Effect of Care Dependency on Self-Management and Quality of Life in Older Adults with Chronic Diseases

Effect of Care Dependency on Self-Management and Quality of Life in Older Adults with Chronic Diseases | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of Care Dependency on Self-Management and Quality of Life in Older Adults with Chronic Diseases Naz GÖKDEMİR, Gülendam Hakverdioğlu Yönt This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6498674/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Aim This study was planned as a cross-sectional and correlational study to determine the effect of care dependency on chronic disease, self-management, and quality of life in the elderly individuals with chronic diseases. Methods A cross-sectional, correlational study was conducted with 200 older adults diagnosed with chronic diseases and living in a nursing home in western Turkey. Data were collected data collection tools and analyzed using descriptive and inferential statistics. Results A significant difference was found between employment and Care Dependency status of older adults and chronic disease self-management. Conclusion Increasing age and prolonged chronic disease duration reduce independence and quality of life. Strategies aimed at promoting independence, improving functional capacity, and enhancing self-management are essential to maintaining a higher quality of life. Relevance to Clinical Practice: Health professionals should plan the care and treatment of the older adults with chronic diseases with a holistic perspective while identifying the health problems that the older adults with chronic diseases experience and may experience, provide education and counseling to the older adults and their families to increase functional capacity, and take an active role in improving the quality of life of the older adult and adding years to life by making special care and education plans for each older adults and their families. Patient or Public Contribution: These findings provide practical guidance for health care management and highlight the need for individualized care and the priority of promoting independence to improve self-management and quality of life of older adults with chronic diseases. Chronic disease self-management care dependency nursing care older adult Summary Statement of Implications for Practice What does this research add to existing knowledge in gerontology? Our study emphasizes the importance of recognizing the relationship between dependency levels and chronic disease self-management and quality of life of the elderly individuals with chronic diseases. We contribute to the existing knowledge by emphasizing the central role of screening as a proactive strategy to plan, implement and evaluate health practices to improve the quality of life of the elderly, to improve care outcomes, and to encourage independence and increase functional capacity of the elderly. What are the implications of this new knowledge for nursing care with older people? In order to improve the quality of life of the elderly with chronic disease, holistic approaches that address physical, psychological and social well-being from a holistic perspective should be used in the planning of nursing care for the elderly and integrated into care. Our research supports the development of personalized chronic disease self-management interventions that focus on the management of dependency level and may have a transformative effect on physical and psychological functioning and thus quality of life in the elderly with chronic disease. How could the findings be used to influence policy or practice or research or education? Policymakers and health care organizations can use our findings to advocate that assessments of care dependency and self-management are important to the quality of life of older people with chronic disease and should be included as standard components of clinical care guidelines. Educators in nursing and health programs can incorporate the importance of multifaceted approaches to care into their curricula, with particular emphasis on care dependency, self-management and quality of life of older adults, thereby ensuring that future health care workers are well prepared to address the unique challenges faced by older adults. Introduction Life expectancy is increasing, birth rates are decreasing and therefore the elderly population is increasing numerically and proportionally. According to World Health Organization (WHO) data, while there were 600 million people over the age of 60 in the world in 2000, this number is expected to double in 2025, and the population over the age of 60 is estimated to reach 2 billion in 2050. 1 The increasing aging of society and the increasing frequency of chronic diseases requiring care due to aging cause an increase in the care needs of the elderly and many related problems. Care dependency is defined as a decrease in the ability of individuals to meet their self-care needs and the need for professional support. 2 Chronic diseases are defined by the WHO and the United Nations (UN) as the most important health problems of the 21st century and pose a global threat to the sustainability of health systems with high mortality rates and excessive costs in health expenditures. Chronic diseases in old age, such as chronic heart failure, cancer, stroke, chronic obstructive pulmonary disease, asthma, hypertension, Alzheimer's disease, dementia, and diabetes, account for more than half of the global burden of disease. 3 , 4 WHO emphasizes that the majority of health expenditures (60–80%) are made for the treatment of chronic diseases. Worldwide, deaths due to chronic diseases account for 60% of all deaths. 1 , 3 According to data from the Turkish Statistical Institute (TÜİK), similarly, 76.4% of all deaths in Turkey are reported to be due to chronic diseases. 5 Many negative emotions such as having a chronic disease, coping with the symptoms of the disease, the distress or limitations of the treatment, and worries about the future can affect the physical, cognitive, and social life of the individual. 6 In addition, due to changes in cardiovascular, musculoskeletal, and neuromuscular structures in the elderly, the level of performing activities of daily living without assistance decreases and these changes cause the elderly to become dependent on care actions. 7 , 8 Being dependent on others in daily living activities negatively affects the quality of life of the elderly. 9 Since chronic diseases are long-term and usually slowly progressive diseases, it is necessary to reduce the complications that may develop due to the disease and to ensure that the elderly can perform self-care functions and responsibilities with a high level of capacity. For the elderly to return to active life, it is important to regain independence with the care and services provided in case of dependency. Among the main goals of health services and nursing care is to increase the ability of the individual diagnosed with chronic disease to cope with the disease and to increase independence in self-care and activities of daily living. 10 Initiatives for healthy and successful aging of elderly individuals, improving their quality of life, integrating with society, and living in harmony with society, which are becoming increasingly important all over the world, are gradually increasing. 11 In particular, increasing the functional capacity of the elderly (increasing the level of self-care/independence) is a priority in maintaining complete well-being and increasing the quality of life. In the world where elderly societies and chronic diseases are increasing day by day, it is known that it is becoming more and more important for elderly individuals with chronic diseases to be able to perform their daily living activities independently and to self-manage themselves in managing the chronic disease process. In the process of elderly care and education, healthcare professionals should assess the health status of the elderly and their families, plan individualized care to improve their quality of life and evaluate the results of care. Especially in aging societies, it is thought that determining the quality of life, care dependency and lack of self-management of the elderly diagnosed with chronic diseases and recognizing other factors affecting this is important in planning the services and care to be provided to the elderly receiving health care and staying in nursing homes and will contribute to improving the quality of life of the elderly. Research Questions 1. Is there a correlation between care dependency and the quality of life in older adults with chronic diseases? 2. Is there a correlation between care dependency and the self-management of chronic diseases in older adults? 3. Is there a correlation between the self-management of chronic diseases and the quality of life in older individuals? Methods Study Design This study is a cross-sectional and correlational study planned to determine the effect of care dependency on disease management and quality of life in older adults with chronic diseases. The study was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline. 12 Clinical trial number: not applicable. Research Setting and Participants The population of the study consisted of older adults living in a nursing home in the western region of Turkey and diagnosed with chronic diseases between January 2024 and May 2024. The inclusion criteria were the older who were 65 years of age or older, had been staying in a nursing home for one month or more, had no difficulty in communicating, had no visual and hearing problems, had no cognitive deficits, and could express themselves. Exclusion criteria were the older adults who had diagnosed with Alzheimer's disease or dementia. The G*Power 3.1.9.4 analysis using Epi Info version 7.2 software to calculate the sample size was used and sample size was found to be 155 at a 95% confidence interval. A total of 200 older adults met the inclusion criteria and agreed to participate. Data Collection Tools Demographic Information Form, Care Dependency Scale, Chronic Disease Self-Management Scale, and Turkish Version of the World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-Old. TR) were used to collect the data. Demographic Information Form The form included questions such as the older adult's age, gender, chronic disease, duration of chronic disease, family, and employment status. Care Dependency Scale (CDS) The validation and reliability study of CDS in Turkey was conducted by Hakverdioglu Yönt et al. (2010) CDS is a scale that determines the dependency levels of individuals, is graded with 5-point likert type scoring, and comprises a total of 17 items that include daily life activities. 