What Elders Want: A Qualitative Meta-synthesis of Elders’ Views on Interactions with their General Practitioners (original) (raw)
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Physician-patient interaction: what do elders want?
The Journal of the American Osteopathic Association
The purpose of this study was to identify communication styles and physician characteristics that correlate with improved patient adherence and satisfaction during geriatric healthcare interactions. A multiphase study design, incorporating the use of focus groups, socialization hours, educational seminars, and survey questionnaires, was used to discover the most effective methods for improving communication between physicians and their geriatric patients. Elders favored direct, interactive verbal communication over alternative communication styles such as role-playing activities or the use of visual aids. Chi-square analyses showed that men desired more time with medical providers than women, who instead expressed a preference for more thorough explanations of disease processes. Further, men--and African American men in particular--sought medical advice from trusted friends more frequently than did women, who often preferred to solicit medical advice from family members. The most si...
There is growing evidence that the outcomes of health care for seniors are dependent not only upon patients' physical health status and the administration of care for their biomedical needs, but also upon care for patients' psychosocial needs and attention to their social, economic, cultural, and psychological vulnerabilities. Even when older patients have appropriate access to medical services, they also need effective and empathic communication as an essential part of their treatment. Older patients who are socially isolated, emotionally vulnerable, and economically disadvantaged are particularly in need of the social, emotional, and practical support that sensitive provider-patient communication can provide. In this review paper, we examine the complexities of communication between physicians and their older patients, and consider some of the particular challenges that manifest in providers' interactions with their older patients, particularly those who are socially isolated, suffering from depression, or of minority status or low income. This review offers guidelines for improved physician-older patient communication in medical practice, and examines interventions to coordinate care for older patients on multiple dimensions of a biopsychosocial model of health care.
Satisfaction with Medical Encounters Among Caregivers of Geriatric Outpatients
Sociological Practice, 2014
Caregivers' experiences and satisfaction with physicians and medical services provided to geriatric patients are reported. An outstanding predictor of satisfaction with physician communication and overall patient care was the extent to which caregivers were experiencing role strain. Other significant predictors included caregiver knowledge of clinic and social support services provided to patients. The data suggest that, irrespective of the quality of clinic services and physician communication style, some caregivers will be dissatisfied because their encounter is mediated by the stress of activities separate from the medical encounter. We assert the importance of specialized geriatric services and argue that if these services are not in place, caregiver satisfaction with the overall medical encounter will likely be much lower.
Annals of Behavioral Medicine, 2005
Background: The lack of instruments and methodologies designed specifically for assessing doctor-elderly patient interactions has constricted research on effective communication in the medical care of older adults. Purpose: This article reports on the development, qualitative analyses, and psychometric testing of the Assessment of Doctor-Elderly Patient Transactions (ADEPT), an instrument for assessing interactions between doctors and their elderly patients. Methods: The ADEPT was based on the recommendations of an expert panel and designed around the three-function model of the medical interview. The ADEPT is meant to operationalize the research findings of interactional analysis studies of doctor-patient interaction. Following preliminary testing with standardized patients, the ADEPT was applied to videotaped visits of 433 patients 65 years of age and older to the doctor (n = 40) identified as their primary source of care. Results: Four final scales derived from exploratory and confirmatory factor analyses were scored: Supporting, comprised of the 12 items from the first factor; Eliciting Needs, containing the 5 items from the second factor; and Informing, based on the final 6-item factor. Individual Cronbach's alphas across raters for this sample ranged from .71 to .79 for the first scale, from .83 to .88 for the second scale, and from .64 to .81 for the third scale. The reliability estimates for the total scale (23 items) ranged from .80 to .86 across raters. A fifth summed index composed of 46 binary checklist items also was computed. Conclusions: The findings indicate that credible scales can be developed for assessing communication behaviors.
The Relevance and Added Value of Geriatric Medicine (GM): Introducing GM to Non-Geriatricians
Journal of Clinical Medicine, 2021
Geriatric Medicine (GM) holds a crucial role in promoting health and managing the complex medical, cognitive, social, and psychological issues of older people. However, basic principles of GM, essential for optimizing the care of older people, are commonly unknown or undermined, especially in countries where GM is still under development. This narrative review aims at providing insights into the role of GM to non-geriatrician readers and summarizing the main aspects of the added value of a geriatric approach across the spectrum of healthcare. Health practitioners of all specialties are frequently encountered with clinical conditions, common in older patients (such as cancer, hypertension, delirium, major neurocognitive and mental health disorders, malnutrition, and peri-operative complications), which could be more appropriately managed under the light of the approach of GM. The role of allied health professionals with specialized knowledge and skills in dealing with older people’s ...
Objectives This study explored the experience of delivering care remotely among practitioners in a UK geriatric medicine clinic. Methods Nine semi-structured interviews were conducted with consultants (n = 5), nurses (n = 2), a speech and language and an occupational therapist, and thematically analysed. Results Three themes developed; Rapport Building; Setting and Context; Patient-Professional relationships. Discussion Participants felt that rapport and trust had been more feasible to develop remotely than they had anticipated, although this was more challenging for new patients and those with cognitive or sensory impairments. While practitioners identified advantages of remote consultations, including involving relatives, saving time, and reducing anxiety, they also experienced disadvantages such as consultations feeling like a ‘production line’, missing visual cues and reduced privacy. Some participants felt their professional identity was threatened by the lack of face-to-face c...
Dialogue on Geriatrics: How Should We Fix the Problem? (letter)
Annals of Internal Medicine, 2012
Golden and colleagues (1) ask if geriatric medicine is terminally ill and make a case to restructure training by reallocating resources from fellowship training to teaching initiatives to "gerontologize" medical students and nongeriatricians. We would counter that geriatrics is very much alive and that the fellowship-trained geriatricians have accomplished much of what Golden and colleagues propose. Academic geriatrics was started in recent decades by nongeriatricians who saw a need to improve the health care of seniors through research, education, and program innovation. They developed fellowship programs to train physicians to lead this movement. The care of seniors has been enriched by this growing number of fellowship-trained geriatricians. Two points exemplify these accomplishments. First, the geriatrization of students and nongeriatricians has been ongoing for years with support of foundations, the U.S. Department of Veterans Affairs, and the National Institute on Aging and the National Institutes of Health. The impact of geriatricians has been magnified greatly by training many nongeriatrician scholars who have won career development awards in geriatrics, such as those named for the late leaders Dennis W. Jahnigen, T. Franklin Williams, and Paul B. Beeson. The emerging nongeriatricians represent nearly every specialty and subspecialty of medicine and surgery. They would admit that their careers were greatly nurtured by fellowship-trained geriatricians. Second, new knowledge in caring for seniors is vital and has been accomplished mostly by fellowship-trained geriatricians. For example, consider advances in care delivery systems (such as Guided Care, Hospital at Home, post-hospital care management, acute care of the elderly units, innovations involved in transitions of care) and the understanding, impact, evaluation, prevention, and treatment of polypharmacy, frailty, incontinence, falls, and delirium. Decreasing support of fellowship training and subsequently diminishing the core group of teachers and researchers trained in and focused on geriatrics as suggested by Golden and colleagues would be unwise in light of the increasing number of seniors with complex medical problems coupled with the need for experts trained to guide clinical program development for these individuals. Nongeriatricians can and should continue to teach geriatric principles and do innovative research to improve the care of seniors. But there remains a need for a robust corps of fellowship-trained geriatricians who stay tightly focused on the care of seniors and who nurture, challenge, and inspire each other and other physicians. The enduring metaphor, "Don't throw the baby out with the bathwater," seems applicable to the Golden and colleagues' thesis.