Confronting finitude and treatment adherence in older adults with chronic diseases: a qualitative study

Adherence in older adults with chronic conditions is shaped not only by clinical demands but also by how individuals interpret illness, ageing, and the time they perceive they have left. Understanding these meaning‑making processes is essential for developing person‑centred strategies that respond to the realities of multimorbidity and functional decline.

A qualitative descriptive study was conducted using semi‑structured interviews with 32 older adults (mean age = 77.0 years) living with chronic illnesses in the metropolitan area of Porto, Portugal. A maximum‑variation sampling strategy captured diverse social, clinical, and functional contexts. Data were analysed using Reflexive Thematic Analysis within a constructivist paradigm.

Five themes described how participants navigated treatment in daily life: (1) Finitude as a catalyst for meaning and therapeutic action: awareness of vulnerability and limited time informed an existential positioning toward self‑care, ranging from protective engagement to ambivalence; (2) Identity in metamorphosis: treatment adherence was negotiated through tensions between preserving autonomy and accommodating the "sick self"; (3) The relational basis of care: family, social contact, and loneliness shaped motivation and confidence in managing treatment; (4) Recognition in care: feeling listened to and respected reinforced trust, whereas rushed or dismissive encounters undermined engagement; (5) Systemic precariousness: access barriers, financial strain, and service shortages constrained what adherence was practically possible. Across themes, adherence emerged as a contextual, relational, and existential process shaped by personal priorities, support networks, communication quality, and structural feasibility.

Adherence in later life reflects how older adults position themselves toward self‑care in the face of vulnerability, changing identities, and real‑world constraints. Clinical practice may benefit from linking recommendations to what matters most to patients, simplifying regimens, strengthening relational support, and addressing structural barriers. Tailoring care to patients' life contexts may foster more sustainable and meaningful engagement with treatment.