Illness Identity and Its Influence on Self-Management in Older Adults With Multimorbidity: A Hybrid Thematic Analysis

Illness identity refers to the way people integrate health conditions into their sense of self and plays a vital role in managing chronic illness. While most research has examined illness identity in relation to a single diagnosis, this study addressed the added complexity of living with multiple conditions in later life. The aim was to examine how illness identity shapes self-management among older persons with multimorbidity (PwMs) and to refine the relevance of existing illness identity categories by deepening understanding of how evolving identities influence adaptive self-management practices. Semi-structured interviews were conducted with 40 older PwMs in Ireland. Collaborative thematic analysis was used to analyse the data, and a hybrid approach combining inductive and deductive methods was employed. Transcripts were open-coded, discussed collaboratively to deepen interpretation, and then examined in relation to four established dimensions of the illness identity framework: engulfment, rejection, acceptance, and enrichment. In addition to the four established categories, the study identified a further theme linking illness identity with experiences of ageing. Findings showed that older adults with multimorbidity negotiate several, fluid, and context-dependent illness identities rather than a single fixed one. This study extends our understanding of illness identity in the context of multimorbidity and ageing and points to concrete implications for how clinicians communicate with patients, how self-management support can protect autonomy, and how care can be integrated for older adults living with multiple conditions.