Background: Treatment adherence in older adults is shaped by subjective, existential, and structural factors, yet an empirically grounded integrative model remains underdeveloped. This study presents an existential-biographical model derived from a sequential research programme beginning with two literature reviews: Perceptions and Self Perceptions of Treatment Adherence in Older Adults: A Scoping Review, which identified subjective determinants of self-care; and Psychological and Behavioural Responses to Death Anxiety in Older Adults with Chronic Illnesses: An Integrative Review, which demonstrated how awareness of finitude influences responses to treatment.
Methods: Review findings informed a qualitative study with in-depth interviews, analysed using reflexive thematic analysis, that explored experiences of finitude, temporality, identity change, and self-care among older adults with multimorbidity. A cross-sectional quantitative study was subsequently conducted, incorporating measures of adherence, illness experience, psychosocial well-being, and attitudes towards death. Integration followed an iterative process that combined qualitative insights, quantitative patterns, and core theoretical constructs.
Results: Across data sources, awareness of time as limited emerged as a structuring element reshaping health priorities. Yet the extent and direction of this reorganisation were modulated by multiple factors: health status and functional capacity; religious and spiritual beliefs; family relationships and social support; economic conditions; illness perceptions; and accessibility and organisation of care services. These interacting influences underpin distinct profiles of existential positioning and therapeutic engagement.
Conclusion: The model proposes that adherence results from the interaction between awareness of finitude and biographical, social, and structural conditions, offering an integrated evidence-based framework for understanding self-care in later life with multimorbidity.

Authors:
Leovaldo Alcântara, University of Porto, Portugal
Luís Midão, University of Porto, Portugal
Elísio Costa, University of Porto, Portugal
Constança Paúl, University of Porto, Portugal

About the Presenter(s)
Psychologist and PhD researcher in Geriatrics and Gerontology at the University of Porto, focusing on ageing, health behaviour and treatment adherence. Author of studies on digital health and psychosocial factors in older adults.

See this presentation on the full schedule – Saturday Schedule

Bookmark