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The Meaning and Significance of Self-Management Among Socioeconomically Vulnerable Older Adults

¹ Indiana University Center for Aging Research, Indianapolis.
² Regenstrief Institute, Inc., Indianapolis, Indiana.
³ Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis.
⁴ Richard L. Roudebush VA Medical Center, Indianapolis, Indiana.
⁵ Department of Sociology, Portland State University, Oregon.

Address correspondence to: Daniel O. Clark, PhD, Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indiana University School of Medicine, 410 West 10th Street, HITS Building Suite 2000, Indianapolis, IN 46202-3012. E-mail: dclark{at}regenstrief.org

Objectives. The aim of this study was to describe and contrast perceptions of self-management among socioeconomically vulnerable and nonvulnerable older adults.

Methods. We used in-depth, in-home interviews guided by identity theory. Analyses included reviewing audiotapes, creating and comparing field notes, coding transcripts, and identifying themes based on case summaries. Interviews took place in patients' homes. Participants were 23 vulnerable older adults with incomes at or below 200% of the federal poverty level and no private insurance and 12 older adults with private health insurance.

Results. The vulnerable sample had lower educational attainment and lower health literacy than the privately insured sample. Keeping doctor visits and taking prescription medications largely defined self-management for the vulnerable sample but were just two of a number of roles noted by the privately insured group, who expressed health promotion as the key to healthy aging. The vulnerable interviewees relayed few examples of healthy aging and did not have expectations for healthful aging. In contrast, the privately insured interviewees gave examples and had expectations of living long and healthfully into old age.

Discussion. Improved understanding of the role of social context in expectations regarding aging, and awareness of and priorities for self-management, could lead to improvements in self-management support and thus chronic care outcomes.

Key Words: Self-management • Health literacy • Qualitative research • Health disparities