13 Grading is in the form of 1 = entirely dependent, 5 = nearly/entirely independent. The minimum score from the scale is 17 and the maximum score is 85. While a high score on the scale shows that the patients are independent in fulfilling their care needs, a low score on the scale shows that the patients are dependent on others in fulfilling their care needs. Chronic Disease Self-Management Scale : The Turkish validity and reliability study of the Chronic Diseases Self-Management Scale was conducted by Öztürk et al. 14 The scale consists of 21 items and 4 sub-dimensions: “self-stigmatization, “coping with stigmatization”, “health care effectiveness”, and “treatment compliance”. Scale items are prepared in 5-point likert type and participants mark the most appropriate option in the range of 1 = never 2 = rarely; 3 = average; 4 = quite often; 5 = always. The scale is calculated by the arithmetic mean method. A high score on the scale indicates an increase in self-management, while a low score indicates a decrease in self-management. 15 World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-OLD.TR) : The WHOQOL-OLD was validated for use in Turkey by Eser et al. (2010) To determine the QOL of the older adult, the WHOQOL-OLD Turkish version was used. The WHOQOL-OLD module comprises 24 questions in six dimensions, answers to which are determined with the 5-point likert scale. These six dimensions are presented under the titles of “sensory abilities”, “autonomy”, “history”, “past present-and-future activities”, “social participation”, “death-and-dying”, and “intimacy”. The 5-point likert scale is graded as 1: none, 2: slightly, 3: moderately, 4: too much, 5: extremely. The minimum possible score for each question is 1, and the maximum score is 5. The possible dimension scores are between 4 and 20. Also, the "overall score" can be calculated by adding each singular point value together. The maximum overall score from the scale is 120, and the minimum overall score is 24. Quality of life improves as the score from the scale increases. 16 Data Collection Procedures Before interviewing the older adults, the necessary information about the health of the older adults and their ability to participate or not participate in the research was obtained by contacting the doctor of the institution. The research data were collected by face-to-face with older adults. Data Analysis Statistical analyses were performed with SPSS 26 (SPSS Inc., Chicago, IL, USA) software. The conformity of the data to normal distribution was evaluated by Kolmogorov-Smirnov test. For descriptive analyses, mean ± standard deviation was used for normally distributed variables, and median and minimum-maximum values were used for non-normally distributed data. Descriptive statistics were made by giving frequency and percentage values for categorical variables related to sociodemographic and clinical information. Mann-Whitney U test and Kruskal-Wallis test were used to analyze the data. The relationship between the scales, sub-dimensions, and other variables will be evaluated by Spearman's rho correlation analysis. The statistical significance level was accepted as p < 0.05. Ethics Statement Ethical approval was obtained from the İzmir Tınaztepe University Non-Intervention Studies Ethics Committee (Date: 29.11.2023 No: MUKCE2023/31) and was conducted in accordance with the Declaration of Helsinki. All participants were informed about the study and signed an informed consent form before the data collection. Human Ethics and Consent to Participate declarations: not applicable. Results Characteristics of the participants Two hundred older adults participated in the study. The mean age of the elderly is 77.59 (min: 65, max: 99). Of the older adults, 26.5% were 85 years or older, 56.0% were female and 32.0% were primary school graduates. Over half of the older adults were widowed or divorced (55.0%) and most of the older adults had not been employed (85.0%). It was found that 37.5% of the older adults had more than one chronic disease, 44.0% had been diagnosed with a chronic disease for 6–10 years, and 98.5% used medication for their disease. Most participants (79%) required assistance with daily activities (Table 1). Mean scores of the elderly in Chronic Diseases Self-Management, CDS, and WHOQOL-OLD.TR Older adults had a mean score of 80.9 ± 13,27 on care dependency, a mean score of 2.72 ± 0,39 on chronic disease self-management, and a mean score of 86.8 ± 13,64 on the WHOQOL-OLD.TR. It was determined that the care dependency levels of the elderly were low, and their chronic disease self-management levels and quality of life were moderate. Health care effectiveness sub-dimension of the chronic diseases self-management scale had a mean of 4.49 ± 1.06 and the intimacy sub-dimension of WHOQOL-OLD.TR scale had the highest mean of 18.10 ± 3.56 (Table 2). The relationship between the demographic and disease-related information of the older adults and the total scores of the scales A significant difference was found between the employment of older adults and CDS (p = 0.01) and chronic disease self-management (p = 0.038). It was observed that working elderly people had lower dependency levels and better chronic disease self-management than non-working elderly people. Similarly, a significant difference was found between the duration of chronic disease and CDS (p = 0.004) and quality of life (p = 0.001) (Table 3). The CDS scores and the "coping with stigmatization" (r = 0.293) found a weak positive correlation, and a weak negative correlation between the "self-stigmatization" (r=-0.284) and "treatment compliance" (r=-0.281) sub-dimensions, and a moderate positive correlation with the "health care effectiveness" (r = 0.541) sub-dimension. The CDS score and the “autonomy” (r = 0.356), “past-present-and-future activities” (r = 0.337), “social participation” (r = 0.326), and “intimacy” (r = 0.201) were found to have a weak positive correlation (Table 4). Discussion Care dependency is a significant determinant of self-management and quality of life in older adults with chronic diseases. The aim of this study was to determine the effect of care dependency on chronic disease, self-management and quality of life in elderly individuals with chronic disease. With aging, the rate of increase in chronic diseases, consequent decrease in cognitive and functional competence, and the need for assistance from others in performing activities of daily living are gradually increasing. In addition, due to changes in cardiovascular, musculoskeletal, and neuromuscular structures in the elderly, the level of performing activities of daily living without assistance decreases and these changes cause the elderly to lose their independence. 7 Many negative emotions such as having a chronic disease, coping with the symptoms of the disease, the distress or limitations of the treatment, worries about the future, and complex medication regimens, can affect the physical, cognitive, and social life of the individual. 6 Evidence suggests that the likelihood of being functionally dependent increases with age, that women are more likely to be functionally dependent than men in all age groups, and that the presence of chronic diseases is positively associated with the likelihood of being functionally dependent. 17 Care dependency is defined as individuals' reduced ability to meet their own self-care needs and their need for professional support. Care dependency requires subjective support and requirements to compensate for deficiencies in self-care. In previous studies, the mean CDS total score of the elderly was determined as 68.7 ± 15.3 and 55.3 ± 15.1, respectively. 18 , 19 In studies conducted with the elderly with chronic diseases, it was found that the level of dependency increased with the advancement of age, although the results of the research on the level of care dependency of the elderly differed. 20 , 21 It has been reported that older adults who receive continuous treatment for chronic diseases are more dependent on activities of daily living than those who do not receive treatment. 22 In particular, it was found that elderly people with comorbidities had high levels of care dependency 23 . Epidemiologic studies show that there is a deterioration in functionality and an increase in chronic diseases with advancing age. 19 Care and treatment management of chronic diseases can be possible with adequate self-management and self-care. In a broad context, self-management is defined as the process of observing, making decisions, and giving realistic reactions for individuals to manage 24 and to be able to manage their chronic conditions during the disease process. 25 In a study conducted with a total of 355 elderly people with chronic diseases, it was found that the self-management of the elderly was moderate (74.75 ± 12.93). 26 The quality of life of older adults with care dependency and chronic disease self-management deficits is negatively affected. It has been reported in the literature that care dependency in older adults negatively affects the quality of life. 2 In a study evaluating the quality of life and care dependency levels of older adults in Turkey, it was determined that the quality of life of older adults was at a moderate level (77.3 ± 8.3), with the highest mean score (14.2 ± 2.2) in the "past-present and future activities" and the lowest mean score (10.1 ± 3.1) in the "death-death" sub-dimension. 