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Kurasz AM, Smith GE, Curiel RE, Barker WW, Behar RC, Ramirez A, Armstrong MJ. Patient values in healthcare decision making among diverse older adults. PATIENT EDUCATION AND COUNSELING 2022; 105:1115-1122. [PMID: 34509339 PMCID: PMC8980797 DOI: 10.1016/j.pec.2021.08.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 08/10/2021] [Accepted: 08/24/2021] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To provide high-quality healthcare, it is essential to understand values that guide the healthcare decisions of older adults. We investigated the types of values that culturally diverse older adults incorporate in medical decision making. METHODS Focus groups were held with older adults who varied in cognitive status (mildly impaired versus those with normal cognition) and ethnicity (Hispanic and non-Hispanic). Investigators used a qualitative descriptive approach to analyze transcripts and identify themes. RESULTS Forty-nine individuals (49% with cognitive impairment; 51% Hispanic) participated. Participants expressed a wide range of values relating to individual factors, familial/cultural beliefs and expectations, balancing risks and benefits, receiving decisional support, and considering values other than their own. Participants emphasized that values are individual-specific, influenced by aging, and change throughout life course. Participants described barriers and facilitators that interfere with or promote value solicitation and incorporation during medical encounters. CONCLUSION Study findings highlight that in older adults with various health experiences, cognitive and physical health status, and sociocultural backgrounds, medical decisions are influenced by a variety of values. PRACTICAL IMPLICATIONS Clinicians should take time to elicit, understand, and reassess the different types of values of older adults.
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Affiliation(s)
- Andrea M Kurasz
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Glenn E Smith
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Rosie E Curiel
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Warren W Barker
- Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL USA
| | - Raquel C Behar
- Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL USA
| | - Alexandra Ramirez
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA.
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Aliberti MJR, Covinsky KE. Home Modifications to Reduce Disability in Older Adults With Functional Disability. JAMA Intern Med 2019; 179:211-212. [PMID: 30615064 DOI: 10.1001/jamainternmed.2018.6414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Marlon J R Aliberti
- Division of Geriatrics, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Division of Geriatrics, University of California, San Francisco, San Francisco.,Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, California
| | - Kenneth E Covinsky
- Division of Geriatrics, University of California, San Francisco, San Francisco.,Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, California
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Nielsen G, Larsen KL, Uhrenfeldt L. Older hospitalized patients' experiences of dialogue with healthcare providers in hospitals: a systematic review protocol. ACTA ACUST UNITED AC 2017; 15:2507-2511. [PMID: 29035963 DOI: 10.11124/jbisrir-2016-003208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The objective is to identify and synthesize findings from qualitative studies of older (over 65 years) hospitalized patients' experiences of the barriers and facilitators to their dialogues with healthcare providers (HCPs) concerning their health and well-being.Specifically, the review questions are.
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Affiliation(s)
- Gitte Nielsen
- 1School of Nursing, University College of Northern Denmark, Hjørring, Denmark 2North Denmark Regional Hospital, Hjørring, Denmark 3Danish Centre of Systematic Reviews: a Joanna Briggs Institute Centre of Excellence, Department of Health Science and Technology, Aalborg University, Denmark 4Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
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Herrera-Tejedor J. [Healthcare preferences of the very elderly: A review]. Rev Esp Geriatr Gerontol 2016; 52:209-215. [PMID: 27751613 DOI: 10.1016/j.regg.2016.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 07/29/2016] [Accepted: 08/24/2016] [Indexed: 10/20/2022]
Abstract
The preferences of the very elderly are not taken into account in healthcare planning. For this reason, a medical literature review was performed in order to fill the gap in appropriate information on this issue. The majority of them think that they receive good healthcare. They favour building a trusting relationship, with the physician handling their decision-making. They also maximise their quality of life at the expense of quantity, and give great importance to comfort and safety. Most of them express the wish to be cared for and die at home. But when an acute event occurs, they want to be transferred to hospital. More explicit communication must be encouraged between very elderly patients, providers, and families to meet their subjective needs, through on-going discussions, focused on expected outcomes and patient care goals. A healthcare system designed to look after them should be based on individual and flexible care, with coordination between healthcare services. Such a healthcare system could enable a growing number of them to die in their preferred conditions.
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Affiliation(s)
- Juan Herrera-Tejedor
- Unidad de Geriatría, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, España.
