Rationale

The proportion of older adults living with long-term conditions (LTCs) is increasing. Self-care and self-management approaches are seen as valuable in helping older people with LTCs to manage their health and care, yet the theoretical overlaps and divergences are not always clear.

Objectives

The objectives of this review were to: (1) systematically identify and appraise studies of self-care or self-management of LTCs by community-dwelling older adults (aged ≥60 years) either informed by, applying, creating, or testing theory; (2) explore similarities or points of convergence between the identified theories; and (3) use a meta-ethnographic approach to synthesise the theories and group related concepts into core constructs.

Methods

We conducted a systematic theory synthesis, searching six electronic databases. Three reviewers independently screened titles and abstracts followed by full texts and two reviewers appraised study quality. Theoretical data were synthesised within and across individual theories using meta-ethnographic line-of-argument synthesis.

Results

A total of 141 articles (138 studies) and 76 theories were included in the review. Seven core constructs were developed: (1) temporal and spatial context; (2) stressors; (3) personal resources; (4) informal social resources; (5) formal social resources; (6) behavioural adaptations; and (7) quality of life outcomes. A line of argument was developed that conceptualised older adults’ self-care and self-management as a dynamic process of behavioural adaptation, enabled by personal resources and informal and formal social resources, aimed at alleviating the impacts of stressors and maintaining quality of life.

Conclusion

This synthesis provides an overview of theories used in research on older adults’ LTC self-care and self-management. Our synthesis describes the complex interplay of intrinsic and extrinsic factors influencing self-care and self-management behaviours and provides considerations for future research, intervention design, and implementation. The utility of the constructs in research and practice requires further attention and empirical validation.

中文翻译：

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社区老年人自我护理和自我管理长期状况的理论：系统评价和元人种学

基本原理

患有长期疾病 (LTC) 的老年人的比例正在增加。自我保健和自我管理方法被认为有助于帮助患有 LTC 的老年人管理他们的健康和护理，但理论上的重叠和分歧并不总是很清楚。

目标

本综述的目的是：（1）系统地识别和评估社区老年人（≥60 岁）对 LTC 的自我护理或自我管理的研究，这些研究要么被告知、应用、创建或测试理论；(2) 探索已识别理论之间的相似之处或收敛点；(3) 使用元人种学方法来综合理论并将相关概念分组为核心结构。

方法

我们进行了系统的理论综合，检索了六个电子数据库。三名审稿人独立筛选标题和摘要，然后是全文，两名审稿人评估研究质量。使用元人种学论据线合成在单个理论内部和之间合成理论数据。

结果

该评价共纳入 141 篇文章（138 项研究）和 76 条理论。开发了七个核心结构：（1）时间和空间背景；(2) 压力源；(3) 个人资源；(4) 非正式的社会资源；（五）正规的社会资源；(6) 行为适应；(7) 生活质量结果。提出了一种观点，将老年人的自我保健和自我管理概念化为一个动态的行为适应过程，由个人资源和非正式和正式的社会资源实现，旨在减轻压力源的影响并保持生活质量。

结论

该综合概述了用于研究老年人 LTC 自我护理和自我管理的理论。我们的综合描述了影响自我护理和自我管理行为的内在和外在因素的复杂相互作用，并为未来的研究、干预设计和实施提供了考虑因素。结构在研究和实践中的效用需要进一步关注和实证验证。