18 In a study conducted with elderly people living in nursing homes (n = 250), the mean WHOQOL-OLD score was 66.78 ± 8.58, the highest mean score (15.71 ± 3.50) was found as "autonomy" and the lowest (8.79 ± 4.43) was found as "death and dying" sub-dimension. 27 In the study in which the validity and reliability of the WHOQOL-OLD scale were performed in our country, the mean score scale was 56.02 ± 11.86, the highest sub-dimension mean was "intimacy" (14.48 ± 2.44), and the lowest was "death and dying" (11.85 ± 3.82). 16 Most older adults (82.41%) have a moderate quality of life and older adults with chronic diseases have a lower quality of life compared to those without chronic diseases (p < 0.001). 20 In a study conducted with elderly individuals with chronic diseases, a positive relationship was found between care dependency and physical, social/family, emotional, functional well-being and fatigue, which are components of quality of life. 2 According to the data of the WHO elderly quality of life module development project conducted within the scope of the European Union framework program and covering 22 countries including Turkey, it was observed that Turkish elderly had lower scores in terms of perceived general quality of life scores among 22 centers (European countries, Australia, Japan, USA, Brazil, Uruguay, Israel, China centers). 28 It is stated that as the self-management level of older adults increases, dependence on the health system decreases, quality of life increases, and the burden associated with chronic disease decreases. 29 Özdelikara et al. (2020) it was determined that adaptation to lifestyle changes and self-care management decreased as age increased. 30 It is emphasized that the level of self-stigmatization increases with aging, coping with stigmatization, and health care effectiveness decreases. 31 Conclusion The findings in this study reveal a significant decline in both the capacity to perform activities of daily living independently and the overall quality of life as age and chronic disease duration increase in older adults. Self-management capabilities diminish with advancing age, further exacerbating the deterioration in quality of life. Addressing this issue requires targeted strategies that promote adaptation to chronic disease treatments. Empowering older adults to effectively manage disease symptoms through comprehensive care plansfocused on enhancing functional capacity and fostering independencecan substantially improve both self-management and quality of life outcomes. This approach emphasizes the importance of individualized, holistic health practices in geriatric care. Relevance to Clinical Practice This study shows how important it is to improve the quality of life for older adults living with chronic diseases. It highlights the need to care for both their physical and mental well-being while also helping them maintain independence and manage their conditions more effectively. By giving older adults a voice in their care and treatment decisions, healthcare providers can boost their sense of control, confidence, and overall satisfaction. The study also stresses the importance of continuous mental health support and personalized care plans to help older adults cope with their health challenges. These focused efforts can lead to better self-management and a higher quality of life over time. For researchers, this study serves as a foundation to further explore care strategies that are both holistic and centered on the needs of older adults with chronic conditions. Limitations of the study This study only includes results from older people living in a nursing home. Therefore, caution should be exercised in generalizing the results to other elderly people and nursing homes. Declarations Conflict of Interest All authors declare having no conflict of interest. Funding Information This research has been supported by TUBITAK (No: 1919B012208724). Author Contribution G.H.Y and N.G. manuscript text and N.G. data collection, G.H.Y. analysis and interpretation, writing and critical evaluation Acknowledgement AcknowledgmentsWe thank all the older people for their contributions to this study.Conflict of Interest All authors declare having no conflict of interest. Data Availability The datasets generated and/or analysed during the current study are not publicly available due [Within the scope of the rule of confidentiality of the personal data of the people participating in the research] but are available from the corresponding author on reasonable request. References World Health Organization. Retrieved January 10. 2024, from http://www.who.int/chp/en Dijkstra A, Hakverdioglu G, Muszalik M, Andela R, Korhan EA, Kędziora-Kornatowska K. Health related quality of life and care dependency among elderly hospital patients: An international comparison. Tohoku J Exp Med. 2015;3:193–200. United Nations Organization. World Population to Reach 8 Billion 2022. Retrieved September 21. 2024, from https://www.un.org/en/events-and-news Benziger CP, Roth GA, Moran AE. The global burden of disease study and the preventable burden of NCD. Glob Heart. 2016;11:393–7. 10.1016/j.gheart.2016.10.024 . Turkish Statistical Institute (TUIK). Older Persons in Statistics. 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Byrne G, Keogh B, Daly L. Self-management support for older adults with chronic illness: implications for nursing practice. Br J Nurs. 2022;31:86–94. 10.12968/bjon.2022.31.2.86 . Özdelikara A, Taştan Gürkan A, Şen Atasay B. Assessment of self-care management and compliance in chronic diseases. Samsun J Health Sci. 2020;5:42–9. Bektaş G, Uysal N. Determination of self-management and health seeking behaviors in individuals with chronic diseases: a descriptive study Turkey. Clin J Nurs Sci. 2024;16:207–18. Tables Table 1. Socio demographic and Disease-Related Information (n = 200) Sample characteristics Variable n (200) % Age 65-69 49 24,5 70-74 36 18,0 75-79 22 11,0 80-84 40 20,0 85 and above 53 26,5 Gender Female 112 56,0 Male 88 44,0 Education level Illiterate 17 8,5 Primary school 64 32,0 Middle school 30 15,0 High school 48 24,0 University 36 18,0 Postgraduate 5 2,5 Marital status Married 90 45,0 Divorced/Widowed 110 55,0 Employment Yes 30 15,0 No 170 85,0 Chronic disease Diabetes 62 31,0 Hypertension 83 41,5 *COPD 17 8,5 Cancer 9 4,5 Heart failure 25 12,5 **CKD 4 2,0 More than one 75 37,5 Duration of chronic disease Less than one year 7 3,5 1-5 year 33 16,5 6-10 year 88 44,0 11-15 year 32 16,0 16 years and over 40 20,0 Medication use Yes 197 98,5 No 3 1,5 Care requirement Yes 158 79 No 23 11,5 Partially 19 9,5 *Chronic Obstructive Pulmonary Disease, **Chronic Kidney Failure Table 2. CDS, Chronic Diseases Self-Management, and WHOQOL-OLD.TR and Subscales Score Averages of the Older Adults Mean Scale Scores Mean ± SD CDS 80.9 ± 13.27 Chronic Diseases Self-Management Self- stigmatization 1.54±0.97 Coping with stigmatization 4.04±1.32 Health care effectiveness 4.49±1.06 Treatment compliance 1.59±1.18 Total score 2.72±0.39 WHOQOL-OLD.TR Sensory function 9.74±3.01 Autonomy 16.40±4.31 Past, present, and future activities 17.08±3.70 Social inclusion 17.29±3.80 Death and dying 8.23±6.19 Intimacy 18.10±3.56 Total score 86.8±13.64 Table 3: Comparison of demographic and disease-related information of the older adults and total scores of the scales Sample characteristics and total scores the scales Variables CDS Total Score Chronic Diseases Self-Management Total Score WHOQOL-OLD.TR Total Score Mean±SD Mean±SD Mean±SD Age 65-69 79.00±17.47 2.71±0.38 89.86±14.01 70-74 84.69±1.36 2.67±0.35 87.00±13.21 75-79 81.73±9.98 2.72±0.49 85.91±17.86 80-84 80.90±11.26 2.83±0.36 83.80±12.05 85 and upper 79.62±15.49 2.64±0.40 86.58±12.59 3.16 p=0.53 3.81 p=0.43 7.71 p=0.10 Gender Female 80.89±12.67 2.69±0.40 86.12±14.00 Male 80.84±14.06 2.73±0.38 87.74±13.17 Z=-093 p=0.35 Z=-0.32 p=0.74 Z=-0.84 p=0.39 Education Illiterate 78.06±17.89 2.63±0.38 87.29±19.81 Primary school 79.81±15.45 2.68±0.41 86.16±12.95 Middle school 81.87±12.45 2.69±0.37 84.93±16.34 High school 79.63±14.02 2.76±0.40 88.10±12.42 University 84.33±2.91 2.75±0.38 87.17±8.77 Postgraduate 85.00±0.00 2.71±0.46 90.60±23.22 4.18 p=0.52 1.15 p=0.94 1.79 p=0.87 Marital status Married 78.84±15.98 2.73±0.45 86.59±13.82 Divorced/Widowed 82.53±10.33 2.70±0.34 87.03±13.54 Z=-1.03 p=0.30 Z=-0.69 p=0.48 Z=-0.77 p=0.93 Working Yes 85.00±0.00 2.89±0.45 88.70±13.02 No 80.14±14.27 2.68±0.37 86.50±13.75 Z=-2.52 p=0.01 Z=-2.08 p=0.038 Z=-0.67 p=0.50 Duration of chronic disease Less than one year 55.47±36.08 2.55±0.35 74.29±20.11 1-5 year 84.82±0.76 2.78±0.40 90.55±11.74 6-10 year 81.98±9.31 2.73±0.33 90.15±10.66 11-15 year 82.75±12.01 2.66±0.30 85.00±12.31 16 years and over 78.10±15.74 2.68±0.55 80.13±16.89 15.24 p=0.004 2.39 p=0.66 p=0.001 Table 4. The Relationship Between CDS and Chronic Disease Self-Management and WHOQOL-OLD.TR Relationship between the Scales Sub-dimension Chronic Disease Self-Management Self-stigmatization Coping with stigmatization Health care effectiveness Treatment compliance CDS r=-.021 r=-.284 r=.293 r=.541 r=-.281 p=.763 p=.000 p=.000 p=.000 p=.000 WHOQOL-OLD.TR Sensory abilities Autonomy Past-present-and-future activities Social participation Death-and-dying Intimacy r=0.228 r=-0.026 r=0.356 r=0.337 r=0.326 r=-0.151 r=0.201 p=0.001 p=0.720 p=0.000 p=0.000 p=0.000 p=0.033 p=0.004 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 16 Jun, 2025 Reviewers agreed at journal 07 Jun, 2025 Reviewers invited by journal 28 May, 2025 Editor assigned by journal 20 May, 2025 Editor invited by journal 30 Apr, 2025 Submission checks completed at journal 29 Apr, 2025 First submitted to journal 29 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6498674","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":463175306,"identity":"17f7b812-8825-4b6f-8d2f-381bd53812ef","order_by":0,"name":"Naz GÖKDEMİR","email":"","orcid":"","institution":"İzmir Tınaztepe University","correspondingAuthor":false,"prefix":"","firstName":"Naz","middleName":"","lastName":"GÖKDEMİR","suffix":""},{"id":463175307,"identity":"f3a23f11-ec99-44fd-a525-84b99cc5a676","order_by":1,"name":"Gülendam Hakverdioğlu Yönt","email":"data:image/png;base64,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","orcid":"","institution":"İzmir Tınaztepe University","correspondingAuthor":true,"prefix":"","firstName":"Gülendam","middleName":"Hakverdioğlu","lastName":"Yönt","suffix":""}],"badges":[],"createdAt":"2025-04-21 21:08:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6498674/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6498674/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83608902,"identity":"03cef3bb-8203-4b4e-9ed8-b86aa2629467","added_by":"auto","created_at":"2025-05-29 11:46:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1459136,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6498674/v1/bc02d077-50ec-458c-ac0c-f69e056c51a3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEffect of Care Dependency on Self-Management and Quality of Life in Older Adults with Chronic Diseases\u003c/p\u003e","fulltext":[{"header":"Summary Statement of Implications for Practice","content":"\u003cp\u003e\u003cb\u003eWhat does this research add to existing knowledge in gerontology?