Person-centered Care For Older Adults Research Articles

Person-centered Care for Older Adults in the Era of Medicalized Psychiatry

Over the last few decades, psychiatry has benefited from the development of safer, increasingly evidence-based treatment and improved access to care through innovations in telehealth and the expansion of community-based psychiatric services. Despite these advances, treatment outcomes for underserved populations continue to lag behind, both in terms of access to and quality of care (Alegeria et al., 2015). These concerns are particularly evident in vulnerable older adults, such as those receiving aging social services, who are more likely to have lower income, lower education, higher needs for activities of daily living and more chronic health conditions (Lee et al., 2015). This population experiences higher rates of depression are observed despite similar rates of mental health treatment and higher rates of psychiatric medication use compared to older adults not receiving aging services (Pepin et al., 2017).A possible explanation for this phenomenon is the field's movement towards biologically focused interventions, leaving the important impact of psychological and social factors relatively neglected. Though ideas such as the “biopsychosocial model” and “patient-centered medicine” are well known and accepted in psychiatry, their impact on clinical practice are curtailed by external pressures for efficiency, the lack of resources, and a fragmented system of care delivery (Mintz, 2022). This shift towards medicalization is exemplified in the ubiquity of the 15-minute “med check” or medication management visits in today's practice of psychiatry. These changes are particularly worrying when applied to older adults, who have more complex medical comorbidities and are at higher risk of adverse effects from medications.In the first presentation, we will discuss the art of prescribing and patient-centered care in the context of older adults. We will provide an overview of non-pharmacological variables affecting treatment outcomes in older adults. We will also discuss the key psychodynamic concepts relevant to psychopharmacology and how they influence treatment outcomes.This will be followed by a case study demonstrating how these practices could be expanded to underserved communities through team-based care for older adults in the community psychiatry setting. The case study will focus on an innovative program to expand geriatric behavioral health services at a Federally Qualified Health Center in Northeast Ohio. It will outline how the program conducted a needs assessment and developed a strategic plan for expanding geriatric psychiatry services by improving the competency of existing staff to assess and treat older adults, collaborating with local geriatric services, and developing a multidisciplinary team-based approach to geriatric behavioral health treatment. Finally, the outcomes of the program will be presented, focusing on both staff experience and patient outcomes.

Age-Friendly Framework in Post-Acute and Long-Term Care: Implementing the 4Ms in Long-Term Care

Age-Friendly Health Systems is an initiative of The John A. Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States that uses a framework to ensure high-quality, person-centered care for older adults. The framework, called the 4 Ms, includes what matters, mobility, medications, and mentation. This work outlines a practical, evidence- based approach to implementing 4 Ms care in long-term care (LTC).

Implementation of patient priorities-aligned care in a home-based primary care program

BackgroundOlder adults may be limited in their ability to access care that meets their health goals owing to disease burden, financial instability, and psychosocial barriers. A home-based primary care (HBPC) program established in 2020 within a large family medicine practice uses the Patient Priorities Care (PPC) approach to identify and address patients’ health priorities. When incorporated as part of the HBPC model of care, the PPC approach has the potential to enhance person-centered care for older adults in a way that best supports their health goals. ObjectiveThe objective of this study is to summarize common recommendations for alignment of care with patients’ health outcome goals after implementation of the PPC approach in an HBPC population. MethodsThis retrospective study was exempt from review by an institutional review board. After enrollment in the HBPC program, patients participated in a PPC priorities identification conversation to identify their health outcome goals and care preferences. Through chart review, 2 researchers independently categorized these goals based on the set of values they most reflect: connecting, managing health, enjoying life, and functioning. Aspects of care in place before enrollment in HBPC were considered to determine any adjustments that needed to be made to align care with patients’ identified priorities. ResultsThe most common value associated with patients’ most desired health outcome goal was functioning (n = 33, 66%). For secondary and tertiary health outcome goals, the most common value identified was managing health (secondary, n = 28, 56%; tertiary, n = 22, 44%). Common recommendations made to align care with patients’ identified priorities included stopping potentially harmful medications, starting medications for untreated conditions, starting physical or occupational therapy, and adjusting medications. ConclusionThrough the PPC approach, patients’ values were identified and care was assessed to aid in attainment of individualized health outcome goals and tailor care to What Matters most.

