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Caring for Patients with Functional Impairment in Middle Age: Perspectives from Primary Care Providers and Geriatricians

  • Original Research: Qualitative Research
  • Published:
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Abstract

Background

The prevalence of functional impairment is increasing among middle-aged adults and is associated with adverse health outcomes. Primary care providers (PCPs) and geriatricians may have important insights about optimal approaches to caring for these patients, but little is known about their perspectives.

Objective

To examine PCPs’ and geriatricians’ perspectives on clinical needs and optimal approaches to care for middle-aged patients with functional impairment.

Design

Qualitative study using semi-structured interviews.

Participants

PCPs and geriatricians from outpatient practices in the San Francisco Bay area.

Approach

Interviews focused on characteristics and care needs of middle-aged patients with functional impairment and models of care to address these needs. We analyzed interviews using hybrid deductive-inductive qualitative thematic analysis.

Key Results

Clinicians (14 PCPs, 15 geriatricians) described distinct characteristics of functional impairment in middle-aged versus older adults, such as different rates of onset, but similar clinical needs. Despite these similar needs, clinicians identified age-specific barriers to delivering optimal care to middle-aged patients. These included system-level challenges such as limited access to insurance and social services; practice- and clinician-level barriers including inadequate clinician training; and patient-level factors including less access to family caregivers and perceptions of stigma. To overcome these challenges, clinicians suggested clinical approaches including addressing health-related social needs within healthcare systems; implementing practice-based models that are multi-disciplinary, team-based, and coordinated; training clinicians to effectively manage functional impairment; and expanding community-based services and supports to help patients navigate the medical system. Identified needs, challenges, and solutions were generally similar across geriatricians and PCPs.

Conclusions

Clinicians face challenges in delivering optimal care to middle-aged patients who have functional impairments similar to their older counterparts but lack access to services and supports available to older people. These findings suggest the importance of increasing access to care models that address functional impairment regardless of age.

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Funding

This work was supported by the National Institute on Aging at the National Institutes of Health (grant numbers K23AG045290 and K76AG057016 to Brown and grant number K24AG067003 to Karliner) and the American Federation for Aging Research (grant number K76AG057016 to Brown). These funding sources had no role in the preparation, review, or approval of the manuscript. Dr. Brown is an employee of the Veterans Health Administration. The opinions expressed in this manuscript may not represent those of the Department of Veterans Affairs. SFBayCRN resources used for this study were supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF-CTSI Grant Number UL1 TR001872. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Abigail M. Schmucker MD

  2. Division of Geriatric Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA

    David Reyes-Farias MA & Rebecca T. Brown MD, MPH

  3. Geriatrics, Palliative, and Extended Care, San Francisco VA Health Care System, San Francisco, CA, USA

    Francesca M. Nicosia PhD

  4. Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA

    Francesca M. Nicosia PhD

  5. Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA

    Edison Xu MD & Leah S. Karliner MD, MAS

  6. Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA

    Michael B. Potter MD

  7. Geriatrics and Extended Care Program, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA

    Rebecca T. Brown MD, MPH

  8. Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA

    Rebecca T. Brown MD, MPH

  9. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA

    Rebecca T. Brown MD, MPH

Authors
  1. Abigail M. Schmucker MD
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  2. David Reyes-Farias MA
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  3. Francesca M. Nicosia PhD
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  7. Rebecca T. Brown MD, MPH
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Correspondence to Abigail M. Schmucker MD.

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Schmucker, A.M., Reyes-Farias, D., Nicosia, F.M. et al. Caring for Patients with Functional Impairment in Middle Age: Perspectives from Primary Care Providers and Geriatricians. J GEN INTERN MED (2024). https://doi.org/10.1007/s11606-024-08701-1

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