Experience of Elderly Korean Women with Diabetes and Multimorbidity in Elderly Couple Households: A Qualitative Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Participants
2.2. Data Collection
2.3. Data Analysis
2.4. Ethical Considerations
3. Results
3.1. Treating Illness as a Part of Life and Taking Care of Personal Health
3.1.1. Accepting the Growing Number of Incurable Diseases as a Part of Aging
“All the diseases I have are chronic. However, even if the diseases are not cured, I do not get sick often because I take care of myself. So…I have to live with it (diseases) like friends.”(Participant A)
“My husband and I both go to the hospital often. I went to the hospital for treatment this morning... Going to the hospital is the most important part of our daily routine.”(Participant B)
“I think the older I get, the more diseases I get. I think a lot of people at my age have knee pain. I am 71 years old, and this year I feel that my energy is lower than last year. So, I feel I’m getting older.”(Participant C)
3.1.2. While Facing Multimorbidity, Focusing on Managing Diabetes to Include Complementary Treatment Methods Obtained through Self-Education
“My husband eats salty food so much. I keep trying (to be careful with salty food), but it doesn’t work. Even if I ask him to eat blander food, he always says (if the food is not salty enough) that it doesn’ttaste good. I cook food for my husband separately and add salt to it, but I also end up eating salt (laughs). Even though I’m more careful than before…it is not easy.”(Participant E)
“I took painkillers for back pain, but I saw on TV that it was not good to take too many painkillers. So I stopped taking the medicine and (my back) hurts a lot. (Omission) I don’t eat red ginseng because my doctor told me not to eat it. I don’t take anything else (except the medicine), but these days I don’t have energy, so I should have to eat something like red ginseng…”(Participant F)
3.1.3. Following Medication Regimens despite Difficulties Associated with Managing Multimorbidity
“A high blood pressure medicine, a hyperlipidemia medicine, and a medicine that prevents dementia, etc. (I take) a handful. (Omission) Ha (Sighs)… Anyway, it’s hard because I take several medications.”(Participant D)
“My blood pressure has gone down, so I went to the doctor and changed the medicine again. My blood sugar level was slightly higher this time... But I don’t think I’ve changed my diabetes medication...ah… no, no, it seems that even one pill for diabetes has changed...ah…I do not know for sure.”(Participant B)
“There are separate medicines for diabetes and rheumatoid arthritis, but I take them (both medicines) together, so I don’t forget to take them. I don’t know if it’s okay to take them together, but the doctor told me to take both medicines 30 minutes after a meal, so I take them together. However, I stopped taking the rheumatoid medication that I used to take once a week. (Why did you stop?) I thought it would be bad if I kept taking the medicine even though I wasn’t sick.”(Participant G)
3.2. Daily Functioning While Coping with Various Diseases
3.2.1. Continuing Household Upkeep and Social Activity Participation despite Illnesses
“I live a busy life because I have to go to the hospital for my hurt back, to exercise, and to go to senior classes. I have also to do housekeeping. So I am busy.”(Participant F)
“Back pain is the hardest for me. I can’t walk freely, and if I walk a lot, my back hurts more, so I have to sit and rest a few times… I don’t think diabetes or high blood pressure is too difficult because all I need to do is take medicine. But the back pain gets better only after taking medication or physical therapy and comes back after a while... It’s hard, but I just live with it.”(Participant D)
3.2.2. Helping Children, Such as Cooking for their Children or Caring for Their Grandchildren
“Our youngest son is part of a dual-income couple, so my husband and I are taking care of our grandchildren. If we don’t help, it’s difficult for them (the youngest son and his wife) to live. (Shakes head) (If we don’t help them) they have to leave the baby with someone else… I think it’s bad. I think it’s normal as a parent (to be helping children).”(Participant C)
3.3. Caring for and Receiving Help from the Husband
3.3.1. Being Husband’s Caregiver While Coping with Multimorbidity
