Multimorbidity and Decision-Making Preferences Among Older Adults

Winnie, Cheng Lai Sheung; Wolff, Jennifer L.; Greer, Raquel C.; Dy, Sydney M.

doi:10.1370/afm.2106

Cited by 80 publications

(71 citation statements)

References 38 publications

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“…Furthermore, decisions based on patients' healthcare preferences improve adherence . Even persons who desire clinicians to make most decisions want their preferences considered . Aligning care (treatment) options with patients' health priorities also lessens the likelihood of conflicting recommendations and treatment burden if all clinicians focus on the same priorities.…”

Section: Rationale For the MCC Stepsmentioning

confidence: 99%

Decision Making for Older Adults With Multiple Chronic Conditions: Executive Summary for the American Geriatrics Society Guiding Principles on the Care of Older Adults With Multimorbidity

Boyd

Smith

Masoudi

et al. 2019

J American Geriatrics Society

222

174

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Caring for older adults with multiple chronic conditions (MCCs) is challenging. The American Geriatrics Society (AGS) previously developed The AGS Guiding Principles for the Care of Older Adults With Multimorbidity using a systematic review of the literature and consensus. The objective of the current work was to translate these principles into a framework of Actions and accompanying Action Steps for decision making for clinicians who provide both primary and specialty care to older people with MCCs. A work group of geriatricians, cardiologists, and generalists: (1) articulated the core MCC Actions and the Action Steps needed to carry out the Actions; (2) provided decisional tips and communication scripts for implementing the Actions and Action Steps, using commonly encountered situations: (3) performed a scoping review to identify evidence‐based, validated tools for carrying out the MCC Actions and Action Steps; and (4) identified potential barriers to, and mitigating factors for, implementing the MCC Actions. The recommended MCC Actions include: (1) identify and communicate patients' health priorities and health trajectory; (2) stop, start, or continue care based on health priorities, potential benefit vs harm and burden, and health trajectory; and (3) align decisions and care among patients, caregivers, and other clinicians with patients' health priorities and health trajectory. The tips and scripts for carrying out these Actions are included in the full MCC Action Framework available in the supplement (http://www.geriatricscareonline.org). J Am Geriatr Soc 67:665–673, 2019.

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Section: Rationale For the MCC Stepsmentioning

confidence: 99%

Decision Making for Older Adults With Multiple Chronic Conditions: Executive Summary for the American Geriatrics Society Guiding Principles on the Care of Older Adults With Multimorbidity

Boyd

Smith

Masoudi

et al. 2019

J American Geriatrics Society

222

174

View full text Add to dashboard Cite

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“…Few studies have reported high levels of patient participation in goal setting [8,38]. Health professionals' perceptions that these patients do not wish to be involved are contrary to research showing that older people with multi-morbidity in community settings prefer to participate actively, although, admittedly, to a lesser extent when they have four or more conditions [39]. In our study, health professionals found it easier to set goals with patients with less complex needs; for these patients they used the approach of 'specifying goals'.…”

Section: Discussionmentioning

confidence: 83%

Sharing responsibility: municipal health professionals’ approaches to goal setting with older patients with multi-morbidity – a grounded theory study

