Older Adults’ Mental Health Function and Patient-Centered Care: Does the Presence of a Family Companion Help or Hinder Communication?
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Late-life mental health disorders are prevalent, costly, and commonly under-diagnosed and under-treated.
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.
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+).
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.
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.
KEY WORDSpatient–provider communication visit companions RIAS primary care mental health
1) Substantial contributions to conception and design (JLW and DLR), or acquisition of data (DLR), or analysis and interpretation of data (JLW and DLR; 2) drafting the article (JLW) or revising it critically for important intellectual content (JLW and DLR); and 3) final approval of the version to be published (JLW and DLR). Dr. Wolff had full access to all of the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis.
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 (firstname.lastname@example.org). These data were presented at the 2011 Annual Meeting of the American Association for Geriatric Psychiatry.
Conflict of Interest
Debra Roter is the author of the Roter Interaction Analysis System (RIAS) and holds the copyright for the system. Johns Hopkins University also has rights to enhancements of the system. Neither Debra Roter nor Johns Hopkins collect royalties for use of the system in research which is the current case. Debra Roter is owner of RIASWorks LLC, a company that provides RIAS coding services to clients. It may be possible that RIASWorks will benefit indirectly from dissemination of the current research.
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