Feb 10 2012
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Going It Together: Physician Visits as a Family Affair

By Jennifer L. Wolff, PhD, and Robert Wood Johnson Foundation Physician Faculty Scholar Cynthia M. Boyd, MD, MPH

file Jennifer Wolff

It is widely recognized that family members and trusted friends make an enormous difference by assisting disabled older adults with daily household and personal activities. There is less awareness, however, that families and trusted friends also often help older adults navigate our complex and fragmented health care system to get the best care possible—by scheduling and arranging transportation to appointments, engaging in medical decision-making, or overseeing adherence to health care treatments. As we learn more about how older adults navigate the health system, it is becoming clear that they often do so with the support and active engagement of a “family companion” —and that this role is enduring.

file Cynthia Boyd

In a study we published in the January issue of the Journal of the American Geriatrics Society (JAGS), we found that nearly one-third of adults over age 65 were accompanied by what we called a “family companion” during routine physician visits. These companions were almost always family members (93.3 percent), and they typically accompanied their loved one to physician visits on a regular basis—70.3 percent were identified as “always” present.

We were surprised by the persistence and consistency of family companion involvement. Three quarters (74.5 percent) of older adults continued to be accompanied by a companion at one year follow-up, nearly always the same family companion (87.1 percent).

Study participants also reported through the Medicare Current Beneficiary Survey that their companions performed or assisted with a variety of functions: transportation, physical assistance, scheduling appointments, taking notes, asking questions, providing information to the physician about the patient’s medical condition, explaining physicians’ instructions to the patient, and acting as an English language translator.

Family companions were more regularly present, and more actively engaged in physician visit communication and logistics when they accompanied older adults who were functionally disabled and required assistance with activities of daily life.

Given this information, it’s startling that the research base regarding when and how providers might best partner with patients and an accompanying companion is limited. We see a need for health care professional competencies to maximize their interactions with older adults who are accompanied by a family companion. There is also a need to develop health care delivery infrastructure that is responsive to patient needs and preferences for involving their family companion—for example in documenting preferences for companion access to health information in their electronic health record.

As the country’s population ages at an unparalleled rate, we believe that it will be increasingly important to better understand and devise strategies that strengthen the patient-family-provider partnership.

Read a post written by Boyd and Wolff for the Human Capital Blog’s National Family Caregivers Month series.

Tags: Coordinated care, Family caregiving, Health & Health Care Policy, Human Capital, Patient-centered care, Physician Faculty Scholars, Research & Analysis, Seniors (65+), Shared decisionmaking, Voices from the Field