Chronic disease self-management support for persons with dementia, in a clinical setting
Open accessAbstract
The burden of chronic disease is greater in individuals with dementia, a patient group that is growing as the population is aging. The cornerstone of optimal management of chronic disease requires effective patient self-management. However, this is particularly challenging in older persons with a comorbid diagnosis of dementia. The impact of dementia on a person's ability to self-manage his/her chronic disease (eg, diabetes mellitus or heart failure) varies according to the cognitive domain(s) affected, severity of impairment and complexity of self-care tasks. A framework is presented that describes how impairment in cognitive domains (attention and information processing, language, visuospatial ability and praxis, learning and memory and executive function) impacts on the five key processes of chronic disease self-management. Recognizing the presence of dementia in a patient with chronic disease may lead to better outcomes. Patients with dementia require individually tailored strategies that accommodate and adjust to the individual and the cognitive domains that are impaired, to optimize their capacity for self-management. Management strategies for clinicians to counter poor self-management due to differentially impaired cognitive domains are also detailed in the presented framework. Clinicians should work in collaboration with patients and care givers to assess a patient's current capabilities, identify potential barriers to successful self-management and make efforts to adjust the provision of information according to the patient's skill set. The increasing prevalence of age-related chronic illness along with a decline in the availability of informal caregivers calls for innovative programs to support self-management at a primary care level.
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There is a clear lack of appropriate knowledge and training for healthcare professionals on dementia, which had a knock-on effect on discharge planning and patient access to services.
“Our findings suggest that there is a clear lack of appropriate knowledge and training for HCPs on dementia, which had a knock-on effect on discharge planning and patient access to services [46, 50, 51, 54, 59, 61, 73, 74, 77, 78, 80–86].”
From Do hospital-to-home transitions work for older adults with multiple long-term conditions including dementia? A realist review (2025) · cites this paper as [61]
The ‘Implications for clinicians’ section says broader dementia education and training for clinicians would be valuable and describes dementia as under-recognized. It does not establish a clear lack of training or link that lack to discharge planning or patient access to services; the access difficulties it discusses arise from patients’ cognitive impairments. (LLM, conf=0.78)
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Cites
2016 Alzheimer's disease facts and figures
Alzheimer's Association (2016) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2016.03.001 · Cited by 5,069 · see citing works
The global prevalence of dementia: a systematic review and metaanalysis.
Prince, M., Bryce, R., Albanese, E., Wimo, A., Ribeiro, W., & Ferri, C. P. (2013) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2012.11.007 · Cited by 4,941 · see citing works
Self-management education: History, definition, outcomes, and mechanisms
Lorig, K. R., & Holman, H. R. (2003) · Annals of Behavioral Medicine · doi:10.1207/s15324796abm2601_01 · Cited by 4,094 · see citing works
Gauthier, S. G., Reisberg, ., Zaudig, M., Petersen, R. C., Ritchie, K. A., Broich, K., Belleville, S., Brodaty, H., Bennett, D. A., Chertkow, H. M., et al. (2006) · The Lancet · doi:10.1016/s0140-6736(06)68542-5 · Cited by 3,920 · see citing works
Organizing Care for Patients with Chronic Illness
Wagner, E. H., Austin, B. T., & Korff, M. V. (1996) · The Milbank Quarterly · doi:10.2307/3350391 · Cited by 2,877 · see citing works
Lorig, K. R., Sobel, D. S., Stewart, A. L., Brown, B. W., Bandura, A., Ritter, P., Gonzalez, V. M., Laurent, D. D., & Holman, H. R. (1999) · Medical Care · doi:10.1097/00005650-199901000-00003 · Cited by 2,261 · see citing works
A systematic review of adherence with medications for diabetes
Cramer, J. A. (2004) · Diabetes Care · doi:10.2337/diacare.27.5.1218 · Cited by 1,203 · see citing works
Can patient self-management help explain the SES health gradient?