BARRIERS AND FACILITATORS FOR FOREIGN EDUCATED NURSES TO PROVIDE QUALITY LONG-TERM CARE

Abstract Unprecedented registered nursing shortages in long-term care (LTC) threaten the provision of person-centered care for older adults in the United States (US). LTC facilities recruit Foreign Educated Nurses (FENs) to address shortages, which raises concerns about care quality due to cultural, linguistic and communication differences among nurses; yet studies have not thoroughly explored FENs’ perspectives on these issues. The purpose of this study was to advance our understanding of FENs’ professional experiences as they began employment in LTC by exploring factors that inhibit or facilitate their provision of quality care. This qualitative descriptive study used purposive sampling to recruit FENs through professional organizations. Eligible FENs were ≥ 18 years old, worked ≥1 year in LTC, and represented racial and ethnic minority groups from Low and Middle Income Countries. In-depth narrative interviews, ranging from 45–60 minutes, were conducted. Applying content analysis, a priori and inductive coding generated themes. Participants (n=12) interviewed were all married females. Most were 50–59 years old (41.7%), Asian (75.0%), BSN-prepared (58.3%), and reported 31–50 years of nursing experience (50%). Positive facility characteristics, acculturation, effective workplace integration and positive support from colleagues, residents, and their families facilitated the provision of quality care. Conversely, negative facility characteristics, cultural barriers, discrimination and ineffective workplace integration were barriers to providing quality care. FENs highlighted culturally-sensitive strategies such as providing structured mentorship and preceptorship programs that supported them in providing person-centered care. FENs confirmed the need to address racial and anti-immigrant discrimination for achieving more equitable and inclusive workplaces.

Domestic Helpers as Frontline Workers in Home-Based Long-Term Care in China: Opportunities and Challenges

ABSTRACT Domestic helpers (also called baomu or jiazhengfuwuyuan in Chinese) enter personal residences to provide care and services. This study explored challenges and opportunities facing the long-term care (LTC) domestic service in urban China from the perspectives and experiences of domestic helpers (n = 25) and their employers (older adults or their family, n = 25), domestic service company managers (n = 8) and industry association staff (n = 6). Challenges identified pertain to the domestic helper-older adult relationship, day-to-day care, training, domestic service company role, and workforce shortages and instability. Opportunities include possibilities for supporting career development and increased access to social welfare and medical assistance, enhancing person-centered care for older adults by helping domestic helpers build core competencies, and establishing peer support and connections through mobile technologies.

Person-centered care for older adults at nursing homes in the Iberian Peninsula: A Systematic Review

Portugal and Spain are neighboring countries, and both have aged populations. The aging of a population leads to a higher need for gerontological care. Person-centered care for older adults (PCCOA) offers a higher standard of quality at nursing homes. This systematic review aimed to: synthesize Portuguese and Spanish studies on PCCOA; describe the process of implementation of PCCOA; explore the impact of interventions based on PCCOA and determine the measurement tools used to evaluate PCCOA. This review was conducted in accordance with the PRISMA guidelines. Eleven electronic databases were used. All of the included studies examined PCCOA at Portuguese and/or Spanish nursing homes. Thirty-one of the included studies were conducted in Spain, and six were conducted in Portugal. Studies involved the development of models/recommendations, the promotion of resident participation in care processes and education/training. Their results indicated that PCCOA has positive outcomes for staff members and residents. Six measurement tools were used in the studies conducted in Spain. This review highlights the importance of PCCOA and the need for scientific advances, especially in Portugal. The current knowledge emerging from this systematic review will guide care planning and interventions to improve care quality and has the potential to create networking opportunities.

