Preference Consistency: Veteran and Non-Veteran Nursing Home Resident Self-Reported Preferences for Everyday Living

How Do We Achieve Person-Centered Care across Health Care Settings? Expanding Ideological Perspectives into Practice to Advance Person-Centered Care

Person or patient-centered care (PCC) is touted as the gold standard in geriatric medical care across care settings. However, despite more than 3 decades of research and practice initiatives, it remains a challenge to consistently implement PCC that fully places the individual at the center of care planning and the delivery process. The lack of universal implementation of PCC, we argue, may be in large part due to the use of multiple terms and ideologies leading to an inability to coordinate efforts across medical settings. This article reviews recent ideological PCC movements ("What Matters to You," the Age Friendly Health Systems 4 Ms/5 Ms, "Whole Health," Patient Priorities Care, and Medicare/Medicaid person-centered care initiatives), provides a discussion of how these ideologies are implemented in a nursing home setting through preference-based care and provides implications for coordinated integration of PCC across all care settings now and into the future. We argue for the need to draw on known information and validated methodologies for assessing and implementing PCC to collectively move beyond an ideological representation of the concept into an integrated model of PCC for all older adults receiving care.

Methods to elicit and evaluate the attainment of patient goals in older adults: A scoping review

OBJECTIVE

This scoping review aimed to identify patient goal elicitation and evaluation methods for older adults, and to investigate which methods can be used in medication optimization interventions for nursing home residents (NHRs).

METHODS

The Arksey and O'Malley framework guided the review. A search was launched in PubMed, Embase, CINAHL, and Web of Science. Reference selection and data extraction were performed by three independent reviewers, followed by team discussions to solve discrepancies. Inductive thematic analysis was applied to synthesize the data. Included papers were reconsidered to identify methods for medication optimization interventions for NHRs.

RESULTS

Ninety-six references, encompassing 38 elicitation and 12 evaluation methods, were included. Elicitation methods differed in structure, content, and patient involvement levels. Qualitative and quantitative methods were found to assess goal attainment. Five elicitation and three evaluation methods were developed for NHRs, but none of these contained a medication-related assessment.

CONCLUSION

A variety of goal elicitation and evaluation methods for older adults was found, but none for medication optimization interventions in NHRs.

PRACTICE IMPLICATIONS

A holistic approach seems important to integrate patient goals into medication optimization interventions, not limiting goal elicitation to a medication-related assessment. Also, the choice of assessor seems important to obtain patient goals.

The Stability of Nursing Home Residents' Ratings of Importance of Recreation Preferences Over One Year

Long-term stability of nursing home (NH) residents' everyday preference remains unknown. We examined 1-year stability in reports of importance of 34-recreational activity preferences (8-MDS 3.0 Section F items; 26-Preferences for Everyday Living Inventory-NH items) by NH residents (N = 161). We examined mean differences on demographic and clinical characteristics of residents for preferences showing change. Importance ratings of preferences were highly stable over 1-year, with 91% of items retaining the same valence of importance for the majority of the sample (<20% change). Three preferences showed greater change. More functionally able residents were more likely to change their importance on "being with groups of people," and older residents were more likely to change their preferences for being "involved in religious practices" and "around animals such as pets". Overall, annual assessments of recreational activity preferences capture an accurate representation of preferences with reassessment only needed in a few circumstances.

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

OBJECTIVES

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.