Relying on Trust: A Qualitative Study on Home-Dwelling Older Adults' Experiences and Preferences With Multimorbidity...

Older adults with multimorbidity present a unique challenge to municipal healthcare due to the complexity of managing multiple health conditions simultaneously. Addressing multimorbidity, especially in older adults, requires an integrated, holistic approach focused on person-centred healthcare and patient participation. Multidimensional assessments in municipal healthcare, which consider physical, psychological, and social factors, are essential to understanding and managing these complex health conditions. Additionally, trust in the system's reliability and in staff competency is crucial for ensuring quality care.

The aim of this study was to explore the experiences and preferences of older adults with assessments in the management of multimorbidity within municipal healthcare.

Qualitative data were obtained through semi-structured individual interviews with 12 home-dwelling older adults with multimorbidity from three Norwegian municipalities. The participants were aged 67-92, with an average of five chronic conditions. Interviews were conducted face-to-face in participants' homes between February 2023 and February 2024. Interviews were transcribed and analysed using reflexive thematic analysis.

We identified three main themes: nurturing trust and security through professional competence and assessment skills, navigating vulnerability and dependence in healthcare systems, and the impact of patient participation on assessment outcomes. The results emphasise the importance of competence, trust, autonomy, collaboration, and effective communication both in clinical interactions between health professionals and patients and as a system approach in the management of multimorbidity.

Older adults with multimorbidity valued professional competence and effective communication in their healthcare assessments, as these fostered personal and system trust, as well as a sense of security. Participants also highlighted the importance of their involvement in treatment decisions and the need for a coordinated, person-centred approach to manage their complex health conditions. Our findings underscore the necessity of enhancing healthcare professionals' communication skills, improving information flow, and actively involving patients in assessment and management processes to better support home-dwelling older adults with multimorbidity in municipal healthcare.

This study builds on a recent James Lind Alliance process, which highlighted improving communication with frail older adults as a key area in the management of multimorbidity and one highly relevant to our aim. A reference group, including a user representative, a healthcare professional, and a professor, contributed to the development of the interview guide and formulation of the study aim and provided input on the results. Additionally, the reference group discussed the implications of the findings, contributed on strategies for dissemination, and promoted the integration of the perspectives and priorities of older adults with multimorbidity throughout the research process.