“My husband also has diabetes, so I was careful not to increase our glycemic index, so he said that food does not raise his blood sugar. But when my husband drinks 6–7 cups of instant coffee a day, his blood sugar rises dramatically... So these days, I don’t buy mixed coffee and I tell my husband to drink black coffee, so (he) drinks black coffee at home, but I think he’ll drink mixed coffee outside.”(Participant I)
3.3.2. Living with Compassion and Consideration for Husband’s Aging
“Wouldn’t my health be bad if I lived alone? If I lived alone, I’d probably be lazy. If my husband lives with me, at least I’ll prepare a meal. But I won’t eat well if I’m alone because I don’t enjoy it.”(Participant H)
3.3.3. Receiving Husband’s Help for Some of the Housework
“My husband washes his dishes by himself. He also runs the vacuum every now and then. When my husband was young, he didn’t do (housework). He didn’t even come into the kitchen.”(Participant H)
3.4. Trying Not to Become a Burden to Their Children
3.4.1. Avoiding Conversations concerning Pain and Discomfort to Keep Children from Worrying
“After I started getting arthritis, my kids told me not to work. But I tell them that I’m OK even if I’m sick. (Laughs) There’s no reason to make the children worry about me. Illness is something I have to manage. Just because my children know doesn’t mean my illness will be cured, it just puts a burden on them.”(Participant G)
3.4.2. Not Expecting to Receive Support from Children and Seeking Solace from Within Occasionally
“Everyone is upset because of their children and husband sometimes. In the past, when I was concerned about my children and husband (especially about upsetting things), my body would hurt. Now… I live without worrying about them. I have to be satisfied because all my kids are healthy.”(Participant J)
3.4.3. Hoping Not to Be a Burden on the Children Due to Worsening Health
“My wish is to die without suffering. (Her eyes began to well up) I’m afraid my kids will suffer because I’ve been lying in bed for a long time… That’s what worries me the most.”(Participant B)
4. Discussion
Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Jung, K.H.; Oh, Y.H.; Lee, Y.K.; Oh, M.A.; Kang, E.N.; Kim, K.R.; Hwang, N.H.; Kim, S.J.; Lee, S.H.; Lee, S.G.; et al. Policy Report: 2017 Survey on the Actual Conditions of the Elderly; Ministry of Health and Welfare & Korea Institute for Health and Social Affairs: Sejong, Korea, 2018. [Google Scholar]
- Kim, Y.K. The change of family life cycle and policy implications. Health Soc. Welf. Forum. 2014, 211, 7–22. Available online: https://www.kihasa.re.kr/web/publication/periodical/view.do?ano=512&menuId=48&aid=326&tid=38&bid=19 (accessed on 4 May 2022).
- Yang, J.; Park, M.S.; Song, J.; Lee, J.H. Development of Teaching Materials for Population Education. 2011 Policy Report. Available online: https://www.gwff.kr/base/board/read?boardManagementNo=1&boardNo=196&board=196&searchCategory=&page=44&searchType=&searchWord=&menuLevel=3&menuNo=26 (accessed on 9 August 2022).
- Statistics Office. 2017 Statistics Related to Older People. Available online: http://kostat.go.kr/portal/korea/kor_nw/1/1/index.board?bmode=read&aSeq=363362 (accessed on 9 August 2022).
- Liang, J.; Brown, J.W.; Krause, N.M.; Ofstedal, M.B.; Bennett, J. Health and living arrangements among older Americans. J. Aging Health 2005, 17, 305–335. [Google Scholar] [CrossRef] [PubMed]
- Park, B.-Y.; Kwon, H.-J.; Ha, M.-N.; Burm, E.-A. A comparative study on mental health between elderly living alone and elderly couples: Focus on gender and demographic characteristics. J. Korean Public Health Nurs. 2016, 30, 195–205. [Google Scholar] [CrossRef]
- Korea Disease Control and Prevention Agency. Women’s’ Health 2020 STATS & FACTS in Korea. Available online: http://kdca.go.kr/board/board.es?mid=a20503050000&bid=0021&act=view&list_no=712552# (accessed on 4 May 2022).
- International Diabetes Federation. IDF Diabetes Atlas. 9th Edition. Available online: https://diabetesatlas.org/atlas/ninth-edition/ (accessed on 9 August 2021).
- World Health Organization. Diabetes. Available online: https://www.who.int/news-room/fact-sheets/detail/diabetes (accessed on 6 August 2021).
- Jung, C.-H.; Son, J.W.; Kang, S.; Kim, W.J.; Kim, H.-S.; Kim, H.S.; Kim, H.S.; Seo, M.; Shin, H.-J.; Lee, S.-S.; et al. Diabetes Fact Sheets in Korea, 2020: An appraisal of current status. Diabetes Metab. J. 2021, 45, 1–10. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. Multimorbidity: Technical Series on Safer Primary Care. Available online: http://www.who.int/iris/handle/10665/252275 (accessed on 6 August 2021).
