Objectives: As age increases, the number of chronic diseases increases too. These illnesses may not lead to death, but they endanger the quality of life of the affected person and can cause early and severe disabilities. The purpose of this review study was to answer the question of whether self-management education for elderly people with chronic diseases improves their quality of life.

Methods & Materials: The complete search carried out in the internal and external databases web of science ,PubMed, Scopus, SID, Medline, Google scholar was conducted with the keywords "education, self-management, elderly, quality of life, chronic disease, and their equivalent in English and also Persian language from 2005 to 2017. There were found 17300 articles in the original search, which after being reviewed in the abstract of the articles and due to repeatability and non-relevance, some studies were excluded from the study due to the failure to implement self-management program in the aging population or lack of evaluation of the quality of life in them. Then 40 articles were selected and were included in the study. of the 40 articles mentioned, 31 articles were published because their full text was in a language other than English and Persian, as well as the lack of use of the self-management training curriculum in the design of instruction as a primary method or in comparison with other educational methods from the list of reviewed articles Abandoned. Finally, 11 articles were included in the study and were fully examined.

Findings: In this study, the findings focus on some of domains that, after a brief explanation in each area, are examined for existing studies. These areas include chronic diseases, quality of life, self-management, and aging.

Discuss: Most of the studies presented in this review study show positive effects of self-management interventions on the physical, mental and social performance of the elderly. Only one study by Muntingh and Rees that had no significant effect on the quality of life and self-management scores of the elderly. Self-management training for patients with chronic diseases has been able to raise the expected outcomes of quality of life in various aspects of physical, mental and social aspects.

Conclusion: Based on this review, due to the low use of self-management programs in the field of vision, self-management education is strongly recommended for the elderly, especially with visual impairment.

Keywords: chronic diseases, self-management, elderly, quality of life

Improving living conditions has led to an increase in life span and life expectancy in older people.¹ As elderly age increases, there will be some changes in their various dimensions of health, including physical, mental, rational and various diseases.² Chronic diseases are limited elderly's activities due to health, social and psychological problems, and reduce their quality of life.³ At present, chronic illness accounts for 60% of all deaths worldwide, causing a heavy burden on society and health services.⁴ Although these diseases are not directly lethal, it can be a threat to the quality of life of individuals and lead to early and severe disabilities.⁵ The most common problem affecting the health and quality of life of the elderly, which leads to their dependence on others, is functional disabilities.⁶ Chronic diseases include: hypertension, diabetes mellitus, joint disease, eye diseases, lung diseases, kidney disease, depression, stroke and a variety of cancers. The findings indicate that a major contribution to the care of the elderly is related to their inadequate education. Training is one of the most effective interventions in all levels of prevention. Of course, such training should be based on acquiring accurate knowledge and understanding of the patient's educational needs.¹ Since the one of the roles of geriatric nursing is the role of education in the field of aging needs and on the basis of its particular considerations, educational interventions can be considered as an important factor for promoting health and improving the quality of life of the in elderly.² Based on the milestone of qualitative studies, self-management programs support individuals for managing their symptoms and their illness, as well as emotional and daily outcomes associated with chronic disease. Self-management models promote health outcomes and reduce health care costs. However, these principles are rarely used in the visual & sight services.⁷ Also according to the importance of the issue and the limited number of studies on the impact of self-management education program on quality of life, The present study with aim of scrutiny the studies conducted in the field of elderly self-management education programs and its effects on improving the quality of life associated with their chronic illnesses were conduct through review of the articles

The present study is a review study which conducted aimed to increasing the knowledge and information of the current research to answer the question of whether self-management education for elderly people with chronic diseases improves their quality of life. First, performed a complete search in internal and external databases, such as web of science, PubMed, Scopus, SID, and Medline, Google scholar, with keywords education, self-management, elderly, Quality of life, Chronic Disease and their Persian equivalents from the beginning of 2005 to 2017. In this research, the criteria for entering the articles into the study, doing research specifically in the elderly population and using self-management education interventions. 17300 articles were found in the original search, which after first reviewed in the abstract of the articles, because repeatability and non-relevance; and that some studies on chronic diseases were not implemented in the aging population; or the lack of measurement of quality of life in they; or were not related to the study topic or had inadequate data; were not included in the inclusion criteria, and were . 40 papers were selected and included in the study. To extract the data, all final papers entered into the study process were extracted from a pre-prepared checklist. The checklist includes the name of the author, the year of the study, the location of the study, the study objectives, sample size, methodology and data collection and the key findings of the study. Of the 40 articles, 31 articles were excluded due to the fact that their full text was in a language other than English and Persian; as well as the lack of use of the self-management education curriculum as a main method or as compared to other educational methods; from the list of reviewed articles abandoned. The articles were limited to the fullest possible access to the full text of the article. Finally, 11 articles were included in the study and were fully have been evaluated. This is a morally approved study of Mashhad University of Medical Sciences.

In this study, the findings focus on a number of domains, which, after a brief explanation in each area, have been evaluated for existing studies. These areas include

1. Elderly
2. Chronic Diseases
3. Quality of Life
4. Self-Management Education (SME)

Most of the studies presented in this review study show positive effects of self-management interventions on the physical, mental and social performance of the elderly. Only one study by Muntingh and Rees that had no significant effect on the quality of life and self-management scores of the elderly. Self-management training for patients with chronic diseases has been able to raise the expected outcomes of quality of life in various aspects of physical, mental and social aspects.