Goldman, D. P., & Smith, J. P. (2002) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.162086599 · Cited by 673 · see citing works
Processes of Self‐Management in Chronic Illness
Schulman‐Green, D., Jaser, S., Martin, F., Alonzo, A., Grey, M., McCorkle, R., Redeker, N. S., Reynolds, N., & Whittemore, R. (2012) · Journal of Nursing Scholarship · doi:10.1111/j.1547-5069.2012.01444.x · Cited by 657 · see citing works
Patient adherence to medical treatment: a review of reviews
van Dulmen, S., Sluijs, E., van Dijk, L., de Ridder, D., Heerdink, R., & Bensing, J. (2007) · BMC Health Services Research · doi:10.1186/1472-6963-7-55 · Cited by 627 · see citing works
Limited literacy and mortality in the elderly
Sudore, R. L., Yaffe, K. S., Satterfield, S., Harris, T. B., Mehta, K. M., Simonsick, E. M., Newman, A. B., Rosano, C., Rooks, R. N., Rubin, S. M., et al. (2006) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2006.00539.x · Cited by 465 · see citing works
Brief cognitive screening instruments: an update
Ismail, Z., Rajji, T. K., & Shulman, K. I. (2009) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.2306 · Cited by 432 · see citing works
Distinguishing Alzheimer’s disease from other major forms of dementia
Karantzoulis, S., & Galvin, J. E. (2011) · Expert Review of Neurotherapeutics · doi:10.1586/ern.11.155 · Cited by 385 · see citing works
Physician Recognition of Cognitive Impairment: Evaluating the Need for Improvement
Chodosh, J., Petitti, D. B., Elliott, M. N., Hays, R. D., Crooks, V. C., Reuben, D. B., Buckwalter, J. G., & Wenger, N. S. (2004) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2004.52301.x · Cited by 350 · see citing works
Comorbidity Profile of Dementia Patients in Primary Care: Are They Sicker?
Schubert, C. C., Boustani, M. A., Callahan, C. M., Perkins, A. J., Carney, C. P., Fox, C., Unverzagt, F. W., Hui, S. L., & Hendrie, H. C. (2005) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2005.00543.x · Cited by 283 · see citing works
Common elements in self-management of HIV and other chronic illnesses: an integrative framework
Swendeman, D., Ingram, B. L., & Rotheram-Borus, M. J. (2009) · AIDS Care · doi:10.1080/09540120902803158 · Cited by 281 · cited 1× · see citing works
“Lorig and Holman(13) have characterized self-management into five core processes (Table 1) that each requires a complex set of physical, emotional and cognitive abilities.(14,15) Conceptualizations of self-management tend to be based on self-efficacy or social cognitive theory.”
the EVIDEM-ED project, Koch, T., & Iliffe, S. (2010) · BMC Family Practice · doi:10.1186/1471-2296-11-52 · Cited by 275 · cited 1× · see citing works
“47 Belief that the carer is able to manage all health-related issues.”
Cognitive Assessment for Clinicians
Hodges, J. R. (2017) · Oxford University Press eBooks · doi:10.1093/med/9780198749189.001.0001 · Cited by 263 · see citing works
Adherence to Medication in Patients with Dementia
Arlt, S., Lindner, R., Rösler, A., & Renteln-Kruse, W. V. (2008) · Drugs & Aging · doi:10.2165/0002512-200825120-00005 · Cited by 249 · see citing works
