Older adults' mental health function and patient-centered care: Does the presence of a family companion help or hinder communication?

摘要

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.