Leveraging Value-Based Purchasing to Improve Advance Care Planning.

Advance care planning (ACP) is an important component of person-centered care for older adults in nursing facilities. Although nursing facilities have a statutory obligation to offer ACP to residents, there are no minimum training requirements for staff. Lack of consistent ACP training contributes to significant variability in ACP conversation quality, inaccurate or incomplete documentation of preferences, and infrequent re-evaluation of prior decisions. Indiana added ACP training for nursing facility staff to the Value-Based Purchasing formula for 2019. Facilities received 5 points (of a 100-point total formula) if at least one staff member completed the designated ACP training during the year. ACP Foundations Training was developed by faculty at Indiana University and made available to all Indiana nursing facilities. A total of 1,087 participants, representing 94.2% (501 of 532) Indiana nursing facilities, completed the training. Approximately every participant (99.4%) agreed that the training had practical value. This academic-government partnership was successful in providing basic information about ACP to staff at most nursing facilities across Indiana and offers a model for states to provide critical educational content to nursing facility staff by incentivizing training. [Journal of Gerontological Nursing, 48(2), 31-35.].

Tracking Progress on Person-Centered Care for Older Adults: Are We Doing Right by Racial and Ethnic Minorities?

Person-Centered care is integral and necessary to high-quality systems of care, providing a holistic approach and addressing the needs and preferences of individuals. Analyzing the 2014 and 2016 Health and Retirement Survey we measure the extent to which the health care system provides person-centered care, to whom and how its receipt affects satisfaction levels and service utilization. About one-third of individuals’ report that their preferences were only rarely or sometimes takes account. Results vary greatly by race, highlighting great disparities in person-centered care. One in four Hispanics and one in six Blacks report never having their preferences taken into account compared to roughly one in ten Whites. When people report that their preferences are ignored, they are more likely to forgo medical care and report lower satisfaction with the system. Strategies exist to strengthen and assure advancements in person-centered care, something particularly needed for people of color and low-income populations.

Person-Centered Care for Older Adults living in Long-term care facilities: A Systematic Literature Review

Person-centered care (PCC) is the empowering approach of ho-listic care that shifts from a traditional biomedical framework to one that emphasizes older adults’ personalized preferences, abilities, and strengths. This systematic literature review aimed to describe the current status of research on PCC for older adults living in long-term care facilities (LTCFs). The method that conducted the search involved using 5 consistent keywords along with adding various descriptor terms to help narrow the search. A total of 18 articles were discussed in the final review after meeting all of the inclusion criteria. The results showed overall beneficial outcomes of PCC for institutionalized older adults, the importance of prioritizing residents’ preferences when implementing PCC, and perspectives of residents and staff workers on the state of PCC in their respective LTCFs, as well as what they think are barriers and facilitators. Identifying what the top shared preferences are is the first step to providing individualized PCC delivery that will improve the quality of care and quality of life for older adults living in LTCFs. Furthermore, taking into account both staff and residents’ perspectives will lead to an improved PCC climate in LTCFs that will enable better care outcomes.

The Academic Collaborative Center Older Adults: A Description of Co-Creation between Science, Care Practice and Education with the Aim to Contribute to Person-Centered Care for Older Adults.

