The overall aim of this research application is to improve the health outcomes of older persons with multiple chronic conditions. Chronic conditions like hypertension and diabetes are highly prevalent among older adults, and contribute to serious cardiovascular morbidity and death. Despite the availability of effective treatments, hypertension remains poorly controlled among older adults, especially for those with co-morbid diabetes. Effective control of multiple morbidities may be hindered by the complex and often-conflicting treatment recommendations. Goal-setting may be an effective strategy for addressing this clinical problem. Goals are the internal, motivating factors for human behavior. Goal-setting behaviors (i.e., setting of specific, challenging, and finite treatment goals;patients'internalization of goal importance;self-efficacy with goal related tasks;and activation of self-management strategies with targeted clinician feedback) have been used in numerous occupational settings. However, no uniform criteria exist to define and circumscribe the processes of goal-setting that occur within patients, and limited data exists to directly relate the setting and internalization of hypertension goals to improved rates of hypertension control, to address this gap in knowledge, the following application will: 1) Assemble two expert panels of clinicians and methodologists to adapt the conceptual model of goal setting to the care of older adults with hypertension and diabetes, and develop a patient questionnaire of items to define and measure the constructs of this model. 2) Further develop the patient questionnaire by using instrument validation methodology to create a goal setting index that quantitatively determines the presence/use of goal-setting behaviors. 3) Conduct multivariable analyses to determine the relation of the goal setting index and hypertension control among a sample of older adults with hypertension (controlled versus uncontrolled) and diabetes. Participants will be enrolled from general medicine and geriatrics clinics serving a diverse population of older adults. 4) To improve the design and development of Goal-setting interventions, we will utilize qualitative methods to explore how goals for hypertension are developed and prioritized among older persons with hypertension and co-morbid conditions, and identify the barriers and facilitators of goal-setting within clinical encounters using in-depth interviews of older persons and their clinicians. In future studies, we will develop and test goal-setting interventions during clinical encounters to improve the health outcomes of older persons with multiple morbid conditions.
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