Hong Kong, as the population continues to age, the number of people having chronic disease is expected to increase rapidly in next few decades. The care for older adults with chronic disease is yet suboptimal. Local older people are predisposed to a number of characteristics, such as low socioeconomic status, poor health literacy and multiple morbidities, which may hinder professionals to provide effective care. Empowering patients through supporting self-management, increasing confidence and assisting decision-making of people with chronic disease has been found to be a solution to the problem. Although literature has suggested that self-management education programmes may improve physical and psychosocial outcomes, and promote health-related behaviours among people with chronic disease, the evidence of the effects of such programmes in older adults is still lacking.;Two studies have been conducted to examine the effects of self-management education programmes in improving health behaviours, physical and psychological status, quality of life and health care utilization in older people with chronic disease. Study One is a quasi-experimental trial exploring the effects of the Chronic Disease Self-Management Programme (CDSMP) in older adults with a wide range of chronic diseases. Study Two is a randomized controlled trial evaluating the effects of the Diabetes Mellitus Self-Management Programme (DMSMP) in older adults with non-insulin-dependent diabetes mellitus.;In Study One, community-dwelling older people with one or more chronic disease were recruited. The intervention group (n = 302) received the 6-week CDSMP, which consisted of 6 group sessions with each session lasting for 2.5 hours. The programme was facilitated either by professional and older lay leaders. The control group (n = 298) continued their usual care for 6 months. Self-management behaviours, self-efficacy, health status, and health care utilization of participants were assessed at baseline and 6 months.;The one-way analysis of covariance showed that the intervention group has significant improvements in all self-management behaviours and self-efficacy outcomes, and 5 out of 10 health status measures (all p < .05). No significant change was detected in the use of health care services.;In Study Two, older people with non-insulin-dependent diabetes mellitus were randomly assigned to either the intervention (n = 90) or control (n = 87) group. The intervention group attended the DMSMP comprising 8 weekly 2-hour sessions. The control group received usual care for 8 weeks. Body mass index, waist-to-hip ratio, blood glucose and blood pressure levels, diabetes-related knowledge, disease-specific and generic quality of life, and nutritional intakes were measured at baseline and 8 weeks.;Using the one-way analysis of covariance, the intervention group found significant improvements in diabetes-related knowledge (p < .0005), the satisfaction subscale score in the diabetes-specific quality of life measure (p = .045), and the mental health score in the generic quality of life measure (p = .003). Significant reductions of total energy (p = .018) and saturated fat intakes (p = .03) were also demonstrated in the intervention group. No significant change was detected in the physiological outcomes, anthropometric indices and other quality of life and nutritional measures.;The present studies enrich the knowledge of the effects of disease-specific and generic self-management education programmes for older adults with chronic disease living in the community. It demonstrated that the programmes specifically tailored for older adults may improve a wide range of behavioural and psychosocial outcomes. Older adults may be able to learn new skills for self-management and change behaviours to improve their health. The effects of using older lay persons to lead such programmes may be similar with those using professional staff. The findings imply that self-management programmes need to be integrated into the routine service of health care systems and community care in order to have maximal effects. The implementation of self-management support at different levels of care and under the local context was discussed. Further studies should be conducted to explore the effects of self-management programmes on older people using prolonged follow-ups and larger sample size. The comparative effects of disease-specific and generic self-management programme should be evaluated. The individual influences of various essential features of self-management interventions need to be determined explicitly. |