Zekry, D., Herrmann, F. R., Grandjean, R., Meynet, M.-P., Michel, J.-P., Gold, G., & Krause, K.-H. (2008) · Age and Ageing · doi:10.1093/ageing/afm132 · Cited by 198 · see citing works
Luck, T., Riedel-Heller, S. G., Kaduszkiewicz, H., Bickel, H., Jessen, F., Pentzek, M., Wiese, B., Koelsch, H., van den Bussche, H., Abholz, H. H., et al. (2007) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000108099 · Cited by 191 · see citing works
Rait, G., Fletcher, A., Smeeth, L., Brayne, C., Stirling, S., Nunes, M., Breeze, E., Ng, E. S.-W., Bulpitt, C. J., Jones, D., et al. (2005) · Age and Ageing · doi:10.1093/ageing/afi039 · Cited by 180 · see citing works
Conceptualizing Self-care in Heart Failure
Moser, D. K., & Watkins, J. F. (2008) · The Journal of Cardiovascular Nursing · doi:10.1097/01.jcn.0000305097.09710.a5 · Cited by 177 · see citing works
A Systematic Review of Adherence With Medications for Diabetes
Wens, J., Vermeire, E., Royen, P. V., & Hearnshaw, H. (2004) · Diabetes Care · doi:10.2337/diacare.27.9.2284 · Cited by 171 · see citing works
Jones, D., Drew, P., Elsey, C., Blackburn, D. J., Wakefield, S., Harkness, K., & Reuber, M. (2015) · Aging & Mental Health · doi:10.1080/13607863.2015.1021753 · Cited by 146 · see citing works
Wayfinding in dementia of the Alzheimer type: Planning abilities
Passini, R., Rainville, C. M., Marchand, N., et al. (1995) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/01688639508402431 · Cited by 127 · see citing works
Marti, C. N., Georgiopoulou, V. V., Giamouzis, G., Cole, R. T., Deka, A., Tang, W. H. W., Dunbar, S. B., Smith, A. L., Kalogeropoulos, A. P., & Butler, J. (2012) · Congestive Heart Failure · doi:10.1111/j.1751-7133.2012.00308.x · Cited by 92 · see citing works
Cramm, J. M., Hartgerink, J. M., Steyerberg, E. W., Bakker, T. J. E. M., Mackenbach, J. P., & Nieboer, A. P. (2012) · Quality of Life Research · doi:10.1007/s11136-012-0131-9 · Cited by 78 · see citing works
Competence thresholds for the use of inhalers in people with dementia
Allen, S. (1997) · Age and Ageing · doi:10.1093/ageing/26.2.83 · Cited by 78 · see citing works
Cognitive assessment for clinicians
Kipps, C. (2005) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.2004.059758 · Cited by 78 · see citing works
Lost and Forgotten? Orientation Versus Memory in Alzheimer's Disease and Frontotemporal Dementia
Yew, B., Alladi, S., Mekala, S., Hodges, J. R., & Hornberger, M. (2012) · Journal of Alzheimer s Disease · doi:10.3233/jad-2012-120769 · Cited by 74 · see citing works
Depression associated with dementia
Gutzmann, H., & Qazi, A. (2015) · Zeitschrift für Gerontologie und Geriatrie · doi:10.1007/s00391-015-0898-8 · Cited by 73 · see citing works
Davis, K. K., Himmelfarb, C. D., Szanton, S. L., Hayat, M. J., & Allen, J. K. (2014) · The Journal of Cardiovascular Nursing · doi:10.1097/jcn.0000000000000130 · Cited by 68 · see citing works
Emilien, G., Durlach, C., Minaker, K. L., et al. (2004) · Birkhäuser Basel eBooks · doi:10.1007/978-3-0348-7842-5_7 · Cited by 66 · see citing works
Efficient identification of adults with depression and dementia.
