Person-environment fit of environmental support provided during medical consultations with older patients

Abstract

As some cognitive functions decline in old age, the ability to decide about important life events such as medical treatment is endangered. Environmental support to improve the comprehension of health-related information is therefore necessary. With a small-scale explorative approach, the present survey study aimed at investigating person-environment fit (PE-fit) of support provided during medical consultations. This fit was calculated by assessing the match between aids provided by five medical practitioners during medical consultations and aids most appreciated by the geriatric patients (N = 88). The results showed that the largest discrepancies of used and appreciated aids could be found concerning the opportunity to discuss decisions with relatives, the possibility to take notes, the use of objects, pictures and a keyword list. Female patients indicated a lower PE-fit. These findings highlight discrepancies between the use of specific aids and the wishes of patients and call for thoughtful use of aids during consultations with geriatric patients.

Project DECIDE, part II: decision-making places for people with dementia in Alzheimer’s disease: supporting advance decision-making by improving person-environment fit

“…From a recent trial evaluating SDM strategies for patients with dementia (EmMa project) [ 9 ], the MacCAT-T subscale scores of the 30 patients with Alzheimer’s disease (14 in the intervention, 16 in the control group) were used to define the relevant standardised location effect for the sample size calculation. While the SDM strategies in EmMa project only increased scores on the “understanding” subscale of the MacCAT-T, we expect that in our trial, the support of the familiar environment of the patient’s home will rather influence the “reasoning” subscale.…”

“…Since a two-step evaluation procedure based on a linear mixed model will be used to analyse the primary endpoint, we verified the sample size in a simulation of the procedure with 10,000 analysis runs per scenario. Based on the relevant standardised effect (see above) and the variance in the ‘reasoning’ scores observed in EmMa project [ 9 ], we considered four scenarios covering a range of realistic outcomes. They are presented in Fig.…”

“…We consider SDM to be a communicative process and base our understanding of it on the combined communication model of Haberstroh et al [ 8 ], in which the mentioned strategies support both verbal and non-verbal content aspects of communication. Poth et al [ 9 ] have shown that such content-related SDM strategies, although leading to a significant enhancement in PwAD’s understanding of information, did not achieve a clinically relevant improvement in overall capacity to consent. The question facing us is therefore what else we can do to support decision-making processes in PwAD?…”

Predementia Counseling

“…Also, geriatric individuals are more likely to suffer from medical conditions (e.g., sight disorder, hearing loss) impairing their communication and the informed-decision process. These considerations affect health literacy skills and health-related competencies, so it is crucial to consider options to enhance healthcare professionals’ skills, for example, by communication training, and to offer individual support for patients (Ivashkov & Van Norman, 2009; Poth et al, 2021; Rostamzadeh et al, 2020).…”