\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003eOur study emphasizes the importance of recognizing the relationship between dependency levels and chronic disease self-management and quality of life of the elderly individuals with chronic diseases.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWe contribute to the existing knowledge by emphasizing the central role of screening as a proactive strategy to plan, implement and evaluate health practices to improve the quality of life of the elderly, to improve care outcomes, and to encourage independence and increase functional capacity of the elderly.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eWhat are the implications of this new knowledge for nursing care with older people?\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003eIn order to improve the quality of life of the elderly with chronic disease, holistic approaches that address physical, psychological and social well-being from a holistic perspective should be used in the planning of nursing care for the elderly and integrated into care.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eOur research supports the development of personalized chronic disease self-management interventions that focus on the management of dependency level and may have a transformative effect on physical and psychological functioning and thus quality of life in the elderly with chronic disease.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eHow could the findings be used to influence policy or practice or research or education?\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e Policymakers and health care organizations can use our findings to advocate that assessments of care dependency and self-management are important to the quality of life of older people with chronic disease and should be included as standard components of clinical care guidelines.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eEducators in nursing and health programs can incorporate the importance of multifaceted approaches to care into their curricula, with particular emphasis on care dependency, self-management and quality of life of older adults, thereby ensuring that future health care workers are well prepared to address the unique challenges faced by older adults.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eLife expectancy is increasing, birth rates are decreasing and therefore the elderly population is increasing numerically and proportionally. According to World Health Organization (WHO) data, while there were 600\u0026nbsp;million people over the age of 60 in the world in 2000, this number is expected to double in 2025, and the population over the age of 60 is estimated to reach 2\u0026nbsp;billion in 2050.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e The increasing aging of society and the increasing frequency of chronic diseases requiring care due to aging cause an increase in the care needs of the elderly and many related problems. Care dependency is defined as a decrease in the ability of individuals to meet their self-care needs and the need for professional support.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eChronic diseases are defined by the WHO and the United Nations (UN) as the most important health problems of the 21st century and pose a global threat to the sustainability of health systems with high mortality rates and excessive costs in health expenditures. Chronic diseases in old age, such as chronic heart failure, cancer, stroke, chronic obstructive pulmonary disease, asthma, hypertension, Alzheimer's disease, dementia, and diabetes, account for more than half of the global burden of disease.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e WHO emphasizes that the majority of health expenditures (60\u0026ndash;80%) are made for the treatment of chronic diseases. Worldwide, deaths due to chronic diseases account for 60% of all deaths.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e According to data from the Turkish Statistical Institute (T\u0026Uuml;İK), similarly, 76.4% of all deaths in Turkey are reported to be due to chronic diseases.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eMany negative emotions such as having a chronic disease, coping with the symptoms of the disease, the distress or limitations of the treatment, and worries about the future can affect the physical, cognitive, and social life of the individual.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e In addition, due to changes in cardiovascular, musculoskeletal, and neuromuscular structures in the elderly, the level of performing activities of daily living without assistance decreases and these changes cause the elderly to become dependent on care actions.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Being dependent on others in daily living activities negatively affects the quality of life of the elderly.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSince chronic diseases are long-term and usually slowly progressive diseases, it is necessary to reduce the complications that may develop due to the disease and to ensure that the elderly can perform self-care functions and responsibilities with a high level of capacity. For the elderly to return to active life, it is important to regain independence with the care and services provided in case of dependency. Among the main goals of health services and nursing care is to increase the ability of the individual diagnosed with chronic disease to cope with the disease and to increase independence in self-care and activities of daily living.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Initiatives for healthy and successful aging of elderly individuals, improving their quality of life, integrating with society, and living in harmony with society, which are becoming increasingly important all over the world, are gradually increasing.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e In particular, increasing the functional capacity of the elderly (increasing the level of self-care/independence) is a priority in maintaining complete well-being and increasing the quality of life.\u003c/p\u003e \u003cp\u003eIn the world where elderly societies and chronic diseases are increasing day by day, it is known that it is becoming more and more important for elderly individuals with chronic diseases to be able to perform their daily living activities independently and to self-manage themselves in managing the chronic disease process. In the process of elderly care and education, healthcare professionals should assess the health status of the elderly and their families, plan individualized care to improve their quality of life and evaluate the results of care. Especially in aging societies, it is thought that determining the quality of life, care dependency and lack of self-management of the elderly diagnosed with chronic diseases and recognizing other factors affecting this is important in planning the services and care to be provided to the elderly receiving health care and staying in nursing homes and will contribute to improving the quality of life of the elderly.\u003c/p\u003e \u003cp\u003e \u003cb\u003eResearch Questions\u003c/b\u003e \u003c/p\u003e \u003cp\u003e1. Is there a correlation between care dependency and the quality of life in older adults with chronic diseases?\u003c/p\u003e\u003cp\u003e2. Is there a correlation between care dependency and the self-management of chronic diseases in older adults?\u003c/p\u003e \u003cp\u003e3. Is there a correlation between the self-management of chronic diseases and the quality of life in older individuals?\u003c/p\u003e "},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThis study is a cross-sectional and correlational study planned to determine the effect of care dependency on disease management and quality of life in older adults with chronic diseases. The study was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Clinical trial number: not applicable.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eResearch Setting and Participants\u003c/h3\u003e\n\u003cp\u003eThe population of the study consisted of older adults living in a nursing home in the western region of Turkey and diagnosed with chronic diseases between January 2024 and May 2024. The inclusion criteria were the older who were 65 years of age or older, had been staying in a nursing home for one month or more, had no difficulty in communicating, had no visual and hearing problems, had no cognitive deficits, and could express themselves. Exclusion criteria were the older adults who had diagnosed with Alzheimer's disease or dementia.\u003c/p\u003e \u003cp\u003eThe G*Power 3.1.9.4 analysis using Epi Info version 7.2 software to calculate the sample size was used and sample size was found to be 155 at a 95% confidence interval. A total of 200 older adults met the inclusion criteria and agreed to participate.