Older adults' mental health function and patient-centered care: does the presence of a family companion help or hinder communication?

BACKGROUND

Late-life mental health disorders are prevalent, costly, and commonly under-diagnosed and under-treated.

OBJECTIVE

To investigate whether family companion presence in routine primary care visits helps or hinders patient-centered processes among older adults with poor mental health function.

DESIGN AND PARTICIPANTS

Observational study of accompanied (n = 80) and unaccompanied (n = 310) primary care patients ages 65 and older.

MAIN MEASURES

Audio-taped medical visit communication, coded with the Roter Interactional Analysis System, and three process measures: visit duration (in minutes), patient/companion verbal activity, and a ratio of patient-centered communication, adjusted for patient age, gender, race, and physical function. Participants were stratified by SF-36 mental health subscale (MCS) using two approaches (1) standardized population midpoint to delineate "good" (50+) and "poor" health (< 50) and (2) clinically derived cut-points (<35; 35-49; 50+).

RESULTS

When patients with poor mental health were accompanied by a family companion, patient/companions provided less psychosocial information, physicians engaged in less question-asking and partnership-building, and both patient/companions and physicians contributed more task-oriented, biomedical discussion. Accompanied patients with poor mental health were less likely to experience patient-centered communication relative to unaccompanied patients (aOR = 0.21; 95% CI: 0.06, 0.68); no difference was observed for patients with good mental health (aOR = 1.02; 95% CI: 0.46, 2.27). Verbal activity was comparable for accompanied patients/companions and unaccompanied patients in both mental health strata. Medical visits were 2.3 minutes longer when patients with good mental health were accompanied (b = 2.31; p = 0.006), but was comparable for patients with poor mental health (b = -0.37; p = 0.827). Study findings were amplified in the lowest functioning mental health subgroup (MCS < 35): medical visits were shorter, and communication was least patient-centered (p = 0.019) when these patients were accompanied.

CONCLUSIONS

Older adults with poor mental health function may experience more communication challenges in the form of shorter visits and less patient-centered communication when a family companion is present.