Whatever is eventuated of the results and discussions of the mentioned studies, Knowledge transfer and the principled use of self-management education methods can be effective in the elderly with chronic diseases and make him/her more consistent with the disease. On the other hand, designing new self-management methods and models based on well-known and identifiable needs of patients can help to control the disease and reduce the complications of the disease on the quality of life of the elderly. The findings of this review article support the importance of self-management interventions to increase control and care for health promotion in the elderly with chronic diseases, especially visual impairment. Therefore, it seems that the use of self-management education programs related to health for the elderly is a necessity and can improve all aspects of their life. Knowledge transferring about chronic diseases and creating proper habits may help the elderly to reduce disorder and improve their quality of life. Therefore, in view of the high prevalence of chronic diseases in the elderly and the related complications and treatment costs, and with regard to the effectiveness of self-management educational interventions such as Khezri ,⁸ Markel Reed,⁹ Marconcin,¹⁰ Brody,¹¹ Rees,¹² Girdler,¹³ Chein,¹⁴ Baljani,¹⁵ & Burgle et al.¹⁶ as a low-cost intervention, acceptable and non-compliant nursing practice, general self-management education for patients with chronic diseases has been able to improve the expected outcomes of quality of life in a variety of physical, mental, and social aspects. Therefore, self-management education to the elderly with chronic diseases and specifically, visual impairment is strongly recommended Based on this review, due to the low use of self-management programs in the field of vision, self-management education is strongly recommended for the elderly, especially with visual impairment.

This study was derived from a thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in Geriatric Nursing approved by the Ethics Committee of Mashhad University of Medical Sciences with the code of IR.MUMS.REC.1396.155 and the code of IRCT2017081133966N1 in the Iranian Registry of Clinical Trials. We hereby express our gratitude to the Research Deputy of this university for their financial supports.

The authors declare that there is no conflicts of interest regarding the publication of this article.

1. Abedi HA, Alavi M. The experiences of health care team and elderly in-patients about concept of “elderly patients’ education” in a hospital affiliated to isfahan unifersity of medical sciences. Iranian Journal of Medical Education. 2007;7(1):93–100.
2. Heidari M, Shahbazi S. Effect of self-care training program on quality of life of elders. Iran Journal of Nursing. 2012;25(75):1–8.
3. Habibi A, NEMADI VM, Habibi S, et al. Quality of life and prevalence of chronic illnesses among elderly people: A cross-sectional survey. 2012.
4. Griffiths C, Foster G, Ramsay J, et al. How effective are expert patient (lay led) education programmes for chronic disease?. BMJ. 2007;334(7606):1254.
5. Pourtaghi F, Emami MZ, Ramezani M, et al. Effect of resistance training using thera-band on muscular strength and quality of life among the elderly. Evidenced Based Care Jurnal. 2017;7(3):7–16.
6. Chalise HN, Saito T, Kai I. Functional disability in activities of daily living and instrumental activities of daily living among nepalese newar elderly. Public Health. 2008;122(4):394-396.
7. Girdler SJ, Boldy DP, Dhaliwal SS, et al. Vision self-management for older adults: a randomised controlled trial. Br J Ophthalmol. 2010;94(2):223–228.
8. Khezri R, Ravanipour M, Motamed N, et al. Effect of self-management empowering model on the quality of life in the elderly patients with hypertension. Iranian Journal of Ageing. 2016;10(4):68–79.
9. Markle RM, Ploeg J, Fraser KD, et al. Community program improves quality of life and self‐management in older adults with diabetes mellitus and comorbidity. Journal of the American Geriatrics Society. 2018;66(2):263–273.
10. Marconcin PEP. The PLE2NO self-management and exercise program: effects on knee osteoarthritis symptoms, health behaviors, quality of life and physical fitness in elderlies. 2016.
11. Brody BL, Roch LAC, Thomas RG, et al. Self-management of age-related macular degeneration at the 6-month follow-up: a randomized controlled trial. Archives of Ophthalmology. 2005;123(1):46–53.
12. Rees G, Xie J, Chiang PP, et al. A randomised controlled trial of a self-management programme for low vision implemented in low vision rehabilitation services. Patient education and counseling. 2015;98(2):174–181.
13. Girdler SJ, Boldy DP, Dhaliwal SS, et al. Vision self-management for older adults: a randomised controlled trial. Br J Ophthalmol. 2010;94(2):223–228.
14. Chien CL, Liu YF, Liu WT, et al. Impact of multidisciplinary self-management education program in patients with chronic obstructive pulmonary disease: self-efficacy, exercise tolerance and quality of life. B109 highlights and advances in pulmonary rehabilitation. Am Thoracic Soc. 2016;7863-A.
15. Bajani S, Rahimi Z, Sasan A. The effectof self-management programs on the quality of life in patients undergoing hemodialysis. Journal of Nursing and Midwifery Urmia University of Medical Sciences. 2014;12(9):815–824.
16. Brugel L, Laurent M, Caillet P, et al. Impact of comprehensive geriatric assessment on survival, function, and nutritional status in elderly patients with head and neck cancer: protocol for a multicentre randomised controlled trial (EGeSOR). BMC Cancer. 2014;14:427.