\u003c/p\u003e\n\u003ch3\u003eData Collection Tools\u003c/h3\u003e\n\u003cp\u003e Demographic Information Form, Care Dependency Scale, Chronic Disease Self-Management Scale, and Turkish Version of the World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-Old. TR) were used to collect the data.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eDemographic Information Form\u003c/strong\u003e \u003cp\u003eThe form included questions such as the older adult's age, gender, chronic disease, duration of chronic disease, family, and employment status.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCare Dependency Scale (CDS)\u003c/strong\u003e \u003cp\u003eThe validation and reliability study of CDS in Turkey was conducted by Hakverdioglu Y\u0026ouml;nt et al. (2010) CDS is a scale that determines the dependency levels of individuals, is graded with 5-point likert type scoring, and comprises a total of 17 items that include daily life activities.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Grading is in the form of 1\u0026thinsp;=\u0026thinsp;entirely dependent, 5\u0026thinsp;=\u0026thinsp;nearly/entirely independent. The minimum score from the scale is 17 and the maximum score is 85. While a high score on the scale shows that the patients are independent in fulfilling their care needs, a low score on the scale shows that the patients are dependent on others in fulfilling their care needs.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eChronic Disease Self-Management Scale\u003c/b\u003e: The Turkish validity and reliability study of the Chronic Diseases Self-Management Scale was conducted by \u0026Ouml;zt\u0026uuml;rk et al.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e The scale consists of 21 items and 4 sub-dimensions: \u0026ldquo;self-stigmatization, \u0026ldquo;coping with stigmatization\u0026rdquo;, \u0026ldquo;health care effectiveness\u0026rdquo;, and \u0026ldquo;treatment compliance\u0026rdquo;. Scale items are prepared in 5-point likert type and participants mark the most appropriate option in the range of 1\u0026thinsp;=\u0026thinsp;never 2\u0026thinsp;=\u0026thinsp;rarely; 3\u0026thinsp;=\u0026thinsp;average; 4\u0026thinsp;=\u0026thinsp;quite often; 5\u0026thinsp;=\u0026thinsp;always. The scale is calculated by the arithmetic mean method. A high score on the scale indicates an increase in self-management, while a low score indicates a decrease in self-management.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eWorld Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-OLD.TR)\u003c/b\u003e: The WHOQOL-OLD was validated for use in Turkey by Eser et al. (2010) To determine the QOL of the older adult, the WHOQOL-OLD Turkish version was used. The WHOQOL-OLD module comprises 24 questions in six dimensions, answers to which are determined with the 5-point likert scale. These six dimensions are presented under the titles of \u0026ldquo;sensory abilities\u0026rdquo;, \u0026ldquo;autonomy\u0026rdquo;, \u0026ldquo;history\u0026rdquo;, \u0026ldquo;past present-and-future activities\u0026rdquo;, \u0026ldquo;social participation\u0026rdquo;, \u0026ldquo;death-and-dying\u0026rdquo;, and \u0026ldquo;intimacy\u0026rdquo;. The 5-point likert scale is graded as 1: none, 2: slightly, 3: moderately, 4: too much, 5: extremely. The minimum possible score for each question is 1, and the maximum score is 5. The possible dimension scores are between 4 and 20. Also, the \"overall score\" can be calculated by adding each singular point value together. The maximum overall score from the scale is 120, and the minimum overall score is 24. Quality of life improves as the score from the scale increases.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003ch3\u003eData Collection Procedures\u003c/h3\u003e\n\u003cp\u003eBefore interviewing the older adults, the necessary information about the health of the older adults and their ability to participate or not participate in the research was obtained by contacting the doctor of the institution. The research data were collected by face-to-face with older adults.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed with SPSS 26 (SPSS Inc., Chicago, IL, USA) software. The conformity of the data to normal distribution was evaluated by Kolmogorov-Smirnov test. For descriptive analyses, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation was used for normally distributed variables, and median and minimum-maximum values were used for non-normally distributed data. Descriptive statistics were made by giving frequency and percentage values for categorical variables related to sociodemographic and clinical information. Mann-Whitney U test and Kruskal-Wallis test were used to analyze the data. The relationship between the scales, sub-dimensions, and other variables will be evaluated by Spearman's rho correlation analysis. The statistical significance level was accepted as p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthics Statement\u003c/h2\u003e \u003cp\u003eEthical approval was obtained from the İzmir Tınaztepe University Non-Intervention Studies Ethics Committee (Date: 29.11.2023 No: MUKCE2023/31) and was conducted in accordance with the Declaration of Helsinki. All participants were informed about the study and signed an informed consent form before the data collection. Human Ethics and Consent to Participate declarations: not applicable.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of the participants\u003c/h2\u003e \u003cp\u003eTwo hundred older adults participated in the study. The mean age of the elderly is 77.59 (min: 65, max: 99). Of the older adults, 26.5% were 85 years or older, 56.0% were female and 32.0% were primary school graduates. Over half of the older adults were widowed or divorced (55.0%) and most of the older adults had not been employed (85.0%). It was found that 37.5% of the older adults had more than one chronic disease, 44.0% had been diagnosed with a chronic disease for 6\u0026ndash;10 years, and 98.5% used medication for their disease. Most participants (79%) required assistance with daily activities (Table\u0026nbsp;1).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eMean scores of the elderly in Chronic Diseases Self-Management, CDS, and WHOQOL-OLD.TR\u003c/h2\u003e \u003cp\u003eOlder adults had a mean score of 80.9\u0026thinsp;\u0026plusmn;\u0026thinsp;13,27 on care dependency, a mean score of 2.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0,39 on chronic disease self-management, and a mean score of 86.8\u0026thinsp;\u0026plusmn;\u0026thinsp;13,64 on the WHOQOL-OLD.TR. It was determined that the care dependency levels of the elderly were low, and their chronic disease self-management levels and quality of life were moderate.\u003c/p\u003e \u003cp\u003eHealth care effectiveness sub-dimension of the chronic diseases self-management scale had a mean of 4.49\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06 and the intimacy sub-dimension of WHOQOL-OLD.TR scale had the highest mean of 18.10\u0026thinsp;\u0026plusmn;\u0026thinsp;3.56 (Table\u0026nbsp;2).\u003c/p\u003e \u003cp\u003e \u003cb\u003eThe relationship between the demographic and disease-related information of the older adults and the total scores of the scales\u003c/b\u003e \u003c/p\u003e \u003cp\u003eA significant difference was found between the employment of older adults and CDS (p\u0026thinsp;=\u0026thinsp;0.01) and chronic disease self-management (p\u0026thinsp;=\u0026thinsp;0.038). It was observed that working elderly people had lower dependency levels and better chronic disease self-management than non-working elderly people. Similarly, a significant difference was found between the duration of chronic disease and CDS (p\u0026thinsp;=\u0026thinsp;0.004) and quality of life (p\u0026thinsp;=\u0026thinsp;0.001) (Table\u0026nbsp;3).\u003c/p\u003e \u003cp\u003eThe CDS scores and the \"coping with stigmatization\" (r\u0026thinsp;=\u0026thinsp;0.293) found a weak positive correlation, and a weak negative correlation between the \"self-stigmatization\" (r=-0.284) and \"treatment compliance\" (r=-0.281) sub-dimensions, and a moderate positive correlation with the \"health care effectiveness\" (r\u0026thinsp;=\u0026thinsp;0.541) sub-dimension. The CDS score and the \u0026ldquo;autonomy\u0026rdquo; (r\u0026thinsp;=\u0026thinsp;0.356), \u0026ldquo;past-present-and-future activities\u0026rdquo; (r\u0026thinsp;=\u0026thinsp;0.337), \u0026ldquo;social participation\u0026rdquo; (r\u0026thinsp;=\u0026thinsp;0.326), and \u0026ldquo;intimacy\u0026rdquo; (r\u0026thinsp;=\u0026thinsp;0.201) were found to have a weak positive correlation (Table\u0026nbsp;4).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eCare dependency is a significant determinant of self-management and quality of life in older adults with chronic diseases. The aim of this study was to determine the effect of care dependency on chronic disease, self-management and quality of life in elderly individuals with chronic disease. With aging, the rate of increase in chronic diseases, consequent decrease in cognitive and functional competence, and the need for assistance from others in performing activities of daily living are gradually increasing. In addition, due to changes in cardiovascular, musculoskeletal, and neuromuscular structures in the elderly, the level of performing activities of daily living without assistance decreases and these changes cause the elderly to lose their independence.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Many negative emotions such as having a chronic disease, coping with the symptoms of the disease, the distress or limitations of the treatment, worries about the future, and complex medication regimens, can affect the physical, cognitive, and social life of the individual.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eEvidence suggests that the likelihood of being functionally dependent increases with age, that women are more likely to be functionally dependent than men in all age groups, and that the presence of chronic diseases is positively associated with the likelihood of being functionally dependent.