Long-term care for older adults is in transition. Organizations offering long-term care for older adults are expected to provide person-centered care (PCC) in a complex context, with older adults aging in place and participating in society for as long as possible, staff shortages and the slow adoption of technological solutions. To address these challenges, these organizations increasingly use scientific knowledge to evaluate and innovate long-term care. This paper describes how co-creation, in the sense of close, intensive, and equivalent collaboration between science, care practice, and education, is a key factor in the success of improving long-term care for older adults. Such co-creation is central in the Academic Collaborative Center (ACC) Older Adults of Tilburg University. In this ACC, Tilburg University has joined forces with ten organizations that provide care for older adults and CZ zorgkantoor to create both scientific knowledge and societal impact in order to improve the quality of person-centered care for older adults. In the Netherlands, a “zorgkantoor” arranges long-term (residential) care on behalf of the national government. A zorgkantoor makes agreements on cost and quality with care providers and helps people that are in need of care to decide what the best possible option in their situation is. The CZ zorgkantoor arranges the long-term (residential) care in the south and southwest of the Netherlands. This paper describes how we create scientific knowledge to contribute to the knowledge base of PCC for older adults by conducting social scientific research in which the perspectives of older adults are central. Subsequently, we show how we create societal impact by facilitating and stimulating the use of our scientific knowledge in daily care practice. In the closing section, our ambitions for the future are discussed.

A comprehensive assessment for community-based, person-centered care for older adults

BackgroundMany health and social needs can be assessed and met in community settings, where lower-cost, person-centered, preventative and proactive services predominate. This study reports on the development and implementation of a person-centered care model integrating dental, social, and health services for low-income older adults at a community dental clinic co-located within a senior wellness center.MethodsA digital comprehensive geriatric assessment (CGA) and referral system linking medical, dental, and psychosocial needs by real-time CGA-derived metrics for 996 older adults (age ≥ 60) was implemented in 2016–2018 as part of a continuous quality improvement project. This study aims to describe: 1) the development and content of a new CGA; 2) CGA implementation, workflows, triage, referrals; 3) correlations between CGA domains, and adjusted regression models, assessing associations with self-reported recent hospitalizations, emergency department (ED) visits, and clinically-assessed dental urgency.ResultsThe multidisciplinary team from the senior wellness and dental centers planned and implemented a CGA that included standard medical history along with validated instruments for functional status, mental health and social determinants, and added oral health. Care navigators employed the CGA with 996 older adults, and made 1139 referrals (dental = 797, care coordination = 163, social work = 90, mental health = 32). CGA dimensions correlated between oral health, medical status, depressive symptoms, isolation, and reduced quality of life (QoL). Pain, medical symptoms, isolation and depressive symptoms were associated with poorer self-reported health, while general health was most strongly correlated with lower depressive symptoms, and higher functional status and QoL. Isolation was the strongest correlate of lower QoL.Adjusted odds ratios identified social and medical factors associated with recent hospitalization and ED visits. General and oral health were associated with dental urgency. Dental urgency was most strongly associated with general health (AOR = 1.78,95%CI [1.31, 2.43]), dental symptoms (AOR = 2.39,95%CI [1.78, 3.20]), dental pain (AOR = 2.06,95%CI [1.55–2.74]), and difficulty chewing (AOR = 2.80, 95%CI [2.09–3.76]). Dental symptoms were associated with recent ED visits (AOR = 1.61, 95%CI [1.12–2.30]) or hospitalizations (AOR = 1.47, 95%CI [1.04–2.10]).ConclusionCommunity-based inter-professional care is feasible with CGAs that include medical, dental, and social factors. A person-centered care model requires coordination supported by new workflows. Real-time metrics-based triage process provided efficient means for client review and a robust process to surface needs in complex cases.

Effects Of Increasing The Involvement Of Community-Dwelling Frail Older Adults In A Proactive Assessment Service: A Pragmatic Trial.

