Everyday Preferences Research Articles

Projection of Care Partners’ Preferences in the Proxy Assessments of Everyday Preferences for Persons With Cognitive Impairment

Bias in surrogate decision-making can occur when proxy decision-makers overestimate the degree to which their preferences are shared by others, resulting in a projection of their beliefs onto others. The purpose of this study is to assess projection of care partners' preferences onto surrogate assessments of everyday preferences for persons with cognitive impairment (CI) and to address clinical and demographic factors as predictors of projection. The sample included 116 dyads of persons with CI (Clinical Dementia Rating Scale score ≥ 0.5) and their care partners. The Preferences for Everyday Living Inventory (PELI) was used to assess importance of preferences among persons with CI. Care partners completed two separate PELI assessments: one from the perspective of the persons with CI (i.e., acting as a surrogate decision-maker) and one from their own perspective. To assess for projection of care partners' preferences onto surrogate assessments of preferences for persons with CI, two-step regression with multivariable-adjusted general linear models was used. Significant projection was noted within the PELI domains of autonomous choice, personal growth, and keeping a routine (p < 0.005). More significant cognitive impairment was associated with increased projection within the PELI domains of autonomous choice and personal growth (p < 0.05). The results of this study suggest that projection of care partners' own preferences may be a significant source of bias in proxy decision-making regarding everyday preferences for persons with CI, particularly for those with more significant CI.

Projection in Proxy Assessments of Everyday Preferences for Persons with Cognitive Impairment

AbstractBackgroundA source of bias in surrogate decision‐making has been articulated alternatively as the false consensus effect, assumed similarity, and attributive/social projection by which proxies overestimate the degree that their values and preferences are shared by others, resulting in a projection of their own beliefs onto others in the process of surrogate decision‐making. The aims of this study are to assess for projection of proxies’ preferences onto surrogate assessments of everyday preferences for persons with cognitive impairment (CI) and to address cognitive and neuropsychiatric symptom burden as predictors of projection.MethodThe sample included 116 dyads of persons with CI (Clinical Dementia Rating Scale score ≥ 0.5) and their care partners. The Preferences for Everyday Living Inventory (PELI) was used to assess importance of preferences among persons with CI. Care partners completed two separate PELI assessments: one from the perspective of the persons with CI (i.e., acting as a surrogate decision‐maker) and one from their own perspective. To assess for projection of care partners’ preferences onto surrogate assessments of preferences for persons with CI, two‐step regression with multivariable‐adjusted general linear models was used.ResultSignificant projection effects were noted within the PELI domains of autonomous choice, personal growth, and keeping a routine (p &lt; 0.0005). More significant cognitive impairment was associated with increased projection effects within the PELI domains of autonomous choice and personal growth (p &lt; 0.01)ConclusionThe results of this study suggest that projection effects of care partners own preferences may be a significant source of bias in everyday proxy decision‐making for persons with CI, particularly for those with more significant CI.

The Dark Tetrad and aesthetic preferences: The role of the dark side of personality in the aesthetic preference for paintings

The role of so-called normal and dark personality traits in everyday preferences, interests, and choices is visible in different domains of life. However, a small number of studies have dealt with individual differences in dark personality traits and aesthetic preferences. The domain of dark personality traits is in recent studies generally conceptualized as the Dark Tetrad — comprised of Machiavellianism, narcissism, psychopathy, and sadism. Thus, the aim of this research was to examine the relationship between the Dark Tetrad and visual aesthetic preferences. The sample consisted of 170 participants (Mage = 29.09, SDage = 10.66; 77.1 % females). Participants completed the Short Dark Triad and the Varieties of Sadistic Tendencies questionnaires, and also rated their familiarity and preference for 15 paintings with five different types of motives (religious, abstract, oriental, violence, and landscape). It was shown, based on looking at zero-order correlations that only narcissism positively correlates with the preference for paintings with violent motives. Also, a series of regression analyses were performed, which showed that the only significant regression model is the one that reflects the role of reduced psychopathy in the preference for religious motives. The first finding can be explained on the basis of stable findings on the relationship between narcissism and aggression, and also narcissism and violence. The second finding can be interpreted in the context that general religiosity has previously been shown to be negatively associated with psychopathy. It can be concluded that dark personality traits are one of the factors that affect aesthetic preferences.