- Lenzi, J.; Avaldi, V.M.; Rucci, P.; Pieri, G.; Fantini, M.P. Burden of multimorbidity in relation to age, gender and immigrant status: A cross-sectional study based on administrative data. BMJ Open 2016, 6, e012812. [Google Scholar] [CrossRef]
- Ward, B.W.; Black, L.I. State and regional prevalence of diagnosed multiple chronic conditions among adults aged ≥18 years—United States, 2014. Morb. Mortal. Wkly. Rep. 2016, 65, 735–738. [Google Scholar] [CrossRef] [PubMed]
- Kim, S.; Bennett, K.; Wallace, E.; Fahey, T.; Cahir, C. Measuring medication adherence in older community-dwelling patients with multimorbidity. Eur. J. Clin. Pharmacol. 2018, 74, 357–364. [Google Scholar] [CrossRef]
- Rosbach, M.; Andersen, J.S. Patient-experienced burden of treatment in patients with multimorbidity—A systematic review of qualitative data. PLoS ONE 2017, 12, e0179916. [Google Scholar] [CrossRef]
- Gu, J.; Chao, J.; Chen, W.; Xu, H.; Zhang, R.; He, T.; Deng, L. Multimorbidity and health-related quality of life among the community-dwelling elderly: A longitudinal study. Arch. Gerontol. Geriatr. 2018, 74, 133–140. [Google Scholar] [CrossRef]
- Marengoni, A.; Angleman, S.; Melis, R.; Mangialasche, F.; Karp, A.; Garmen, A.; Meinow, B.; Fratiglioni, L. Aging with multimorbidity: A systematic review of the literature. Ageing Res. Rev. 2011, 10, 430–439. [Google Scholar] [CrossRef]
- Quah, J.H.M.; Wang, P.; Ng, R.R.G.; Luo, N.; Tan, N.C. Health-related quality of life of older Asian patients with multimorbidity in primary care in a developed nation. Geriatr. Gerontol. Int. 2017, 17, 1429–1437. [Google Scholar] [CrossRef] [PubMed]
- van Manen, M. Researching Lived Experience: Human Science for An Action Sensitive Pedagogy, 2nd ed.; Left Coast Press: New York, NY, USA, 1997. [Google Scholar]
- Sandelowski, M. The problem of rigor in qualitative research. Adv. Nurs. Sci. 1986, 8, 27–37. [Google Scholar] [CrossRef] [PubMed]
- Duguay, C.; Gallagher, F.; Fortin, M. The experience of adults with multimorbidity: A qualitative study. J. Comorbidity 2014, 4, 11–21. [Google Scholar] [CrossRef]
- Ho, H.Y.; Chen, M.H.; Lou, M.F. Exploring the experiences of older Chinese adults with comorbidities including diabetes: Surmounting these challenges in order to live a normal life. Patient Prefer. Adherence 2018, 12, 193–205. [Google Scholar] [CrossRef] [PubMed]
- Chung, M.S.; Lim, K.-C.; Kim, Y.H. Effects of health status and health management on activities of daily living among urban-dwelling older Koreans. J. Korean Acad. Soc. Nurs. Educ. 2016, 22, 72–82. [Google Scholar] [CrossRef]
- Dumbreck, S.; Flynn, A.; Nairn, M.; Wilson, M.; Treweek, S.; Mercer, S.W.; Alderson, P.; Thompson, A.; Payne, K.; Guthrie, B. Drug-disease and drug-drug interactions: Systematic examination of recommendations in 12 UK national clinical guidelines. BMJ 2015, 350, h949. [Google Scholar] [CrossRef] [PubMed]
- Costa, E.; Giardini, A.; Savin, M.; Menditto, E.; Lehane, E.; Laosa, O.; Pecorelli, S.; Monaco, A.; Marengoni, A. Interventional tools to improve medication adherence: Review of literature. Patient Prefer. Adherence 2015, 9, 1303–1314. [Google Scholar] [CrossRef]
- Joo, S.; Jun, H.J. Predictors of life satisfaction of husbands and wives in elderly couple households. J. Fam. Relat. 2014, 19, 193–211. Available online: https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART001926166 (accessed on 3 May 2022).
- Chen, H.-M.; Huang, M.-F.; Yeh, Y.-C.; Huang, W.-H.; Chen, C.-S. Effectiveness of coping strategies intervention on caregiver burden among caregivers of elderly patients with dementia. Psychogeriatrics 2015, 15, 20–25. [Google Scholar] [CrossRef]
- Jaracz, K.; Grabowska-Fudala, B.; Górna, K.; Jaracz, J.; Moczko, J.; Kozubski, W. Burden in caregivers of long-term stroke survivors: Prevalence and determinants at 6 months and 5 years after stroke. Patient Educ. Couns. 2015, 98, 1011–1016. [Google Scholar] [CrossRef]
- Cho, H.C. A longitudinal analysis of the drinking of middle-aged men on the spouse’s drinking. Ment. Health Soc. Work 2015, 43, 63–87. Available online: https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART002061559 (accessed on 6 May 2022).
