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Striving for Control: Cognitive, Self-Care, and Faith Strategies Employed by Vulnerable Black and White Older Adults with Multiple Chronic Conditions

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Abstract

The average older adult reaches age 65 with at least two chronic, co-occurring illnesses, or multiple morbidities (MM). We currently lack critical information about the specific strategies older adults use to attempt to control these MM. To increase our understanding of how older adults attempt to manage these MM and retain control of their health, in-depth interviews were conducted with 41 Black and White middle aged and older men and women with MM. We were particularly interested in representing the experience of those groups more vulnerable to adverse health outcomes due to greater disease prevalence and low income. During in-depth interviews, we asked open-ended questions on life and health history and open-ended and semi-structured questions about self-care for multiple morbidities. Participants expressed a strong desire to remain in control of their health; to do so they employed a wide range of strategies including cognitive structuring techniques (being health vigilant, normalizing, resignation/relinquishing control, and social comparison), self-care activities (emphasizing diet, exercise, medication taking, modifying existing activities, going to the doctor), and faith orientations (prayer as a constructive support strategy, gaining strength from God, church as a central part of life). With the exception of faith orientations, there were no race/ethnicity differences in the strategies participants use. Future studies should expand on this knowledge by exploring the contextual, cultural, and psychological backdrop and characteristics that shape the use of these coping strategies.

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Notes

  1. We use the term “multiple morbidity” (MM) to describe the co-occurrence of two or more chronic illnesses, as opposed to “comorbidity” in which conditions are linked with an index disease under study. We use this term since we are not referring to any specific coexisting illness

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Acknowledgements

This research was supported by the Department of Behavioral Science at the University of Kentucky. We also acknowledge the contributions of Michelle Johnson, William Edwards, Heather Wallace, Joy Jacobs–Lawson and, most especially, the 41 elders who gave generously of their time.

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Authors and Affiliations

  1. Cancer Prevention Fellow, National Cancer Institute and Master of Public Health Student, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA

    Corinne R. Leach

  2. Department of Behavioral Science, University of Kentucky, Lexington, KY, USA

    Nancy E. Schoenberg

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  1. Corinne R. Leach
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Correspondence to Corinne R. Leach.

Appendix

Appendix

Partial list of questions asked during in-depth interviews:

Please tell me about your health these days.

Probes:

What illnesses do you have?

What do you do to take care of these illnesses?

For each disease, the following questions were asked:

What do you do to take care of it?

Do you do these things on a daily basis?

Do you consider the illness serious?

We hear a lot about people say that it is difficult to deal with more than one illness. Would you say this is true for you? What are the most difficult parts of caring for more than one disease?

I’d like to ask you now to think about all of the things you do to take care of your disease/health condition on a typical day, from when you wake up to when you go to bed. This would include the meals that you eat, any exercise or pills you take, medical care you get, etc.

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Leach, C.R., Schoenberg, N.E. Striving for Control: Cognitive, Self-Care, and Faith Strategies Employed by Vulnerable Black and White Older Adults with Multiple Chronic Conditions. J Cross Cult Gerontol 23, 377–399 (2008). https://doi.org/10.1007/s10823-008-9086-2

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