Thibault, J. M., & Steiner, R. W. P. (2004) · PubMed · Cited by 59 · see citing works
Aggressive and impulsive behavior in Alzheimer’s disease and progression of dementia
Bidzan, L., Bidzan, M., & Pąchalska, M. (2012) · Medical Science Monitor · doi:10.12659/msm.882523 · Cited by 56 · see citing works
Violent and criminal manifestations in dementia patients
Cipriani, G., Lucetti, C., Danti, S., Carlesi, C., & Nuti, A. (2015) · Geriatrics and gerontology international/Geriatrics & gerontology international · doi:10.1111/ggi.12608 · Cited by 53 · see citing works
Pathak, K. P., & Montgomery, A. (2014) · Aging & Mental Health · doi:10.1080/13607863.2014.976170 · Cited by 51 · see citing works
Evaluation of adherence to therapy in patients of chronic kidney disease
Sontakke, S. D., Budania, R., Bajait, C. S., Jaiswal, K., & Pimpalkhute, S. A. (2015) · Indian Journal of Pharmacology · doi:10.4103/0253-7613.169597 · Cited by 49 · see citing works
Communicating with older people with dementia
de Vries, K. (2013) · Nursing Older People · doi:10.7748/nop2013.05.25.4.30.e429 · Cited by 47 · see citing works
Factors influencing self-management of Diabetes Mellitus; a review article
Kisokanth, G., Prathapan, S., Indrakumar, J., et al. (2013) · Journal of Diabetology · doi:10.4103/2078-7685.198288 · Cited by 28 · see citing works
Diagnosing dementia: No easy job
Buntinx, F., Lepeleire, J. D., Paquay, L., Iliffe, S., & Schoenmakers, B. (2011) · BMC Family Practice · doi:10.1186/1471-2296-12-60 · Cited by 26 · see citing works
Impaired Acquisition and Rapid Forgetting of Patterned Visual Stimuli in Alzheimer's Disease
Reed, B., Paller, K. A., & Mungas, D. (1998) · Journal of Clinical and Experimental Neuropsychology · doi:10.1076/jcen.20.5.738.1123 · Cited by 19 · see citing works
Identification of Daily Activity Impairments in the Diagnosis of Parkinson Disease Dementia
Cheon, S., Park, K. W., & Kim, J. W. (2015) · Cognitive and Behavioral Neurology · doi:10.1097/wnn.0000000000000081 · Cited by 14 · see citing works
Communicating with people with dementia: Avoiding mistakes.
Voyer, P. (2015) · PubMed · Cited by 1 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [1]World Health Organization Preventing Chronic Diseases: A Vital Investment: WHO Global Report Switzerland WHO Press 2005 200
Cited by
Sorted by citations
eHealth for improving quality of life in breast cancer patients: A systematic review
Triberti, S., Savioni, L., Sebri, V., & Pravettoni, G. (2019) · Cancer Treatment Reviews · doi:10.1016/j.ctrv.2019.01.003 · Cited by 184 · see citing works
Supporting self-care of long-term conditions in people with dementia: A systematic review
Rees, J., Tuijt, R., Burton, A., Walters, K., & Cooper, C. (2021) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2019.103432 · Cited by 21 · see citing works
Lawson, L., Cooper, M., Tolley, C., Hand, A., & Nazar, H. (2025) · BMC Geriatrics · doi:10.1186/s12877-025-06123-0 · Cited by 10 · see citing works
“Key features of discharge planning included developing meaningful care plans, which were communicated to all involved in the transition, informed by the patient’s goals of care and provided opportunities for follow-up in the community [28, 39, 43–61].”
Chronic disease management and dementia: a qualitative study of knowledge and needs of staff
Baird, C., Woolford, M. H., Young, C., Winbolt, M., & Ibrahim, J. (2019) · Australian Journal of Primary Health · doi:10.1071/py18197 · Cited by 6 · see citing works
Self-citation
- Authors
- Ibrahim, J. E., Anderson, L., MacPhail, A., Lovell, J. J., Davis, M.-C., & Winbolt, M.
- Affiliations
- Monash University (AU)
- Ballarat Health Services (AU)
- La Trobe University (AU)
- Corresponding author
- Ibrahim, Joseph Elias
- Venue
- Journal of Multidisciplinary Healthcare
- Publisher
- Informa UK Limited
- Published
- 2017-01
- Volume
- Volume 10
- Pages
- 49-58
- ISSN
- 1178-2390 (ISSN-L)
- PMC
- PMC5283068
- OpenAlex
- W2581511415
- Cited by
- 51
- References
- 45
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 6 · 2023: 2 · 2022: 4 · 2021: 7 · 2020: 8 · 2019: 6 · 2018: 2 · 2017: 8
- FWCI
- 5.38
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Multidisciplinary Healthcare (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Monash University Research Portal (Monash University) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
- Funders
- Monash University
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- dementia, chronic disease self-management, cognitive impairment, executive function, memory impairment, visuospatial ability, language impairment, diabetes mellitus, heart failure, primary care, caregiver involvement, older adults
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