Abbasinia M, Ahmadi F, Kazemnejad A. Patient advocacy in nursing: a concept analysis. Nurs Ethics. 2020; 27:(1)141-151

Person-centered care: a definition and essential elements. J Am Geriatr Soc. 2016; 64:(1)15-8

Banerjee S. Multimorbidity: older adults need health care that can count past one. Lancet. 2015; 385:(9968)587-589

Beauchamp T, Childress JF. Principles of biomedical ethics, 8th edn. Oxford: Oxford University Press; 2019

Bu X, Jezewski MA. Developing a mid-range theory of patient advocacy through concept analysis. J Adv Nurs. 2007; 57:(1)101-110

Coates V. Role of nurses in supporting patients to self-manage chronic conditions. Nurs Stand. 2017; 31:(38)42-46

Daly L, Byrne G, Keogh B. Contemporary considerations relating to health promotion and older people. Br J Nurs. 2019; 28:(21)1414-1419

Davies MJ, Heller S, Skinner TC Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial. BMJ. 2008; 336:(7642)491-495

Dineen-Griffin S, Garcia-Cardenas V, Williams K, Benrimoj SI. Helping patients help themselves: a systematic review of self-management support strategies in primary health care practice. PLoS One. 2019; 14:(8)

Eckerblad J, Theander K, Ekdahl A, Jaarsma T, Hellstrom I. To adjust and endure: a qualitative study of symptom burden in older people with multimorbidity. Appl Nurs Res. 2015; 28:(4)322-327

Federman AD, O'Conor R, Mindlis I Effect of a self-management support intervention on asthma outcomes in older adults: the SAMBA study randomized clinical trial. JAMA Intern Med. 2019; 179:(8)1113-1121

Foo KM, Sundram M, Legido-Quigley H. Facilitators and barriers of managing patients with multiple chronic conditions in the community: a qualitative study. BMC Public Health. 2020; 20:(1)

Gallagher R, Donoghue J, Chenoweth L, Stein-Parbury J. Self-management in older patients with chronic illness. Int J Nurs Pract. 2008; 14:(5)373-382

Garnett A, Ploeg J, Markle-Reid M, Strachan PH. Self-management of multiple chronic conditions by community-dwelling older adults: a concept analysis. SAGE Open Nursing. 2018; 4

Gobeil-Lavoie AP, Chouinard MC, Danish A, Hudon C. Characteristics of self-management among patients with complex health needs: a thematic analysis review. BMJ Open. 2019; 9:(5)

Ha Dinh TT, Bonner A, Clark R, Ramsbotham J, Hines S. The effectiveness of the teach-back method on adherence and self-management in health education for people with chronic disease: a systematic review. JBI Database Syst Rev Implement Reports. 2016; 14:(1)210-247

Health Service Executive (Irish Health Service). Making every contact count. A health behaviour change framework and implementation plan for health professionals in the. 2016. (accessed 10 January 2022)

Health Service Executive (Irish Health Service). Living well with a chronic condition: framework for self-management support. 2017. (accessed 10 January 2022)

Hernández B, Reilly RB, Kenny RA. Investigation of multimorbidity and prevalent disease combinations in older Irish adults using network analysis and association rules. Sci Rep. 2019; 9:(1)

Hevey D, Wilson O'Raghallaigh J Pre-post effectiveness evaluation of Chronic Disease Self-Management Program (CDSMP) participation on health, well-being and health service utilization. Chronic Illn. 2020; 16:(2)146-158

Jonkman NH, Schuurmans MJ, Jaarsma T, Shortridge-Baggett LM, Hoes AW, Trappenburg JCA. Self-management interventions: proposal and validation of a new operational definition. J Clin Epidemiol. 2016; 80:34-42

Jones MC, MacGillivray S, Kroll T, Zohoor AR, Connaghan J. A thematic analysis of the conceptualisation of self-care, self-management and self-management support in the long-term conditions management literature. Journal of Nursing and Healthcare of Chronic Illness. 2011; 3:(3)174-185

Jowsey T, Jeon YH, Dugdale P, Glasgow NJ, Kljakovic M, Usherwood T. Challenges for co-morbid chronic illness care and policy in Australia: a qualitative study. Aust New Zealand Health Policy. 2009; 6:(1)

Kastner M, Hayden L, Wong G Underlying mechanisms of complex interventions addressing the care of older adults with multimorbidity: a realist review. BMJ Open. 2019; 9:(4)

Kennedy A, Rogers A, Chew-Graham C Implementation of a self-management support approach (WISE) across a health system: a process evaluation explaining what did and did not work for organisations, clinicians and service users. Implement Sci. 2014; 9:(1)

Lorig KR, Holman HR. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med. 2003; 26:(1)1-7

Maidment I, Lawson S, Wong G Towards an understanding of the burdens of medication management affecting older people: the MEMORABLE realist synthesis. BMC Geriatr. 2020; 20:(1)

Marengoni A, Angleman S, Melis R Aging with multimorbidity: A systematic review of the literature. Ageing Res Rev. 2011; 10:(4)430-439

Mills SL, Brady TJ, Jayanthan J, Ziabakhsh S, Sargious PM. Toward consensus on self-management support: the international chronic condition self-management support framework. Health Promot Int. 2017; 32:(6)942-952