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eCare dependency is defined as individuals' reduced ability to meet their own self-care needs and their need for professional support. Care dependency requires subjective support and requirements to compensate for deficiencies in self-care. In previous studies, the mean CDS total score of the elderly was determined as 68.7\u0026thinsp;\u0026plusmn;\u0026thinsp;15.3 and 55.3\u0026thinsp;\u0026plusmn;\u0026thinsp;15.1, respectively.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e In studies conducted with the elderly with chronic diseases, it was found that the level of dependency increased with the advancement of age, although the results of the research on the level of care dependency of the elderly differed.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e It has been reported that older adults who receive continuous treatment for chronic diseases are more dependent on activities of daily living than those who do not receive treatment.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e In particular, it was found that elderly people with comorbidities had high levels of care dependency\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. Epidemiologic studies show that there is a deterioration in functionality and an increase in chronic diseases with advancing age.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eCare and treatment management of chronic diseases can be possible with adequate self-management and self-care. In a broad context, self-management is defined as the process of observing, making decisions, and giving realistic reactions for individuals to manage\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e and to be able to manage their chronic conditions during the disease process.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e In a study conducted with a total of 355 elderly people with chronic diseases, it was found that the self-management of the elderly was moderate (74.75\u0026thinsp;\u0026plusmn;\u0026thinsp;12.93).\u003csup\u003e26\u003c/sup\u003e The quality of life of older adults with care dependency and chronic disease self-management deficits is negatively affected. It has been reported in the literature that care dependency in older adults negatively affects the quality of life.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIn a study evaluating the quality of life and care dependency levels of older adults in Turkey, it was determined that the quality of life of older adults was at a moderate level (77.3\u0026thinsp;\u0026plusmn;\u0026thinsp;8.3), with the highest mean score (14.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2) in the \"past-present and future activities\" and the lowest mean score (10.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1) in the \"death-death\" sub-dimension.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e In a study conducted with elderly people living in nursing homes (n\u0026thinsp;=\u0026thinsp;250), the mean WHOQOL-OLD score was 66.78\u0026thinsp;\u0026plusmn;\u0026thinsp;8.58, the highest mean score (15.71\u0026thinsp;\u0026plusmn;\u0026thinsp;3.50) was found as \"autonomy\" and the lowest (8.79\u0026thinsp;\u0026plusmn;\u0026thinsp;4.43) was found as \"death and dying\" sub-dimension.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e In the study in which the validity and reliability of the WHOQOL-OLD scale were performed in our country, the mean score scale was 56.02\u0026thinsp;\u0026plusmn;\u0026thinsp;11.86, the highest sub-dimension mean was \"intimacy\" (14.48\u0026thinsp;\u0026plusmn;\u0026thinsp;2.44), and the lowest was \"death and dying\" (11.85\u0026thinsp;\u0026plusmn;\u0026thinsp;3.82).\u003csup\u003e16\u003c/sup\u003e Most older adults (82.41%) have a moderate quality of life and older adults with chronic diseases have a lower quality of life compared to those without chronic diseases (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003csup\u003e20\u003c/sup\u003e In a study conducted with elderly individuals with chronic diseases, a positive relationship was found between care dependency and physical, social/family, emotional, functional well-being and fatigue, which are components of quality of life.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e According to the data of the WHO elderly quality of life module development project conducted within the scope of the European Union framework program and covering 22 countries including Turkey, it was observed that Turkish elderly had lower scores in terms of perceived general quality of life scores among 22 centers (European countries, Australia, Japan, USA, Brazil, Uruguay, Israel, China centers).\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eIt is stated that as the self-management level of older adults increases, dependence on the health system decreases, quality of life increases, and the burden associated with chronic disease decreases.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e \u0026Ouml;zdelikara et al. (2020) it was determined that adaptation to lifestyle changes and self-care management decreased as age increased.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e It is emphasized that the level of self-stigmatization increases with aging, coping with stigmatization, and health care effectiveness decreases.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings in this study reveal a significant decline in both the capacity to perform activities of daily living independently and the overall quality of life as age and chronic disease duration increase in older adults. Self-management capabilities diminish with advancing age, further exacerbating the deterioration in quality of life. Addressing this issue requires targeted strategies that promote adaptation to chronic disease treatments. Empowering older adults to effectively manage disease symptoms through comprehensive care plansfocused on enhancing functional capacity and fostering independencecan substantially improve both self-management and quality of life outcomes. This approach emphasizes the importance of individualized, holistic health practices in geriatric care.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eRelevance to Clinical Practice\u003c/h2\u003e \u003cp\u003eThis study shows how important it is to improve the quality of life for older adults living with chronic diseases. It highlights the need to care for both their physical and mental well-being while also helping them maintain independence and manage their conditions more effectively. By giving older adults a voice in their care and treatment decisions, healthcare providers can boost their sense of control, confidence, and overall satisfaction.\u003c/p\u003e \u003cp\u003eThe study also stresses the importance of continuous mental health support and personalized care plans to help older adults cope with their health challenges. These focused efforts can lead to better self-management and a higher quality of life over time. For researchers, this study serves as a foundation to further explore care strategies that are both holistic and centered on the needs of older adults with chronic conditions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLimitations of the study\u003c/h2\u003e \u003cp\u003eThis study only includes results from older people living in a nursing home. Therefore, caution should be exercised in generalizing the results to other elderly people and nursing homes.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConflict of Interest\u003c/h2\u003e \u003cp\u003eAll authors declare having no conflict of interest.\u003c/p\u003e\u003ch2\u003eFunding Information\u003c/h2\u003e \u003cp\u003eThis research has been supported by TUBITAK (No: 1919B012208724).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eG.H.Y and N.G. manuscript text and N.G. data collection, G.H.Y. analysis and interpretation, writing and critical evaluation\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eAcknowledgmentsWe thank all the older people for their contributions to this study.Conflict of Interest All authors declare having no conflict of interest.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available due [Within the scope of the rule of confidentiality of the personal data of the people participating in the research] but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. 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Validity and reliability of turkish version of the self care management process in chronic illness. G\u0026uuml;m\u0026uuml;şhane Univ J Health Sci. 2018;7:175\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCong Z, Huo M, Jiang X, Yu H. Factors associated with the level of self-management in elderly patients with chronic diseases: A pathway analysis. BMC Geriatr. 2024;24:377.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eErol S, Sezer A, Şişman FN, Can \u0026Ccedil;andır S. Quality of life and social support in elderly people living in nursing homes. J Intern Med. 2016;23:61\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eS\u0026ouml;zen F, Yavuz \u0026Ccedil;olak M, Ersoy K. Quality of life and perception of old age in the elderly: the example of Başkent University. 