“So I call myself healthy”: a qualitative study on health perceptions and healthcare experiences in older adults with multimorbidity

TL;DR

This study explores how older adults with multiple chronic conditions view their health and interact with healthcare systems designed for single diseases.

Contribution

The study reveals how older adults with multimorbidity resist being labeled as 'sick' and seek autonomy in healthcare.

Findings

Participants used internal strategies to maintain a non-sick identity despite multiple chronic conditions.

Healthcare interactions often threatened their autonomy and non-sick identity.

Patients desire holistic care that avoids stigmatizing terms like 'multimorbidity.'

Abstract

An ageing population and its association with a rising prevalence of co-existing multiple chronic conditions poses increasing challenges for healthcare systems worldwide. In line with the World Health Organization ambition for societies to develop integrated care models and person-centered care, this study aimed to investigate what health means for individuals managing multiple chronic conditions and how these patients navigate a healthcare system primarily designed for single-disease management.

A six-phase reflexive thematic analysis was conducted on 16 individual interviews with patients aged 67 to 87 years old in a Swedish primary care setting.

Two themes were developed. Firstly, Resiliently Positioning as Non-Sick that centered on how participants employed internal strategies to position their identity on the non-sick side of a health spectrum, and secondly, Placing Yourself in the Hands of Healthcare, which focused on the mixed feelings towards interacting with healthcare.

Older individuals with multiple conditions tend to identify as non-sick and strive for autonomy. Engaging with healthcare can pose a threat to both their autonomy and their non-sick identity. They desire healthcare that works holistically, focuses on health and function, and avoids stigmatizing terms like multimorbidity. We recommend that policymakers and healthcare providers integrate this understanding and support for autonomy and holistic approaches into their efforts to deliver person-centered care.

The online version contains supplementary material available at 10.1186/s12875-025-03010-w.

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