A Look at Person-Centered and Family-Centered Care Among Older Adults: Results from a National Survey

Abstract

BACKGROUND:Person-centered and family-centered care represents the pinnacle of health care quality, but delivering it is challenging, as is assessing whether it has occurred. Prior studies portray older adults as passive in health decisions and burdened by care-but emphasize age-based differences or focus on vulnerable subgroups. OBJECTIVES: We aimed to examine domains of person-centered and family-centered care among older adults and whether the social context in which older adults manage their health relates to preferences for participating in health decisions and experiences with care. DESIGN AND PARTICIPANTS: This was an observational study of a nationally representative survey of adults aged 65+ years, conducted in concert with the 2012 National Health and Aging Trends Study (n=2040). MAIN MEASURES: Approach to managing health (selfmanage, co-manage, delegate); preferences for making health care decisions with: (1) doctors, (2) family/close friends; and experiences with care pertaining to treatment burden were measured. KEY RESULTS: Approximately two-thirds of older adults self-manage (69.4 %) and one-third comanage (19.6 %) or delegate (11.0 %) health care activities. The majority prefer an independent or shared role when making health decisions with doctors (84.7 %) and family/close friends (95.9 %). Nearly four in ten older adults (37.9 %) experience treatment burden-that managing health care activities are sometimes or often hard for either them or their family/close friends, that health care activities get delayed or don't get done, or that they are cumulatively too much to do. Relative to older adults who self-manage, those who delegate health care activities are more likely to prefer to share or leave health decisions to doctors (aOR=1.79 (95 % CI, 1.37-2.33) and family/close friends (aOR=3.12 (95 % CI, 2.23-4.36), and are more likely to experience treatment burden (aOR= 2.37 (95 % CI, 1.61-3.47). CONCLUSIONS: Attaining person-centered and familycentered care will require strategies that respect diverse decision-making preferences, minimize treatment burden, and support the broader social context in which older adults manage their health.

Factors associated with patient activation in an older adult population with functional difficulties

“…This finding shows that patient activation and family support are intertwined, which emphasizes the importance of family-centered care. 35 Less than 50% of the participants reported a high level of family support, and half of the study population lived alone. Family support may be an unmet need in this population.…”

Beliefs and attitudes of older adults and carers about deprescribing of medications: a qualitative focus group study

“…The expressed need for a discussion may reflect a desire to be respected (integral to the doctorpatient relationship 33 ). Previous studies have established that most older adults want to be involved in decision making; 34 however, involvement may be perceived as just being informed of medication changes. 35 Participants in the present study acknowledged that the doctors held the knowledge and expected them to be able to convey information to them in a way that they could understand.…”

Family Caregivers and Consumer Health Information Technology

“…Many people with chronic and disabling conditions co-manage or delegate health management activities to others. 31,32 However, family members and close friends are often not aware of patients' specific health issues, treatment recommendations, or care goals and consequently may not know how to best support lifestyle and medication treatment regimen adherence 29,32,33 or decision-making preferences. 34,35 Consumer health information technology is increasingly being used to engage patients in chronic and preventive care.…”