Longitudinal changes in neuropsychiatric symptoms: Impact of discrepancy in everyday preferences between people with cognitive impairment and their care partners

AbstractBackgroundNeuropsychiatric symptoms (NPS) of major neurocognitive disorders are common and debilitating facets of the illness process. Yet, little is known about the impact on NPS of discrepancy in the importance of everyday preferences between persons with cognitive impairment (CI) and proxy ratings by their care partners.MethodThe sample included 48 dyads of persons with CI (Clinical Dementia Rating Scale score ≥ 0.5) and their care partners. NPS of the person with CI were measured using the Neuropsychiatric Inventory brief Questionnaire (NPI‐Q) and 15‐item Geriatric Depression Scale (GDS‐15) at baseline and follow‐up (mean 486 days). The Preferences for Everyday Living Inventory was used to assess importance of preferences for persons with CI at baseline; care partners separately completed concurrent proxy assessments at baseline. Mixed random and fixed effects longitudinal models were used to evaluate the impact of baseline discrepancy in everyday preferences assessment between persons with CI and their car partners on changes in NPS across time.ResultHigher levels of underestimation of the importance of “social engagement” preferences in the proxy ratings of care partners relative to the self‐ratings of persons with CI were associated with a higher degree of neuropsychiatric symptoms across time as a whole as measured by the NPI‐Q but not the GDS‐15.ConclusionThis study yields new insights into the relationship between discrepant importance ratings of “social engagement” preferences and neuropsychiatric manifestations of neurocognitive disorders, suggesting that a baseline level of discrepancy is associated with changes in neuropsychiatric symptoms over time. Resolving such discrepancies may then offer a therapeutic avenue to lessen NPS over time for persons with CI.

Longitudinal Changes in Neuropsychiatric Symptoms: Impact of Discrepancy in Everyday Preferences Between Persons With Cognitive Impairment and Their Care Partners

Neuropsychiatric symptoms (NPS) of dementia are common and may be driven by inability of persons with cognitive impairment (CI) to communicate needs. We addressed the relevance of this unmet-needs model to burden of NPS among persons with milder CI. The sample included 48 dyads of persons with CI and their care partners. NPS were measured at baseline and follow-up (mean 486 days +/-107 SD). Mixed random and fixed effects longitudinal models were used to evaluate impact of discrepancies between persons with CI and their care partners in everyday preferences (baseline) on changes in NPS over time. Higher levels of underestimation of "social engagement" preferences of persons with CI by care partners were associated with a higher average burden of NPS across all follow-up. This study suggests that unmet-needs may be a useful construct for understanding etiology for NPS across the spectrum of severity of cognitive impairment.

Longitudinal differences in everyday preferences: Comparisons between people with cognitive impairment and their care partners.

Persons with progressive cognitive impairment (CI) increasingly rely on surrogate decision-makers for everyday activities. Yet, little is known about changes in everyday preferences over time or about concordance between persons with CI and their care partners regarding longitudinal changes. The sample included 48 dyads of persons with CI (Clinical Dementia Rating Scale score ≥0.5) and their care partners. The Preferences for Everyday Living Inventory was used to assess importance of preferences among persons with CI at baseline and follow-up (mean 486 days). Care partners separately completed concurrent proxy assessments. Mixed random and fixed effects longitudinal models were used to evaluate changes in ratings and concordance levels between persons with CI and care partners. There were significant gender differences regarding importance ratings of "autonomous choice" and "social engagement" preferences over time: women with CI rated these preferences as more important across time as a whole. Higher levels of neuropsychiatric symptoms were associated with less importance of "social engagement" preferences across time as a whole for persons with CI and a more negative discrepancy between persons with CI and care partner proxy assessments as time went on. This study yields new insights into predictors of longitudinal change in everyday preferences among persons with CI and their care partners. Although preferences were largely stable over time, there is increasing support for the relationship between differences in "social engagement" preferences and neuropsychiatric symptoms, which may have implications for monitoring and/or treatment in the context of cognitive impairment.

Live Evaluation of Auditory Preference, a Laboratory Test for Evaluating Auditory Preference.

