Study: Older adults want physicians to advocate on their behalf

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in, Journal of Active Aging, Cancer Today, Kaiser Health News, the Connecticut Health I-Team and other outlets. She is a senior fellow at the Center for Health Policy and Media Engagement at George Washington University and co-produces the HealthCetera podcast.

Photo: Carol Von Canon via Flickr

Older adults rarely ask for referrals to specialists, specific prescriptions, express concerns or follow-up after medical visits. Instead, they trust their doctors to advocate for their health needs, according to a new study.

The findings highlight a disconnect between the expectations of older adults and the realities of a changing health care system, in which doctors have less time to spend with patients. Researchers found that the more adults 65 and older trusted the role of their doctor, the less likely they were to advocate for their health concerns.

The results are concerning because it suggests that older generations are clinging to how health care used to be, when doctors had more personal relationships and continuity with patients, according to co-author Eva Kahana, a humanities professor at Case Western Reserve University in Cleveland. The study, “Whose advocacy counts in shaping elderly patients’ satisfaction with physicians’ care and communication?” appeared in the June 25 issue of the journal Clinical Interventions in Aging.

Patient initiative and shared decision-making are increasingly important factors in the quality of care and patient satisfaction. Older patients, however, may not fully share in this approach, having grown up with a more paternalistic model of care, the researchers pointed out. Patient empowerment may be further limited among those with less education and health literacy, as well as among members of racial and ethnic minority groups. If patients incorrectly assume their physician will act and advocate on their behalf, it could lead to poorer overall health, particularly for those living with one or more chronic conditions such as diabetes or high blood pressure, Kahana said in a statement.

The findings are especially relevant for minorities and the sickest of patients, who have less access to health care and often face additional challenges in finding responsive care, according to previous research.

Researchers analyzed data based on a 90-minute face-to-face interview with a diverse pool of 806 older adults recruited from retirement communities in Clearwater and Orlando Florida and community-dwelling older adults in Miami and Cleveland. The mean age of participants was 77.82.

Among of the study’s other findings:

  • Older adults who feel comfortable advocating for their care feel more empowered.
  • Compared with white patients, African-American patients were less satisfied with their physicians.
  • Latino patients expressed greater satisfaction with their medical care than white and African-American patients.
  • The perceived emotional support of physicians was associated with patients’ satisfaction.
  • Participants who reported higher levels of functional limitations were less likely to report a good relationship with their primary care doctors.

These findings support prior research on the preferences of older adults to have limited involvement in health care decision making. According to Kahana, the results strongly suggest that families of older patients should be ready to step in as advocates for their older relatives. Additionally, health providers need to become more aware of how older patients perceive them.

Here are some ideas for journalists to consider when reporting on this issue:

  • Look at how physicians or other health providers can balance their limited time with the care demands of older adults with complex chronic conditions.
  • How can family members or friends help advocate on behalf of an older adult who may be reluctant to share in decision making? What programs or tools are available to help educate/support caregivers in this role?
  • What, if anything, are insurers doing to support more shared decision making and patient advocacy? Are older people better off hiring a private geriatric care manager or advocate, and how costly is this?

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