TY - JOUR
T1 - Older adults' mental health function and patient-centered care
T2 - Does the presence of a family companion help or hinder communication?
AU - Wolff, Jennifer L.
AU - Roter, Debra L.
N1 - Funding Information:
Funding: This study was supported by National Institute of Mental Health grant K01MH082885 “Optimizing Family Involvement in Late-Life Depression Care” (JLW). The sponsor of this research was not involved in its study concept or design, recruitment of subjects or acquisition of data, data analysis or interpretation, or in the preparation of this manuscript. The original research that funded the collection of these data was supported by NIA Grant #R44-AG15737 to Mary Ann Cook (jvcradiology@att.net). These data were presented at the 2011 Annual Meeting of the American Association for Geriatric Psychiatry.
PY - 2012/6
Y1 - 2012/6
N2 - Background: Late-life mental health disorders are prevalent, costly, and commonly under-diagnosed and under-treated. Objective: To investigate whether family companion presence in routine primary care visits helps or hinders patient-centered processes among older adults with poor mental health function. DESIGN AND Participants: Observational study of accompanied (n∈=∈80) and unaccompanied (n∈=∈310) primary care patients ages 65 and older. Main Measures: Audio-taped medical visit communication, coded with the Roter Interactional Analysis System, and three process Measures: visit duration (in minutes), patient/companion verbal activity, and a ratio of patient-centered communication, adjusted for patient age, gender, race, and physical function. Participants were stratified by SF-36 mental health subscale (MCS) using two approaches (1) standardized population midpoint to delineate "good" (50+) and "poor" health (< 50) and (2) clinically derived cut-points (<35; 35-49; 50+). RESULTS: When patients with poor mental health were accompanied by a family companion, patient/companions provided less psychosocial information, physicians engaged in less question-asking and partnership-building, and both patient/companions and physicians contributed more task-oriented, biomedical discussion. Accompanied patients with poor mental health were less likely to experience patient-centered communication relative to unaccompanied patients (aOR∈=∈0.21; 95% CI: 0.06, 0.68); no difference was observed for patients with good mental health (aOR∈=∈1.02; 95% CI: 0.46, 2.27). Verbal activity was comparable for accompanied patients/companions and unaccompanied patients in both mental health strata. Medical visits were 2.3 minutes longer when patients with good mental health were accompanied (b∈=∈2.31; p∈=∈0.006), but was comparable for patients with poor mental health (b∈=∈-0.37; p∈=∈0.827). Study findings were amplified in the lowest functioning mental health subgroup (MCS∈<∈35): medical visits were shorter, and communication was least patient-centered (p∈=∈0.019) when these patients were accompanied. Conclusions: Older adults with poor mental health function may experience more communication challenges in the form of shorter visits and less patient-centered communication when a family companion is present.
AB - Background: Late-life mental health disorders are prevalent, costly, and commonly under-diagnosed and under-treated. Objective: To investigate whether family companion presence in routine primary care visits helps or hinders patient-centered processes among older adults with poor mental health function. DESIGN AND Participants: Observational study of accompanied (n∈=∈80) and unaccompanied (n∈=∈310) primary care patients ages 65 and older. Main Measures: Audio-taped medical visit communication, coded with the Roter Interactional Analysis System, and three process Measures: visit duration (in minutes), patient/companion verbal activity, and a ratio of patient-centered communication, adjusted for patient age, gender, race, and physical function. Participants were stratified by SF-36 mental health subscale (MCS) using two approaches (1) standardized population midpoint to delineate "good" (50+) and "poor" health (< 50) and (2) clinically derived cut-points (<35; 35-49; 50+). RESULTS: When patients with poor mental health were accompanied by a family companion, patient/companions provided less psychosocial information, physicians engaged in less question-asking and partnership-building, and both patient/companions and physicians contributed more task-oriented, biomedical discussion. Accompanied patients with poor mental health were less likely to experience patient-centered communication relative to unaccompanied patients (aOR∈=∈0.21; 95% CI: 0.06, 0.68); no difference was observed for patients with good mental health (aOR∈=∈1.02; 95% CI: 0.46, 2.27). Verbal activity was comparable for accompanied patients/companions and unaccompanied patients in both mental health strata. Medical visits were 2.3 minutes longer when patients with good mental health were accompanied (b∈=∈2.31; p∈=∈0.006), but was comparable for patients with poor mental health (b∈=∈-0.37; p∈=∈0.827). Study findings were amplified in the lowest functioning mental health subgroup (MCS∈<∈35): medical visits were shorter, and communication was least patient-centered (p∈=∈0.019) when these patients were accompanied. Conclusions: Older adults with poor mental health function may experience more communication challenges in the form of shorter visits and less patient-centered communication when a family companion is present.
KW - RIAS
KW - mental health
KW - patient-provider communication
KW - primary care
KW - visit companions
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U2 - 10.1007/s11606-011-1957-5
DO - 10.1007/s11606-011-1957-5
M3 - Article
C2 - 22180197
AN - SCOPUS:84862659360
SN - 0884-8734
VL - 27
SP - 661
EP - 668
JO - Journal of general internal medicine
JF - Journal of general internal medicine
IS - 6
ER -