Morgan HM, Entwistle VA, Cribb A We need to talk about purpose: a critical interpretive synthesis of health and social care professionals' approaches to self-management support for people with long-term conditions. Health Expect. 2017; 20:(2)243-259

National Institute for Health and Care Excellence. Multimorbidity: clinical assessment and management. 2016. (accessed 10 January 2022)

Narasimhan M, Allotey P, Hardon A. Self care interventions to advance health and wellbeing: a conceptual framework to inform normative guidance. BMJ. 2019; 365

Nursing and Midwifery Council. Future nurse: standards of proficiency for registered nurses. 2018. (accessed 10 January 2022)

Oh EG, Lee HJ, Yang YL, Kim YM. Effectiveness of discharge education with the Teach-back method on 30-day readmission: a systematic review. J Patient Saf. 2021; 17:(4)305-310

Ploeg J, Matthew-Maich N, Fraser K Managing multiple chronic conditions in the community: a Canadian qualitative study of the experiences of older adults, family caregivers and healthcare providers. BMC Geriatr. 2017; 17:(40)

Protheroe J, Brooks H, Chew-Graham C, Gardner C, Rogers A. ‘Permission to participate?’ A qualitative study of participation in patients from differing socio-economic backgrounds. J Health Psychol. 2013; 18:(8)1046-55

Public Health England, NHS England, Health Education England. Making Every Contact Count (MECC): consensus statement. 2016. (accessed 10 January 2022)

Royal College of Nursing. Self care. 2020. (accessed 10 January 2022)

Schulman-Green D, Jaser SS, Park C, Whittemore R. A metasynthesis of factors affecting self-management of chronic illness. J Adv Nurs. 2016; 72:(7)1469-89

Stormacq C, Wosinski J, Boillat E, Van den Broucke S. Effects of health literacy interventions on health-related outcomes in socioeconomically disadvantaged adults living in the community: a systematic review. JBI Evidence Synthesis. 2020; 18:(7)1389-1469

Taylor S, Pinnock H, Epiphaniou E A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS—Practical systematic review of Self-Management Support for long-term conditions. Health Services and Delivery Research. 2014; 2:(53)1-580

Teach-back Training. What is Teach-back?. 2021. (accessed 10 January 2022)

Vaartio H, Leino-Kilpi H. Nursing advocacy-a review of the empirical research 1990–2003. Int J Nurs Stud. 2005; 42:(6)705-714

Van de Velde D, De Zutter F, Satink T Delineating the concept of self-management in chronic conditions: a concept analysis. BMJ Open. 2019; 9:(7)

Van het Bolscher-Niehuis MJT, Uitdehaag MJ, Francke AL. Community nurses' self-management support in older adults: A qualitative study on views, dilemmas and strategies. Health Soc Care Community. 2020; 28:(1)195-203

Vetrano DL, Palmer K, Marengoni A Frailty and multimorbidity: a systematic review and meta-analysis. J Gerontol A Biol Sci Med Sci. 2019; 74:(5)659-666

Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff (Millwood). 2001; 20:(6)64-78

Wilkinson A, Whitehead L. Evolution of the concept of self-care and implications for nurses: A literature review. Int J Nurs Stud. 2009; 46:(8)1143-1147

World Health Organization. Health literacy: the solid facts. 2013. (accessed 10 January 2022)

World Health Organization. World report on ageing and health. 2015. (accessed 10 January 2022)

World Health Organization. WHO consolidated guideline on self-care interventions for health: sexual and reproductive health and rights. 2019. (accessed 10 January 2022)

Yarnall AJ, Sayer AA, Clegg A, Rockwood K, Parker S, Hindle JV. New horizons in multimorbidity in older adults. Age Ageing. 2017; 46:(6)882-888

Self-management support for older adults with chronic illness: implications for nursing practice

27 January 2022
Volume 31 · Issue 2


Self-management is a key skill that older adults with multiple comorbidities require. Self-management interventions include medication management, self-monitoring and self-awareness and self-management often requires the older adult to manage the emotional consequences of having multiple comorbidities. The benefits of self-management for older adults include reduced reliance on the health system, enhanced quality of life, empowerment of the individual and reduction in the burden associated with chronic illness. Many factors can influence an older adult's ability to self-manage, including health literacy, mental health difficulties and socio-economic factors. Self-management support is the provision of structures, services and programmes to support and enhance the skills of older adults in managing their own conditions. Nurses are in a pivotal position across the continuum of care, using both person-centred care and the ‘Making Every Contact Count’ approach, to support older adults to self-manage their conditions.

Self–management is increasingly promoted in healthcare policies and research (Wilkinson and Whitehead, 2009; Jones et al, 2011). Indeed, the World Health Organization (WHO) (2015) identified the importance of self-management for older adults given the ageing demographic profile globally, coupled with the increasing numbers of those living with chronic illness and multi-morbidity. Nurses aim to implement holistic person-centred care and work across the continuum of health care (Nursing and Midwifery Council (NMC), 2018) and are therefore ideally suited to the role of promoting self-management with older adults. The aim of this article is to provide conceptual clarity in relation to self-management by older adults living with chronic illness and multi-morbidity and to explore the implications of self-management support by nurses.

Ireland's Health Service Executive (HSE) (2017) has defined self-management as:

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content