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Samsun J Health Sci. 2020;5:42\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBektaş G, Uysal N. Determination of self-management and health seeking behaviors in individuals with chronic diseases: a descriptive study Turkey. Clin J Nurs Sci. 2024;16:207\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Socio\u003c/strong\u003e\u003cstrong\u003edemographic and Disease-Related Information (n = 200)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"520\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en (200)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 520px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e65-69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e24,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e70-74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e18,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e75-79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e11,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e80-84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e20,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e85 and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e26,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 520px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e56,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e44,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 520px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e8,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e32,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMiddle school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e15,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e24,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eUniversity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e18,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePostgraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e2,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 520px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e45,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eDivorced/Widowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e55,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e15,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e85,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 520px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChronic disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e31,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e41,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e*COPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e8,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e4,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eHeart failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e12,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e**CKD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e2,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMore than one\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e37,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 520px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of chronic disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLess than one year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e3,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1-5 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e16,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e6-10 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e44,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e11-15 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e16,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e16 years and over\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e20,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 520px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedication use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e98,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e1,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCare requirement\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e11,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePartially\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e9,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e*Chronic Obstructive Pulmonary Disease, **Chronic Kidney Failure\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. CDS, Chronic Diseases Self-Management, and WHOQOL-OLD.TR and Subscales Score Averages of the Older Adults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMean Scale Scores\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCDS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e80.9 \u0026plusmn; 13.27\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 454px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChronic Diseases Self-Management\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eSelf-\u0026nbsp;stigmatization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e1.54\u0026plusmn;0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eCoping with stigmatization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e4.04\u0026plusmn;1.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eHealth care effectiveness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e4.49\u0026plusmn;1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eTreatment compliance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e1.59\u0026plusmn;1.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.72\u0026plusmn;0.39\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 454px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQOL-OLD.TR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eSensory function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e9.74\u0026plusmn;3.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eAutonomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e16.40\u0026plusmn;4.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003ePast, present, and future activities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e17.08\u0026plusmn;3.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eSocial inclusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e17.29\u0026plusmn;3.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eDeath and dying\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e8.23\u0026plusmn;6.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eIntimacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e18.10\u0026plusmn;3.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e86.8\u0026plusmn;13.64\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003c/em\u003e\u003c/strong\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Comparison of demographic and disease-related information of the older adults and total scores of the scales\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample characteristics and total scores the scales\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCDS\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChronic Diseases Self-Management Total Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQOL-OLD.TR Total Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u0026plusmn;SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u0026plusmn;SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u0026plusmn;SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e65-69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e79.00\u0026plusmn;17.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e2.71\u0026plusmn;0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e89.86\u0026plusmn;14.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e70-74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e84.69\u0026plusmn;1.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e2.67\u0026plusmn;0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e87.00\u0026plusmn;13.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e75-79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e81.73\u0026plusmn;9.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e2.72\u0026plusmn;0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e85.91\u0026plusmn;17.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e80-84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e80.90\u0026plusmn;11.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e2.83\u0026plusmn;0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e83.80\u0026plusmn;12.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e85 and upper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e79.62\u0026plusmn;15.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e2.64\u0026plusmn;0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e86.58\u0026plusmn;12.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cem\u003e3.16 \u0026nbsp; \u0026nbsp;p=0.53\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cem\u003e3.81 \u0026nbsp; \u0026nbsp;p=0.43\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u003cem\u003e7.71 \u0026nbsp; \u0026nbsp;p=0.10\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e80.89\u0026plusmn;12.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e2.69\u0026plusmn;0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e86.12\u0026plusmn;14.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e80.84\u0026plusmn;14.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e2.73\u0026plusmn;0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e87.74\u0026plusmn;13.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cem\u003eZ=-093 p=0.35\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cem\u003eZ=-0.32 p=0.74\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u003cem\u003eZ=-0.84 p=0.39\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e78.06\u0026plusmn;17.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e2.63\u0026plusmn;0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e87.29\u0026plusmn;19.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e79.81\u0026plusmn;15.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e2.68\u0026plusmn;0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e86.16\u0026plusmn;12.95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMiddle school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e81.87\u0026plusmn;12.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e2.69\u0026plusmn;0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e84.93\u0026plusmn;16.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e79.63\u0026plusmn;14.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e2.76\u0026plusmn;0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e88.10\u0026plusmn;12.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eUniversity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e84.33\u0026plusmn;2.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e2.75\u0026plusmn;0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e87.17\u0026plusmn;8.