Scope and Outcomes of Surrogate Decision Making Among Hospitalized Older Adults

Torke, Alexia M.; Sachs, Greg A.; Helft, Paul R.; Montz, Kianna; Hui, Siu L.; Slaven, James E.; Callahan, Christopher M.

doi:10.1001/jamainternmed.2013.13315

Cited by 154 publications

(122 citation statements)

References 36 publications

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“…Findings support recommendations for proactive and systematic elicitation of individuals' wishes regarding the inclusion of family and close friends who may be present during a visit or at the bedside, in medical decision-making. 34,35 Poor health and delegation of health care activities to others were most strongly associated with aspects of treatment burden related to managing health activities. The clinical relevance of treatment burden has been established for consequential outcomes such as adherence to prescribed treatments, quality of life, and health services utilization.…”

Section: Discussionmentioning

confidence: 99%

“…Systematic elicitation of perspectives of involved family and close friends to complement the perspectives of patients has been raised as a consideration in patient-reported outcomes and performance measurement. [51][52][53] As individuals without the capacity to self-report their preferences and experiences with care are particularly vulnerable and susceptible to receiving contradictory, fragmented, and burdensome care, 34,54 devising methods that incorporate perspectives of knowledgeable informants is necessary to a credible population-based quality measurement enterprise. More broadly, eliciting perspectives of family or close friends involved in managing health care activities 6,9 and health care decision-making 8,20,34 merits consideration, given they may also experience burdens associated with care.…”

Section: Discussionmentioning

confidence: 99%

“…[51][52][53] As individuals without the capacity to self-report their preferences and experiences with care are particularly vulnerable and susceptible to receiving contradictory, fragmented, and burdensome care, 34,54 devising methods that incorporate perspectives of knowledgeable informants is necessary to a credible population-based quality measurement enterprise. More broadly, eliciting perspectives of family or close friends involved in managing health care activities 6,9 and health care decision-making 8,20,34 merits consideration, given they may also experience burdens associated with care. 6,45 In its vision of a high performing, high value health care system, the National Quality Strategy has articulated priorities of making care safer by reducing harm, ensuring that each person and family are engaged as partners in care, and promoting effective communication and coordination of care.…”

Section: Discussionmentioning

confidence: 99%

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

Wolff

Boyd

2015

J GEN INTERN MED

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Wolff

Boyd

2015

J GEN INTERN MED

View full text Add to dashboard Cite

show abstract

“…The initial investigation identified 1083 patients and enrolled 597. Enrolled patients and not enrolled patients were similar in age (mean 76.1 to 77.0 years; P = 0.08), sex (female, 64.5% to 60.8%; P = 0.22), race (African American and other, 48.1% and 1% to 52.3% and 1.3%; P = 0.33), and socioeconomic status (Medicaid 34.0% to 31.4%; P = 0.46) [20].…”

Section: Statistical Analysesmentioning

confidence: 85%

“…This study was a secondary analysis of data from a prospective observational study of patients from hospital medical wards and the Intensive Care Units (ICU) of two metropolitan hospitals in a Midwestern city affiliated with a university and staffed by university faculty, residents, and students [20]. One hospital was a tertiary referral center and the other was a county funded safety net hospital.…”

Section: Setting/patientsmentioning

confidence: 99%