Oksavik

Kirchhoff

Sogstad

et al. 2020

BMC Health Serv Res

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Background: Recent health policy promoting integrated care emphasizes to increase patients' health, experience of quality of care and reduce care utilization. Thus, health service delivery should be co-produced by health professionals and individual patients with multiple diseases and complex needs. Collaborative goal setting is a new procedure for older patients with multi-morbidity. The aim is to explore municipal health professionals' experiences of collaborative goal setting with patients with multi-morbidity aged 80 and above. Methods: A qualitative study with a constructivist grounded theory approach. In total twenty-four health professionals from several health care services in four municipalities, participated in four focus group discussions. Results: Health professionals took four approaches to goal setting with older patients with multi-morbidity: motivating for goals, vicariously setting goals, negotiating goals, and specifying goals. When 'motivating for goals', they educated reluctant patients to set goals. Patients' capacity or willingness to set goals could be reduced, due to old age, illness or less knowledge about the health system. Health professionals were 'vicariously setting goals' when patients did not express or take responsibility for goals due to adaptation processes to disease, or symptoms as cognitive impairment or exhaustion. By 'Negotiating goals', health professionals handled disagreements with patients, and often relatives, who expected to receive more services than usual care. They perceived some patients as passive or having unrealistic goals to improve health. 'Specifying goals' was a collaboration. Patients currently treated for one condition, set sub-goals to increase health. Patients with complex diseases prioritized one goal to maintain health. These approaches constitute a conceptual model of how health professionals, to varying extents, share responsibility for goal setting with patients. Conclusions: Goal setting for patients with multi-morbidity were carried out in an interplay between patients' varying levels of engagement and health professionals' attitudes regarding to what extents patients should be responsible for pursuing the integrated health services' objectives. Even though goal setting seeks to involve patients in co-production of their health service delivery, the health services´aims and context could restrict this co-production.

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“…This low prevalence of subjects with higher metabolic impairment can be explained by the association between age, multimorbidity and functional impairment. 30,31 These associated factors elevate the symptomatology of OA and in this case, they seem to have made the participants' way to the exam collection site more difficult. 25,29 And, although the involvement of metabolic factors in the etiology of OA is supported by both epidemiological studies as for experimental data, some authors did not find a significant association between OA and MS, 20,25 such as in the present research.…”

Section: Discussionmentioning

confidence: 94%

Associação entre osteoartrite de joelho e síndrome metabólica em pacientes idosos não institucionalizados

Franco

Falsarella

Costallat³

et al. 2020

Rev Bras Ortop (Sao Paulo)

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ResumoObjetivo Este estudo teve o objetivo de analisar a associação entre a osteoartrite (OA) de joelho e a síndrome metabólica (SM) em pacientes idosos não institucionalizados. Métodos Pesquisa transversal, aleatorizada, extraída de um estudo probabilístico por conglomerado realizado com 416 idosos de uma Unidade de Saúde da Família do nosso município. A SM foi definida de acordo com o National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), e a OA de acordo com a escala Kellgren-Lawrence (KL) (! 2). Resultados Para a análise estatística, foi realizada uma análise exploratória de dados, testes de Mann-Whitney ou Qui-quadrado e regressões logísticas uni e multivariadas, com nível de significância de p < 0,05; a concordância entre os avaliadores foi verificada através do coeficiente de Kappa. Verificou-se associação entre OA e índice de massa corpórea (IMC) (p ¼ 0,0021) e entre OA e circunferência de cintura (CC) (p < 0,001; razão de chances [RC] ¼ 3,524). Não foi encontrada associação significativa entre a OA e o número de componentes metabólicos nem com a SM em si. Conclusão Conclui-se que a OA de joelho associa-se à CC, independente do peso, e que o aumento em sua medida reflete em uma maior chance de SM em idosos não institucionalizados. AbstractObjective This study aimed to analyze the association between knee osteoarthritis (OA) and metabolic syndrome (MS) in non-institutionalized elderly patients. Methods A cross-sectional, randomized study, drawn from a probabilistic cluster study conducted with 416 elderly people from a Family Health Unit (USF, in the Portuguese acronym) of our municipality. Metabolic syndrome was defined according Ã Trabalho desenvolvido na Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil.

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Multimorbidity and Decision-Making Preferences Among Older Adults

Cited by 80 publications

References 38 publications

Decision Making for Older Adults With Multiple Chronic Conditions: Executive Summary for the American Geriatrics Society Guiding Principles on the Care of Older Adults With Multimorbidity

Decision Making for Older Adults With Multiple Chronic Conditions: Executive Summary for the American Geriatrics Society Guiding Principles on the Care of Older Adults With Multimorbidity

Sharing responsibility: municipal health professionals’ approaches to goal setting with older patients with multi-morbidity – a grounded theory study

Associação entre osteoartrite de joelho e síndrome metabólica em pacientes idosos não institucionalizados

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