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• W1963974328 abstract "To the Editor: Cognitive, physical, and sensory limitations in older adults often limit informed decision-making in medical encounters,1 but they remain interested in making informed healthcare choices, and patient-centered care will require innovations that promote engagement of older adults in care decisions.2, 3 The aim of this study was to determine the proportion of very old adults who felt adequately informed about their care after their most-recent clinical encounter and to identify correlates of informed care. The Health, Aging and Body Composition Study (Health ABC) began in 1997 and recruited a population-based sample of 3,075 participants aged 70 to 79 without mobility disability. By Year 15 (2011–12), 1,396 participants were alive and located. They ranged in age from 82 to 94 (median 86). The current study included 1,082 participants who were able to complete the Year 15 telephone interview independently. Participants resided in Memphis, Tennessee, or Pittsburgh, Pennsylvania (34.9% black, 57.4% female). Whether participants were considered to be “informed” was determined according to their answers to two questions: “Did your doctor or other healthcare professional check to see if you understood your condition and care?” and “How much information did the doctor or other healthcare professional give you about your medical condition?” If a participant answered yes to the former and “just the right amount” or “more than was needed” to the latter, they were considered to be informed. Cognitive performance was assessed using the Telephone Interview for Cognitive Status Test (TICS), a dementia screening tool (≥33, no impairment; 26–32, potential impairment; 21–25, mild impairment; ≤20, moderate to severe impairment).4 Respondents also indicated how frequently they “felt down, depressed, or hopeless.”5 Other measures included information about the last encounter with a clinician. The institutional review boards of the University of Pittsburgh, University of Tennessee Health Sciences Center (Memphis), and University of California at San Francisco approved the study. Three-quarters (76.2%) of participants met criteria for informed care. Informed care status did not differ according to sex, race, level of education, or self-reported health or disability. Pittsburgh residents were somewhat more likely to report receiving informed care (79.5%) than Memphis residents (72.7%) (P = .009). Informed care status was not associated with features of the medical encounter, such as being accompanied to the appointment; use of the Internet to look up medical information; or prescribing of new medicines, tests, or treatments. Cognitive performance as indicated by TICS scores was similar in the two groups (27.9 ± 6.8 vs 27.6 ± 6.5, P = .50). Participants who met criteria for informed care were more likely to prefer sharing treatment decisions with their doctor (70.5%) than those who were not informed (50.4%) (P < .001). Participants who did not meet criteria for informed care were significantly more likely to report depressed mood; 9.4% of these participants reported feeling down, depressed, or hopeless more than half the days over the past 2 weeks, compared with 4.4% of informed participants (P = .002). More than three-quarters of community-dwelling older adults met criteria for informed care based on self-reports that clinicians checked to see that they understood their condition and provided adequate information about their medical condition. Participants who felt they were informed about their care were more likely to prefer shared decision-making with clinicians and reported more-positive mood. The association between informed care and shared decision-making is consistent with results from a qualitative study of individuals aged 80 to 93 that found that people who were less informed about their health were more likely to let physicians make decisions.2 The association between informed care and mood confirms an early study reporting that older adults with depressed or anxious mood were less likely to receive medical information in clinical encounters.6 Neither sociodemographic factors nor cognitive performance were associated with the likelihood of reporting informed care. The difference between Pittsburgh and Memphis residents is hard to explain but may reflect differences in practice patterns or expectations for informed care. Absence of differences in cognitive status is likely due to limitation of the sample to people able to complete the telephone interview. A limitation of this study is that the criteria for informed care were based solely on participant perceptions of clinical encounters. Correlative information from healthcare providers was not available. Nor can it be determined whether participants adequately understood information that clinicians provided. This study demonstrates that a majority of very old adults feel that clinicians seek to inform them about their medical status. Future studies should include a provider interview and determine whether informed care is associated with decision-making and health outcomes. This research was supported in part by the Intramural Research Program of the National Institutes of Health (NIH), National Institute on Aging (NIA). Conflict of Interest: Lunney, Newman, Satterfield, and Albert are PIs or Co-PIs on NIH grants or contracts that support data collection and analysis of Health ABC. Garcia and Harris are employed by NIA and oversee the NIH Health ABC contract. Juliana Hoffelder-Wyne was supported by the American Federation for Aging Research Medical Student Training in Aging program. Health ABC efforts were supported by NIA Contracts N01-AG-6–2101, N01-AG-6–2103, N01-AG-6–2106, R01-AG028050, and R01-AG024827 and National Institute of Nursing Research Contract R01-NR012459. Author Contributions: Study concept: Hoffelder-Wynne, Albert, Lunney. Acquisition of data, quality of data collection: Ives, Newman, Satterfield, Ayonayon, Rubin. Data analyses: Hoffelder-Wynne, Albert. Manuscript preparation: Hoffelder-Wynne, Albert. Review of manuscript for intellectual content: Hoffelder-Wynne, Lunney, Ives, Newman, Satterfield, Garcia, Harris, Ayonayon, Rubin, Albert. Sponsor's Role: NIA staff reviewed the manuscript before submission." @default.
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• W1963974328 date "2015-03-01" @default.
• W1963974328 modified "2023-09-24" @default.
• W1963974328 title "Perceptions of Very Old Adults About Informed Care in Medical Encounters" @default.
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• W1963974328 doi "https://doi.org/10.1111/jgs.13291" @default.
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