‘Personal care networks’ of older people with multimorbidity: social network analysis and qualitative study
The increase in long-term conditions (LTCs) and multimorbidity, particularly in older people, has led to increased demand and a requirement for more complex treatment models in health and social care. The health and social care environment is becoming further characterised by specialisation, often associated with fragmentation across care sectors. Patients with multimorbidity tend to receive formal and informal (unpaid) care from a variety of people and professionals at different times and locations. Finding the right support, at the right time and in the right place (care navigation) is a burdensome task for patients. When navigation is difficult, overuse, underuse and inappropriate use of services has been reported. As patients move through the maze of services, they select carers based on the LTCs with which they are diagnosed and develop their own ‘personal care network’ (PCN). Little is known about how PCNs are structured and function or how patients interact with their PCN. Our study explored how older people with multimorbidity navigate the care system and build their PCN.
We used a mixed methods design. We developed a structured questionnaire to collect PCN data from older people (aged 55 years or over) with multimorbidity living in England. Social network analysis (SNA) was used to produce descriptive statistics and graphs representing participants’ PCNs. In the qualitative strand, face-to-face semi-structured interviews using a pre-designed topic will collect nuanced, in-depth data from participants living in Lincolnshire. PCN and interview data are integrated to aid the design of tools to support care navigation.
We analysed PCN data for 65 people and present the findings of the quantitative strand of our study. Focusing on the patients’ perspective, this study was able to identify the main ‘actors’ involved in their care. The function of these actors, the frequency and type of interaction with them as well as the quality of contacts were analysed including visual representation through the use of ‘care network graphs’. GP and practice nurses in primary care were found to have a central role in the PCNs for the management of multimorbidity (i.e., providing care as well as information and advice). Relatives and friends were beneficial for emotional support and help in navigating the care system.
This is the first study that applies SNA to explore the structure of care networks for older people with multimorbidity. This study identified that GPs, practice nurses and informal carers had a central role in the network. Our study contributes to the information on how older people with multimorbidity navigate the complex health and care environment, their challenges in care navigation and requirements for care navigation support. It informs the design of tools to support care navigation in the future.