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Bynum JPW, Barre L, Reed C, Passow H. Participation of very old adults in health care decisions. Med Decis Making 2013; 34:216-30. [PMID: 24106235 DOI: 10.1177/0272989x13508008] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Some elderly people receive tests or interventions from which they have low likelihood of benefit or for which the goal is not aligned with their values. Engaging these patients in the decision process is one potential approach to improve the individualization of care. Yet some clinicians perceive and some survey data suggest that older adults prefer not to participate in the decision-making process. Those preferences, however, may be formed based on an experience in which factors, such as communication issues, were barriers to participation. Our goal was to shed light on the experience of very old adults in health care decision making from their own point of view to deepen our understanding of their potentially modifiable barriers to participation. DESIGN and METHODS Semistructured interviews of participants aged 80 and older (n = 29, 59% women and 21% black) were analyzed using the constant comparative method in a grounded theory approach to describe decision making in clinic visits from the patient's perspective. RESULTS The average age was 84 years (range, 80-93); each described an average of 6.4 decision episodes. Active participation was highly variable among subjects. Marked differences in participation across participants and by type of decision--surgery, medications, diagnostic procedures, routine testing for preventive care--highlighted barriers to greater participation. The most common potentially modifiable barriers were the perception that there were no options to consider, low patient activation, and communication issues. CONCLUSIONS The experience of very old adults highlights potentially modifiable barriers to greater participation in decision making. To bring very old patients into the decision process, clinicians must modify interviewing skills and spend additional time eliciting their values, goals, and preferences.
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Affiliation(s)
- Julie P W Bynum
- Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA (JPWB, LB, CR, HP).,Department of Medicine, Dartmouth Medical School, Hanover, NH,USA (JPMB)
| | - Laura Barre
- Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA (JPWB, LB, CR, HP)
| | - Catherine Reed
- Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA (JPWB, LB, CR, HP)
| | - Honor Passow
- Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA (JPWB, LB, CR, HP)
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Doba N, Tokuda Y, Goldstein NE, Kushiro T, Hinohara S. A pilot trial to predict frailty syndrome: the Japanese Health Research Volunteer Study. Exp Gerontol 2012; 47:638-43. [PMID: 22664579 DOI: 10.1016/j.exger.2012.05.016] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 05/19/2012] [Accepted: 05/25/2012] [Indexed: 10/28/2022]
Abstract
Most definitions of frailty utilize US populations in their development. The concept of frailty has not been well studied in Japan, which has the largest percentage of older patients (per capita) in the world. We created a 5-year prospective cohort study of community-dwelling older Japanese adults. Participants were not frail at baseline, based on our definition adapted from the Canadian Study for Health and Aging Clinical Frailty Scale. Participants underwent a comprehensive geriatric assessment (CGA) at baseline, and final assessments were either in person or via mailed survey. We enrolled 407 individuals (184 men, mean age 78 ± 4 years; 223 women, mean age 77 ± 4 years). Sixty-five participants met criteria for frailty by the end of the study. In univariate analyses, eighteen separate parameters were associated with frailty, some of which included: age, gender, handgrip, timed walk, systolic blood pressure, pulse pressure, cognitive status, living alone, and hearing deficits. In multivariate analyses, the following elements remained associated with frailty: timed walk, pulse pressure, cognition deficits and hearing deficits. We established cut-off points for timed walk (5m/3s) and pulse pressure (60 mmHg). We then created a simple additive score for these four factors (present = 1; absent = 0). A score of 0 had a 93% negative predictive value for frailty while a score of 4 had a 70% positive predictive value. While further study is needed, this work creates an easy-to-administer tool that may be generalizable to other populations.
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Affiliation(s)
- Nobutaka Doba
- Division of Research and Education, Life Planning Center Foundation, Sasakawa Kinen Kaikan, Eleventh Floor, 12-12, Mita 3-chome, Minato-ku, Tokyo, 108-0073, Japan.
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Abstract
Acute-care hospitals have few structures, programs, or staff prepared to address the special needs of older adults. To address this issue, the Hartford Institute for Geriatric Nursing [including the Nurses Improving Care for Hospitalized Elders (NICHE) program] and the Coalition of Geriatric Nursing Organizations proposed language for a Bill of Rights for Hospitalized Older Adults. The Bill of Rights moves from general value statements to the specific knowledge, skills, and actions necessary to provide quality of care to older adults. The authors describe the development and testing of the Bill of Rights and suggest steps for its adoption and dissemination.
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Quevedo HC, Deravil D, Seo DM, Hebert KA. The Meaningful Use of the Review of Symptoms in Heart Failure Patients. ACTA ACUST UNITED AC 2011; 17:31-7. [DOI: 10.1111/j.1751-7133.2010.00203.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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