Older adults' engagement in managing their chronic health conditions: a scoping review

Patient engagement is central in managing chronic conditions. Engagement may be particularly challenging for older adults with their age-related changes. However, the concept and strategies for promoting patient engagement among older adults remain underdeveloped. We conducted a scoping review to understand the current state of knowledge about older adults' engagement in managing their chronic conditions.

Following Arksey and O'Malley's framework, we searched and reviewed studies focused on older adults' engagement in managing chronic conditions using 3 databases (PubMed, SCOPUS, and CINAHL). Data were extracted using a standardized form and summarized descriptively.

From 6,780 records, 65 articles met the criteria, including 34 observational, 18 qualitative, and 13 experimental studies. Patient activation, participation, and engagement were commonly used terms, but they were used interchangeably and rarely defined. Key factors influencing patient engagement included patient attributes (e.g., age, health literacy), clinician attributes, and healthcare system characteristics. Outcomes were assessed through clinical measures (e.g., blood pressure, hemoglobin A1c), patient-reported outcomes, and self-management behaviors. Although experimental studies reported positive outcomes, the generalizability of findings was limited due to the heterogeneity of interventions and outcome measures without a clear theoretical framework.

Engagement of older adults in their chronic care is inconsistently defined and measured across the literature. Measures without theoretical frameworks make it difficult to translate the findings and build evidence. A systematic approach is needed to build an evidence base to understand and develop interventions to improve older adult engagement in their care.