- Meier, E.A.; Gallegos, J.V.; Thomas, L.P.M.; Depp, C.A.; Irwin, S.A.; Jeste, D.V. Defining a good death (successful dying): Literature review and a call for research and public dialogue. Am. J. Geriatr. Psychiatry 2016, 24, 261–271. [Google Scholar] [CrossRef] [PubMed]
- Seok, H. The study on the living-alone experience of elderly men. Korean J. Soc. Welf. 2014, 66, 29–53. [Google Scholar] [CrossRef]
- Choi, M.R. Daily Living with Consciousness of Mild Cognitive Impairment: Focusing on Cognitive Enhancement Program Participants. Unpublished Ph.D. Thesis, Ewha Womans University, Seoul, Korea, 2018. [Google Scholar]
Participants | Age (yrs) | Education Level | Diagnosis | Diagnosis Period (yrs) | Number of Daily Medications | Age of Husband (yrs) | Diagnosis of Husband |
---|---|---|---|---|---|---|---|
A | 74 | Middle school | Osteoarthritis | Over 25 | 0 (Under treatment with acupuncture) | 74 | Pancreatic cancer |
Cerebrovascular disease | 18 | ||||||
Arrhythmia | 15 | ||||||
Diabetes | 2 | ||||||
B | 79 | High school | Diabetes | 25 | 5 | 87 | No disclosure of her husband’s diagnosis |
Hypertension | Over 10 | ||||||
Osteoarthritis | Over 10 | ||||||
C | 70 | High school | Diabetes | 11 | 6 | 73 | Diabetes Hyperlipidemia |
Hyperlipidemia | Unknown | ||||||
Hypertension | Under 10 | ||||||
Osteoarthritis | 2–3 | ||||||
Osteoporosis | 2–3 | ||||||
Hypothyroidism | 5 months | ||||||
Colorectal cancer | 2 | ||||||
D | 80 | Under elementary school | Hypertension | Over 40 | 12 | 78 | Hypertension Herniation of lumbar disk |
Diabetes | 35 | ||||||
Hyperlipidemia | Unknown | ||||||
Thyroid cancer | Over 20 | ||||||
Herniation of lumbar disk | 3 | ||||||
Lumbar spinal stenosis | 7 months | ||||||
E | 71 | High school | Chronic hepatitis | 12 | 5.5 | 72 | Diabetes Hyperlipidemia |
Diabetes | 10 | ||||||
Hypertension | 9 | ||||||
Osteoporosis | 2 | ||||||
Hyperlipidemia | 2 | ||||||
Osteoarthritis | 7 | ||||||
F | 79 | Under elementary school | Diabetes | 15 | 5 | 82 | Hypertension Back pain |
Hypertension | Over 10 | ||||||
Lumbar spinal stenosis | 1 | ||||||
G | 65 | High school | Diabetes | 20 | 8 | 67 | None |
Rheumatoid arthritis | 2 | ||||||
H | 72 | High school | Diabetes | 30 | 8 | 72 | Diabetes |
Hypertension | 10 | ||||||
Panic disorder | 1 | ||||||
I | 65 | High school | Breast cancer | 7 | 7 | 68 | Diabetes |
Diabetes | 7 | ||||||
Osteoporosis | 7 | ||||||
J | 73 | Under elementary school | Hypertension | 20 | 8.5 | 70 | Hypertension |
Diabetes | 10 | ||||||
Osteoarthritis | 1 |
Theme | Essential Theme |
---|---|
| Treating illness as a part of life and taking care of personal health |
| |
| |
| Daily functioning while coping with various diseases |
| |
| Caring for and receiving help from the husband |
| |
| |
| Trying not to become a burden to their children |
| |
|
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Kim, O.; Dan, H. Experience of Elderly Korean Women with Diabetes and Multimorbidity in Elderly Couple Households: A Qualitative Study. Healthcare 2022, 10, 1675. https://doi.org/10.3390/healthcare10091675
Kim O, Dan H. Experience of Elderly Korean Women with Diabetes and Multimorbidity in Elderly Couple Households: A Qualitative Study. Healthcare. 2022; 10(9):1675. https://doi.org/10.3390/healthcare10091675
Chicago/Turabian StyleKim, Oksoo, and Hyunju Dan. 2022. "Experience of Elderly Korean Women with Diabetes and Multimorbidity in Elderly Couple Households: A Qualitative Study" Healthcare 10, no. 9: 1675. https://doi.org/10.3390/healthcare10091675
APA StyleKim, O., & Dan, H. (2022). Experience of Elderly Korean Women with Diabetes and Multimorbidity in Elderly Couple Households: A Qualitative Study. Healthcare, 10(9), 1675. https://doi.org/10.3390/healthcare10091675