Many laboratory tests are performed under unrealistic conditions. Tasks, such as repeating words or sentences, are performed in simple loudspeaker setups. Currently, many research groups focus on realistic audiovisual laboratory setups. Fewer groups focus on the tasks performed during testing. A semicontrolled laboratory test method focusing on the tasks performed, the Live Evaluation of Auditory Preference (LEAP) was evaluated. LEAP is developed to evaluate hearing-instrument performance in test scenarios that represent everyday listening situations. LEAP was evaluated in a feasibility study. The method comprises conversations between a test participant and one or two test leaders, enabling evaluation of the test participant's own voice. The method allows for visual cues (when relevant) and introduce social pressure to participate in the conversation. In addition, other everyday listening tasks, such as watching television (TV) and listening to radio, are included. In this study, LEAP was used to assess preference for two hearing aid settings using paired comparisons. Nineteen experienced hearing aid users (13 females and 6 males; mean age 74 years), participated in the study. LEAP was performed at three visits to the laboratory. In addition, participants conducted a field trial where the two hearing aid programs were compared using Ecological Momentary Assessments (EMA). During LEAP testing, six mandatory test cases were used, representing commonly occurring everyday listening situations. Individual test cases were also included, selected from individually experienced listening situations during the field trial. Within- and between-session reliability of the LEAP test was investigated. Validity was investigated by comparing the LEAP and the EMA results. For the current signal-processing evaluation, the test was judged to have acceptable reliability and validity. The inclusion of individually selected test cases increased the representativeness of the LEAP test, but it did not substantially alter the results in the current study. LEAP in its current implementation seems suitable for investigating signal-processing preference in the laboratory in a way that is indicative of everyday preference. The LEAP method represents one step forward in bringing the real world into the laboratory.

Translation and culture sensitive adaptation of the PELI ("Preferences for Everyday Living Inventory") for nursing settings

Translation and culture sensitive adaptation of the PELI ("Preferences for Everyday Living Inventory") for nursing settings Abstract. Background: The consideration of individual preferences of people with care needs in the sense of person-centred care requires a systematic recording of preferences related to everyday living. Therefore, the Preferences for Everyday Living Inventory (PELI) was developed in the USA. Aim: The aim was to translate the current version of the PELI-NH© (Nursing Home), into German (PELI-D) and to adapt this version in a culturally sensitive manner home care, adult day care and nursing home. Methods: The German translation of the PELI-NH© was carried out in eleven steps according to the ISPOR principles. Central steps were the forward translations, the expert panel, the cognitive debriefing and the backward translations. Results: As result of the translation the PELI-D (72 items) is the first comprehensive instrument in German language to assess everyday preferences of people with care needs in home care (55 items), adult day care (54 items) und nursing home (65 items). Conclusion: The selected procedure supports a critical reflection of the translation process and ensures the culturally sensitive comparability of the source language and the target language. The practicability of three setting specific versions of PELI-D needs be examined in further studies.

Predictors of the importance of everyday preferences for older adults with cognitive impairment.

Among older people with cognitive impairment and mild dementia, relatively little is known about the factors that predict preferences for everyday living activities and experiences and that influence the relative importance of those activities and experiences. Cross-sectional study. Participants were recruited from the Massachusetts Alzheimer's Disease Research Center (MADRC) Clinical Core longitudinal cohort. The sample included 62 community-dwelling older adults with cognitive impairment (Clinical Dementia Rating global score ≥ 0.5). We used the Preferences for Everyday Living Inventory (PELI) to assess preferences for activities and lifestyle experiences among persons with cognitive impairment. Within-subjects analysis of variance was used to test for significant differences in the mean ratings of importance for four domains of the PELI ("autonomous choice," "social engagement," "personal growth," and "keeping a routine"). Multiple regression models were used to relate predictors, including neuropsychiatric symptoms, to importance ratings for each domain. Significant differences were noted in the mean importance ratings of the preferences domains: "social engagement" preferences were rated as most important, followed by "autonomous choice," "personal growth," and "keeping a routine." For the "social engagement" preferences domain, female sex was significantly associated with higher importance of "social engagement," while depressive symptoms (Geriatric Depression Scale-15 scores) were significantly associated with lower importance. This study adds novel insight into the everyday preferences of community-dwelling older adults with cognitive impairment and highlights the impact of a number of factors, particularly level of depression, on how important various everyday experiences are perceived.

