Role transition in comorbidity management: a qualitative study of dementia home care trajectories

The coexistence of comorbidities is quite common for people living with dementia. Dementia-related symptoms pose challenges for comorbidity management. Nevertheless, our understanding of the comorbidity management process for people living with dementia is rather limited. The aim of this study was to understand the experience of comorbidity management in people living with dementia and to explore the home care trajectories of comorbidity management guided by transition theory.

Qualitative methods based on reflexive thematic analysis were employed. A combination of purposive sampling and maximum variation sampling methods was used, and 18 family caregivers and 8 individuals with dementia were recruited. Semistructured interviews were conducted at a memory clinic in Northeast China between November 2022 and March 2023. The interviews were transcribed verbatim and analyzed using thematic analysis.

Our findings described the comorbidity management of people living with dementia as a role transition process, which was mapped as a dynamic trajectory comprising four stages with a critical point: 'I can do it myself', self-management under family supervision, partial substitution by family members, and complete substitution. To slow the progression of the loss of self-identity, three factors were proposed: consideration of cultural values and beliefs, tailored approaches, and the principle that self-management cannot exist without family support. Among them, Confucian culture and filial piety served as the starting point and context for family caregivers' involvement in comorbidity management. The last theme explored the specific pattern of ill-timed transition as a type of care response.

The findings of this study provide a new perspective on supportive interventions for comorbidity management in people living with dementia. Future longitudinal studies should be conducted to validate our results. Interventions developed on the basis of our findings will help manage comorbidities, striving to preserve self-identification as much as possible while ensuring safety.