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Organizing everyday management in older adults with multimorbidity: a qualitative study from a time-geography
Huiyu Lin1, Huiling Lin1, Zhishou Miao1
1Department of Nursing, Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China.
Background:
Multimorbidity is common among older adults and is associated with substantial treatment burden, functional decline, and complex care needs. Although self-management has received increasing attention, less is known about how older adults organize everyday management activities within the temporal and spatial structures of daily life. This study aimed to explore how older adults with multimorbidity organized their everyday management activities from a time-geography perspective.
Methods:
A qualitative descriptive study was conducted with 26 community-dwelling older adults with two or more chronic conditions. Participants were purposively recruited through the outpatient pharmacy of a tertiary hospital. Semi-structured interviews were conducted face to face and focused on daily routines, management activities, bodily changes, healthcare use, and adjustment strategies. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis informed by time-geography.
Results:
Data from 26 interviews reached saturation. Thematic analysis generated four themes and eight subthemes: (1) management embedded in everyday routines (management within household life, routine as a stabilizing strategy); (2) capability constraints and fragile routines (symptom fluctuation and disrupted plans, limited mobility, energy, and digital capacity); (3) coordination burden under coupling and authority constraints (constant alignment with people and facilities, restricted choice under rules and roles); and (4) active reorganization under multiple constraints (simplifying and planning ahead, unequal capacity to absorb disruption).
Conclusion:
Everyday management among older adults with multimorbidity is not a separate or clearly bounded medical activity but a dynamic time-space process embedded in daily life. A time-geography perspective helps reveal how personal, relational, and institutional constraints shape management practices and highlights the need for more realistic, person-centered support for older adults living with multimorbidity.
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