BackgroundOlder adults and care professionals advocate a more integrated and proactive care approach. This can be achieved by proactive outpatient assessment services that offer comprehensive geriatric assessments to better understand the needs of older adults and deliver person-centered and preventive care. However, the effects of these services are inconsistent. Increased involvement of the older adult during the assessment service could increase the effects on older adult’s well-being.MethodsWe studied the effect of an assessment service (Sage-atAge) for community-dwelling frail adults aged ≥65 years. After studying the local experiences, this service was adapted with the aim to increase participant involvement through individual goal setting and using motivational interviewing techniques by health-care professionals (Sage-atAge+). Within Sage-atAge+, when finishing the assessment, a “goal card” was written together with the older adult: a summary of the assessment, including goals and recommendations. We measured well-being with a composite endpoint consisting of health, psychological, quality of life, and social components. With regression analysis, we compared the effects of the Sage-atAge and Sage-atAge+ services on the well-being of participants.ResultsIn total, 453 older adults were eligible for analysis with a mean age of 77 (± 7.0) years of whom 62% were women. We found no significant difference in the change in well-being scores between the Sage-atAge+ service and the original Sage-atAge service (B, 0.037; 95% CI, −0.188 to 0.263). Also, no change in well-being scores was found even when selecting only those participants for the Sage-atAge+ group who received a goal card.ConclusionEfforts to increase the involvement of older adults through motivational interviewing and goal setting showed no additional effect on well-being. Further research is needed to explore the relationship between increased participant involvement and well-being to further develop person-centered care for older adults.

Conceptualising Person-centered Advance Care Planning for People with Intellectual Disabilities: A Multifaceted Theoretical Approach

ABSTRACTDue to advances in care in recent decades, adults with intellectual disabilities (ID) are living longer than ever before. This requires increased attention to issues surrounding serious illness and end-of-life care. Person-centered advance care planning has been identified as an important aspect of respecting the wishes and values of individuals. Despite this, adults with ID are largely excluded from these discussions. This paper triangulates the Bioecological Theory of Human Development, Symbolic Interactionism, and the Human Rights Perspective to explore the complexity of person-centered care for older adults with ID. Specifically highlighted will be some of the ethical concerns and environmental barriers that limit the participation of adults with ID in person-centered care. The framework outlined in this paper seeks to facilitate a more comprehensive understanding among researchers, social workers, and care systems that there is nothing inherent in people with ID that precludes them from person-centered advance care planning and end-of-life care as they age and experience serious illness. Implications for social work practice will also be discussed.

An assisted living interprofessional education and practice geriatric screening clinic (IPEP-GSC): a description and evaluation

ABSTRACT As the U.S. population ages and lives longer, we need to assure that future providers are prepared to work in highly functioning interprofessional teams to deliver person-centered care for older adults with complex chronic conditions. Assisted living facilities are ideal venues in which to train interprofessional health sciences students in providing such care. After monthly clinics involving interprofessional students (from the colleges of medicine, nursing, pharmacy, public health, and school of social work) providing team-based care to older adults, students’ post-clinic evaluations indicated perceived improvements in knowledge, attitudes, and perceptions about aging and care of older adults. In addition, participating older adults reported improved self-worth and enjoyment. The curriculum, evaluation outcomes, and lessons learned are described to support program replication.

Driving Expert Eldercare Forward-On and Off the Road.

The great American novelist Jack Kerouac (2007) once said: “Nothing behind me, everything ahead of me, as is ever so on the road” (p. 183). Although geriatric health care professionals have made great strides in promoting high-quality, person-centered care for older adults, there is still much to do on the road ahead. In a very literal example, a recent collaboration between the American Geriatrics Society (AGS) and National Highway Traffic Safety Administration (NHTSA) has generated guidance that will help advanced practice nurses (APNs) and other health professionals navigate the intricacies of assessing and counseling older drivers, a key population with unique social and physical needs. More broadly, our recent thought leadership on topics such as high-quality multicultural care speaks to just how much lies ahead in providing comprehensive care for our nation's older adults and support for their caregivers. First, the literal: With older adults accounting for 10% of all individuals injured in traffic accidents annually and 17% of annual traffic fatalities (National Center for Statistics and Analysis, 2015), our new Clinician's Guide to Assessing and Counseling Older Drivers (AGS, 2016) is an example of translating research findings and public health initiatives into practical, person-centered advice for safely navigating the open road. Reviewed and edited by an interprofessional board of nurses, physicians, social workers, occupational therapists, and pharmacists, the guide introduces key issues, opportunities, and challenges faced by older drivers, health care professionals, and caregivers.... Language: en

Person-Centered Care for Older Adults With Serious Mental Illness and Substance Misuse Within a Program of All-Inclusive Care for the Elderly.

