Kleinert Evelyn, Mohacsi Laura, Stange Lena, Broschmann Daniel, Nebel Lisa, Hummers Eva
Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37079, Göttingen, Germany.
Faculty VI - Medicine and Health Sciences, Department of Health Services Research, Division of Ethics in Medicine, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstr. 114-118, 26129, Oldenburg, Germany.
BMC Prim Care. 2025 May 13;26(1):158. doi: 10.1186/s12875-025-02767-4.
Medical decision-making for older adults is becoming increasingly complex due to chronic conditions, multimorbidity, and expanding medical options in old age. As the aging population grows, medical decision-making in old age will become an increasingly common issue. This study explores older adults' perspectives on well-being and medical decision-making to inform patient-centered care practices in family medicine.
A qualitative study was conducted in Germany between August 2022 and August 2023, involving 35 participants aged 75 and older. Six focus group discussions and eight individual interviews were carried out. Focus groups were presented with two patient case histories involving medical decision dilemmas, while individual interviews used a guideline on personal history and experiences of medical care. Audio recordings were transcribed and analyzed using qualitative content analysis with MAXQDA software.
Three main categories emerged as central to well-being in late life: autonomy, physical and cognitive abilities, and social integration. Autonomy was identified as crucial, encompassing independent decision-making and adaptation to changing circumstances. Physical and cognitive abilities, particularly mobility, were considered essential for maintaining autonomy. Participants demonstrated different attitudes toward medical intervention, with some taking significant risks to maintain mobility and others taking a more adaptive approach to age-related limitations. Social integration emerged as a key to well-being, with participants emphasizing the importance of maintaining social connections and engaging in meaningful activities. Family practitioners were recognized as playing a vital role in providing holistic, patient-centered geriatric care.
The study highlights the importance of understanding older adults' perspectives on well-being to inform medical decision-making. Family practitioners can support the evolving needs of older adults by addressing both medical and psychosocial issues, facilitating social engagement, and building long-term relationships with patients. This approach can contribute to improved well-being and more patient-centered care practices in geriatric medicine.
DRKS00027076, 05/11/2021.
由于慢性病、多种疾病并存以及老年医疗选择的不断增加，老年人的医疗决策变得日益复杂。随着老年人口的增长，老年医疗决策将成为一个越来越普遍的问题。本研究探讨老年人对幸福感和医疗决策的看法，以为家庭医学中以患者为中心的护理实践提供参考。
2022年8月至2023年8月在德国进行了一项定性研究，涉及35名75岁及以上的参与者。进行了六次焦点小组讨论和八次个人访谈。向焦点小组展示了两个涉及医疗决策困境的患者病史，而个人访谈则使用了一份关于个人病史和医疗护理经历的指南。录音被转录，并使用MAXQDA软件进行定性内容分析。
出现了三个主要类别，它们是晚年幸福感的核心：自主性、身体和认知能力以及社会融合。自主性被认为至关重要，包括独立决策和适应不断变化的情况。身体和认知能力，特别是 mobility，被认为是维持自主性的关键。参与者对医疗干预表现出不同的态度，一些人愿意冒很大风险来维持 mobility，而另一些人则对与年龄相关的限制采取更适应的方法。社会融合成为幸福感的关键，参与者强调了维持社会联系和参与有意义活动的重要性。家庭医生被认为在提供全面的、以患者为中心的老年护理方面发挥着至关重要的作用。
该研究强调了理解老年人对幸福感的看法以指导医疗决策的重要性。家庭医生可以通过解决医疗和心理社会问题、促进社会参与以及与患者建立长期关系来支持老年人不断变化的需求。这种方法有助于改善老年医学中的幸福感和更以患者为中心的护理实践。
DRKS00027076，2021年11月5日。