Predictors of Everyday Care Preference Importance Ratings for Veterans Living in the Nursing Home Setting

Preference-based care is required by the Centers for Medicare and Medicaid Services and is linked to improved quality of nursing home care. The federally mandated Minimum Data Set (3.0) Preference Assessment Tool (PAT) is a 16-item standardized measure used to facilitate preference-based care through rating how important residents’ daily and activity preferences are. Little work has explored how Veterans’ unique demographic backgrounds and functional/cognitive abilities may influence how they rate their preferences (compared to general nursing home residents). Therefore, the purpose of this retrospective study was to explore the relationships between Veterans’ demographic/clinical characteristics and number of preference importance ratings. Our sample (n=194,068) consisted of Veterans admitted to community nursing homes after hospitalization at a Veterans Affairs facility for heart failure between 2010-2015. We used ordinal regression to explore predictors of preference importance ratings. Veterans were, on average, 78-years-old (SD=10.42) and mostly male (95%), white (81%), married (46%), cognitively intact (74%) with extensive functional impairment (60%) and minimal depressive symptoms (74%). Veterans rated an average of 12.47 preferences as important (SD=2.86; range=0-16). Veterans living with cognitive impairment, depression, and extensive functional impairment who were not married or separated had a lower number of important preferences (all p<0.0001). Veterans that were female, under the age of 85, and any race but white had a higher number of important preferences (all p<0.0001). Discussion will include implications for planning and delivering preference-based care for Veterans as well as next steps in research and practice to better understand and fulfill Veterans’ everyday care preferences.

Evaluating everyday preferences assessment over time between people with cognitive impairment and their care partners

AbstractBackgroundAs cognitive impairment progresses, people with cognitive impairment and dementia increasingly rely on surrogate decision‐makers for everyday activities. Yet, little is known about concordance over time on assessment of everyday preferences between persons with cognitive impairment and their care partners, acting as proxies.MethodThe sample included 44 dyads of persons with cognitive impairment (Clinical Dementia Rating Scale ≥ 0.5) and their care partners. We used the Preferences for Everyday Living Inventory (PELI) to assess preferences for activities and lifestyle choices among persons with cognitive impairment. The PELI was concurrently but separately administered to care partners, who answered as proxies. Assessments were completed at baseline and again approximately one year later. Paired sample t‐tests were used to assess for changes in repeat measures as well as to estimate differences in preference assessment between self‐ratings of persons with cognitive impairment and proxy‐ratings of care partners at baseline and one‐year follow‐up.ResultOur previous factor analysis of the 55‐item PELI identified four factors: autonomous choice, social engagement, personal growth, and keeping a routine. Within each factor of the PELI, there appeared to be consistency in self‐ratings for persons with cognitive impairment and proxy‐ratings by care partners between baseline and annual follow‐up (paired t‐test, p‐value &gt; 0.05; Pearson correlation, r &gt; 0.7). Comparing self‐ratings from persons with cognitive impairment and proxy‐ratings by their care partners, however, there was significant discrepancy for preferences related to “social engagement” (e.g., regular contact with family, meeting new people, volunteering) at baseline and one‐year follow‐up (paired t‐test, p‐value &lt; 0.05). There did not appear to be significant differences by paired t‐test (p‐value &gt; 0.05) with respect to the raw change scores from baseline and one year‐follow within each PELI factor.ConclusionThis study yields new insights regarding the stability of everyday preferences for persons with cognitive impairment over time as well as apparent stability in areas of significant discrepancy between self‐ratings of persons with cognitive impairment and the proxy‐ratings of care partners.

Serious Sociological Games in the ELFE Cohort Study: Using Children’s Play to Gain Perspective on their Visions of the World

Between June and December 2017, a protocol involving questionnaires designed to be enjoyable for children was implemented as part of the ELFE cohort study. This national study has followed 18,000 children since their birth in 2011. These sociological questionnaire/games aimed to collect information on the everyday preferences of young children (then aged 5-6 years old) and indicators of their moral and social sense. But this collection method had neither pre-existing experiments it could draw on, nor technology that had been fully perfected. This article revisits the methodological questions and issues that were raised over the process of developing and then administering these online questionnaires. In particular it looks at the way that social representations of childhood and research with children were raised in exchanges between sociologists and epidemiologists, or between researchers and parents.