Providing person-centered care (PCC) to older adults with dual diagnosis, co-occurring serious mental illness (SMI), and substance misuse is complex and requires an interprofessional team. Older adults, who qualify for both Medicaid and Medicare (i.e., dual-eligibles) are overrepresented in the population of older adults with SMI and substance misuse. Programs of All-Inclusive Care for the Elderly (PACE) exist to support community living needs of nursing home-eligible older adults and are increasingly in a position to serve older adults with SMI and substance misuse issues. PACE programs provide integrated person-centered mental health care to address the serious medical, social, and emotional complications posed by having SMI and substance misuse disorders. The case study presented illustrates PCC provided to a dual-diagnosis PACE participant, illustrating the impact of recent and past trauma on current psychopathology and substance misuse. Finally, recommendations for addressing PCC of dual diagnosis within the PACE model are provided. [Journal of Gerontological Nursing, 42(5), 11-17.].

Moving Toward Implementation of Person-Centered Care for Older Adults in Community-Based Medical and Social Service Settings: "You Only Get Things Done When Working in Concert with Clients".

Specialized, fragmented acute care is not aligned optimally to serve older adults. Person-centered care (PCC) has emerged as an evidence-based solution that involves enlisting patients as partners in treatment planning. Although several efforts have captured person-centered voices in outpatient care, more information is needed at the organizational and provider level to better understand the feasibility, challenges, and effect of PCC in community-based and social services settings. To assess themes and emerging trends, researchers conducted telephone interviews with leaders at nine organizations providing PCC for older adults. Questions were focused on the legacy of PCC services, whether and how PCC was connected to better quality care, and what tools were used for measuring PCC. Three themes on PCC for older adults emerged. (1) Each organization ascribed to a unique definition and operational structure for PCC. (2) Despite these differences, all organizations specified a strong commitment to PCC. Most noted financial resources and staffing as challenges and opportunities affecting feasibility. (3) Terms such as "patient-centered" care and other PCC synonyms may warrant greater clarification, because ideological differences set these classifications apart. Results from this analysis indicate the lack of a single, established definition for PCC. As interest in and support for PCC mounts, organizations in outpatient medical and community-based settings clearly have undertaken individual efforts to interpret what PCC is and how to provide it. Interview responses reflect this inconsistency, highlighting how staff and financing in particular can bolster or burden the PCC paradigm and what a consensus definition could do for the field.

Person-Centered Care for Older Adults with Chronic Conditions and Functional Impairment: A Systematic Literature Review.

Person-centered care (PCC) shifts focus away from the traditional biomedical model in favor of embracing personal choice and autonomy for people receiving health services. It has become an important avenue for improving primary care, and older adults remain a priority target for PCC because they are more likely to have complex care needs than younger individuals. Nevertheless, despite a growing body of evidence regarding its use, PCC still lacks an agreed-upon definition. A literature review was conducted to explore extant scholarship on PCC for older adults, assess corresponding definitions of PCC, and identify important elements of quality PCC. Nearly 3,000 articles published between 1990 and 2014 were identified. Excluding search results outside the parameters of this study, the final review comprised 132 nonduplicate sources focused on patient-centered care or PCC in older adults. Fifteen descriptions of PCC were identified, addressing 17 central principles or values. The six most-prominent domains of PCC were holistic or whole-person care, respect and value, choice, dignity, self-determination, and purposeful living. The body of evidence reviewed suggests that PCC is an important area of growing interest. Although multiple definitions and elements of PCC abound-with many commonalities and some overlap-the field would benefit from a consensus definition and list of essential elements to clarify how to operationalize a PCC approach to health care and services for older adults. This work guided the development of a separate American Geriatrics Society expert panel statement presenting a standardized definition and a list of PCC elements for older adults with chronic conditions or functional impairment.