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003ePostgraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e85.00\u0026plusmn;0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e2.71\u0026plusmn;0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e90.60\u0026plusmn;23.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cem\u003e4.18 \u0026nbsp;p=0.52\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cem\u003e1.15 \u0026nbsp;p=0.94\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u003cem\u003e1.79 \u0026nbsp; p=0.87\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e78.84\u0026plusmn;15.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e2.73\u0026plusmn;0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e86.59\u0026plusmn;13.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eDivorced/Widowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e82.53\u0026plusmn;10.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e2.70\u0026plusmn;0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e87.03\u0026plusmn;13.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cem\u003eZ=-1.03 p=0.30\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cem\u003eZ=-0.69 p=0.48\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u003cem\u003eZ=-0.77 p=0.93\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWorking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e85.00\u0026plusmn;0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e2.89\u0026plusmn;0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e88.70\u0026plusmn;13.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e80.14\u0026plusmn;14.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e2.68\u0026plusmn;0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e86.50\u0026plusmn;13.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cem\u003eZ=-2.52 \u003cstrong\u003ep=0.01\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cem\u003eZ=-2.08 \u003cstrong\u003ep=0.038\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u003cem\u003eZ=-0.67 p=0.50\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of chronic disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eLess than one year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e55.47\u0026plusmn;36.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e2.55\u0026plusmn;0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e74.29\u0026plusmn;20.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1-5 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e84.82\u0026plusmn;0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e2.78\u0026plusmn;0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e90.55\u0026plusmn;11.74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e6-10 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e81.98\u0026plusmn;9.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e2.73\u0026plusmn;0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e90.15\u0026plusmn;10.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e11-15 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e82.75\u0026plusmn;12.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e2.66\u0026plusmn;0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e85.00\u0026plusmn;12.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e16 years and over\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e78.10\u0026plusmn;15.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e2.68\u0026plusmn;0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e80.13\u0026plusmn;16.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cem\u003e15.24 \u0026nbsp;\u003cstrong\u003ep=0.004\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cem\u003e2.39 \u0026nbsp;p=0.66\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003col start=\"17\"\u003e\n \u003cli\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;p=0.001\u003c/em\u003e\u003c/strong\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. The Relationship Between CDS and Chronic Disease Self-Management and WHOQOL-OLD.TR\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRelationship between the Scales\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"662\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSub-dimension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eChronic Disease Self-Management\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSelf-stigmatization\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eCoping with stigmatization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHealth care effectiveness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eTreatment compliance\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCDS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003er=-.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003er=-.284\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003er=.293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003er=.541\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003er=-.281\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ep=.763\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ep=.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ep=.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ep=.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ep=.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQOL-OLD.TR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSensory abilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAutonomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003ePast-present-and-future activities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSocial participation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eDeath-and-dying\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eIntimacy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003er=0.228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003er=-0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003er=0.356\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003er=0.337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003er=0.326\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003er=-0.151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003er=0.201\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ep=0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ep=0.720\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ep=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ep=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ep=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ep=0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ep=0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Chronic disease, self-management, care dependency, nursing care, older adult","lastPublishedDoi":"10.21203/rs.3.rs-6498674/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6498674/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eThis study was planned as a cross-sectional and correlational study to determine the effect of care dependency on chronic disease, self-management, and quality of life in the elderly individuals with chronic diseases.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional, correlational study was conducted with 200 older adults diagnosed with chronic diseases and living in a nursing home in western Turkey. Data were collected data collection tools and analyzed using descriptive and inferential statistics.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA significant difference was found between employment and Care Dependency status of older adults and chronic disease self-management.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIncreasing age and prolonged chronic disease duration reduce independence and quality of life. Strategies aimed at promoting independence, improving functional capacity, and enhancing self-management are essential to maintaining a higher quality of life.\u003c/p\u003e\u003ch2\u003eRelevance to Clinical Practice:\u003c/h2\u003e \u003cp\u003eHealth professionals should plan the care and treatment of the older adults with chronic diseases with a holistic perspective while identifying the health problems that the older adults with chronic diseases experience and may experience, provide education and counseling to the older adults and their families to increase functional capacity, and take an active role in improving the quality of life of the older adult and adding years to life by making special care and education plans for each older adults and their families.\u003c/p\u003e\u003ch2\u003ePatient or Public Contribution:\u003c/h2\u003e \u003cp\u003eThese findings provide practical guidance for health care management and highlight the need for individualized care and the priority of promoting independence to improve self-management and quality of life of older adults with chronic diseases.\u003c/p\u003e","manuscriptTitle":"Effect of Care Dependency on Self-Management and Quality of Life in Older Adults with Chronic Diseases","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-29 11:38:49","doi":"10.21203/rs.3.rs-6498674/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-06-16T06:40:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"57204210842760144151510893041023895142","date":"2025-06-07T04:48:23+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-28T08:11:57+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-20T09:02:42+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-30T10:05:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-29T16:27:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-04-29T16:26:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"28b64bb4-fcde-4afe-8507-d66ff428093f","owner":[],"postedDate":"May 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-05-29T11:38:49+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-29 11:38:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6498674","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6498674","identity":"rs-6498674","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}