Differences in Assessment of Everyday Preferences Between People With Cognitive Impairment and Their Care Partners: The Role of Neuropsychiatric Symptoms

ObjectiveAs cognitive impairment progresses, people with dementia increasingly rely on surrogate decision-makers for everyday activities. Yet, little is known about concordance on everyday preferences between persons with cognitive impairment and their care partners. MethodsThe sample included 69 dyads of persons with cognitive impairment (Clinical Dementia Rating Scale ≥0.5) and their care partners. We used the Preferences for Everyday Living Inventory (PELI) to assess preferences for activities and lifestyle choices among persons with cognitive impairment. The PELI was concurrently but separately administered to care partners, who answered as surrogate decision-makers. Factor analysis was used to ascertain factor structure of the PELI; reliability measures were computed within the sample. Paired sample t-tests were used to estimate differences in scores of corresponding PELI items for each factor. Multiple regression models were used to relate predictors, including neuropsychiatric symptoms, to agreement levels. ResultsFour factors were identified from the PELI: autonomous choice, social engagement, personal growth, and keeping a routine. Significant participant-care partner discrepancy was found in “social engagement” preferences (e.g., regular contact with family, meeting new people, volunteering). Geriatric Depression Scale-15 score and care partner sex were significantly associated with participant-care partner discrepancies in “social engagement” preferences. ConclusionThis study yields new insights regarding the most important preferences for persons with cognitive impairment and clarifies a path to optimizing surrogate decision-making around everyday preferences by highlighting areas of apparent disagreement and identifying potential predictors of discrepancy.

Our Everyday Aesthetic Evaluations of Architecture

Abstract I argue that our everyday evaluations of architecture are primarily evaluations of spaces and, in particular, of their inhabitability— that is, whether they serve or can serve to the realization of our individual ideal of life. Inhabitability is not only a functional criterion but an aesthetic one as well. It is aesthetic insofar as the evaluations about inhabitability include evaluations about the quality of the experience of actually doing something in —or simply occupying—a particular space. This aesthetic aspect of our everyday evaluations explains, on one hand, the distinctive features of our everyday preferences for some architectonic spaces over others—namely, (a) their very personal nature; (b) their noticeable value in our daily lives; (c) their inseparability from the activities we plan to realize in those spaces; and (d) the importance of the spaces which are contiguous to the one we are evaluating. And on the other, it both reveals architecture’s significance for the quality of our daily life and serves as a guide for us to choose spaces that improve that quality.

The impact of nursing home residents’ characteristics on ratings of importance of autonomy preferences in daily care over time

Objective: Nursing home (NH) residents’ preferences for everyday living are the foundation for delivering individualized care. Yet, work has not examined the impact of demographic and clinical characteristics of NH residents on the stability of their preferences over time.Method: This study examined the rate of change in reports of importance of 27 autonomy-related everyday preferences from the Preferences for Everyday Living Inventory over 3-months and the demographic and clinical characteristics associated with change for nursing home residents (N = 255). Descriptive frequencies and tests of mean difference were utilized to examine differences between individuals reporting change in importance over time compared to those that did not report change.Results: Autonomy preferences in daily care remained stable over 3-months for the majority of residents. For residents that did report change on autonomy preferences, no systematic associations of demographic or clinical characteristics were found to be associated with change. Rather, change was associated with differential characteristics based on the preference.Conclusion: This study indicates that knowing a person’s demographic or clinical characteristics in care will not uniformly inform a caretaker’s understanding of the individual’s reports of importance for autonomy related preferences over time. Future work should explore the role of care environment on change in preference ratings over time.

Short version of the S3 guideline on screening, diagnosis, therapy and follow-up of abdominal aortic aneurysms

In this article a brief version of the newly developed S3 guidelines on screening, diagnosis, therapy and follow-up of abdominal aortic aneurysms (AAA), which was developed under the auspices of the German Society of Vascular Surgery and VascularMedicine (DGG) is presented. In addition to the DGG, participating professional societies were the German Radiological Society (DRG), German Society for Angiology/Society for Vascular Medicine (DGA), German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), German Society for Ultrasound in Medicine (DEGUM), German Vascular League e.V., German Society for Interventional Radiology (DEGIR), German Society for Anesthesiology and Intensive Care Medicine (DGAI), German Society for Thoracic and Cardiovascular Surgery (DGTHG) and the German Society of Surgery (DGCH). The guidelines are based on a systematic literature search in Medline (PubMed) for the period from 1 January 2000 to 1 January 2017. Important publications from 2017 were also considered. The selection of evidence was made by a multilevel screening process. In addition to the evidence, other criteria were included in the assessment of the recommendation level, such as the consistency of the study results, the clinical relevance of the endpoints and effect sizes, the benefit–risk balance, the applicability of the study results to the patient target group and the care system, the feasibility of the recommendations in everyday life, patient preferences and ethical and legal considerations. All recommendations/findings were approved with strong consensus (approval of >95% of the participating professional societies/associations). Thus, the present text version of the S3 guidelines on AAA represents the view of all participating societies.

Supported Decision-Making from Theory to Practice: Implementing the Right to Enjoy Legal Capacity

The right to equal recognition before the law, protected by Article 12 of the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD), mandates the use of supported decision-making practices to enable disabled people, particularly those with intellectual and/or psychosocial disabilities, to enjoy their legal capacity. Finding ways to translate this theoretical mandate into practice poses a number of particularly challenging socio-legal issues, which this research seeks to address. The English Mental Capacity Act 2005 (MCA) sets out a right to support with decision-making (s.1(3)), underpinned by a presumption of capacity (s.1(2)). Qualitative interviews with intellectually disabled people, their supporters, and care and support professionals were undertaken to explore how disabled people make decisions in their everyday lives, the kinds of support they need, and the strategies for supported decision-making used in practice. Analysis of these interviews suggests that a range of supported decision-making techniques have been developed in practice and are effective in supporting everyday preferences and some life choices. Paradoxically, it appears that as decisions become more complex, the support available to disabled people reduces. Specifically, much less support is available for more difficult decisions around finances, healthcare and legal matters. We argue that the reasons for this are due to a web of regulatory, social and policy issues. We conclude that implementing the right to enjoy legal capacity through supported decision-making will require a combination of regulatory reform, social change and policy amendment.

Effects of Online Recommendations on Consumers’ Willingness to Pay

Recommender systems are an integral part of the online retail environment. Prior research has focused largely on computational approaches to improving recommendation accuracy, and only recently researchers have started to study their behavioral implications and potential side effects. We used three controlled experiments, in the context of purchasing digital songs, to explore the willingness-to-pay judgments of individual consumers after being shown personalized recommendations. In Study 1, we found strong evidence that randomly assigned song recommendations affected participants’ willingness to pay, even when controlling for participants’ preferences and demographics. In Study 2, participants viewed actual system-generated recommendations that were intentionally perturbed (introducing recommendation error), and we observed similar effects. In Study 3, we showed that the influence of personalized recommendations on willingness-to-pay judgments was obtained even when preference uncertainty was reduced through immediate and mandatory song sampling prior to pricing. The results demonstrate the existence of important economic side effects of personalized recommender systems and inform our understanding of how system recommendations can influence our everyday preference judgments. The findings have significant implications for the design and application of recommender systems as well as for online retail practices. The online appendix is available at https://doi.org/10.1287/isre.2017.0703 .

Honoring the Everyday Preferences of Nursing Home Residents: Perceived Choice and Satisfaction With Care.

The nursing home (NH) culture change movement advocates for residents to be able to make choices about important aspects of their care. This study seeks to understand NH residents' perceptions of choice that they have in the care they receive while in the NH setting. We examine the association between residents' perceived choice and satisfaction with care preferences being met using a mixed methods approach. Using the Preferences of Everyday Living Inventory, cognitive interviews were completed with 39 NH residents which resulted in a total of 600 item-level ratings of residents' perceived choice and satisfaction and corresponding open-ended comments on choice. Quantitative findings revealed a significant Pearson correlation between residents' perceived choice and satisfaction (r = .47, p < .001). Participants' responses of free choice were linked to significantly higher ratings of satisfaction compared to no choice and some choice. Responses of some choice were associated with significantly higher ratings of satisfaction than the no choice group. Open-ended comments provided greater depth in understanding regarding how residents perceive the level of choice in fulfilling their preferences. This study establishes a positive association between NH residents' perceived choice and feelings of satisfaction with their care preferences being met. Offering choices that are deemed favorable or solicited from NH residents is a fundamental step toward increasing resident satisfaction with NH care.

Do Family Proxies Get It Right? Concordance in Reports of Nursing Home Residents' Everyday Preferences.

Limited work has examined how well family proxies understand nursing home residents' preferences. With 85 dyads of a nursing home resident and relative, we utilize descriptive statistics and multi-level modeling to examine the concordance in reports of importance ratings of 72 everyday preferences for residents. Results reveal significant mean differences at the p < .001 level between proxies and residents on 12 of 72 preferences; yet, perfect agreement in responses is poor and only increases when dichotomizing responses into an important versus not important outcome. Multi-level modeling further indicates that dyads are discrepant on reports of the importance of growth activities for residents, with residents reporting higher levels of importance than proxies. This discrepancy is associated with residents' hearing impairment and proxies' perception of resident openness. The findings highlight not only how proxies may be able to inform care for residents in nursing homes but also where further discussions are warranted.