Achieving goals in geriatric assessment: role of caregiver agreement and adherence to recommendations.
OBJECTIVE
To determine predictors of recommendation adherence and goal attainment of family caregivers of patients at a geriatric assessment center.


METHODS
One-year prospective cohort study.


METHODS
Outpatient geriatric assessment center in Connecticut.


METHODS
Two hundred consecutive new patients and their family caregivers.


METHODS
: Family caregivers were interviewed after geriatric assessment to ascertain their treatment goals for the patient. Medical records were reviewed to identify treatment recommendations. Family caregivers were interviewed 1 year later to assess adherence to recommendations and attainment of goals.


RESULTS
Follow-up interviews were completed with 176 (88%) family caregivers. Common recommendations pertained to physician referral (71%), medications (46%), counseling/education (31%), diagnostic tests (30%), residential planning (26%), healthcare planning (21%), and community services (21%). Goal attainment was reported in 44% to 67% of the patient cases, depending on goal category. Caregiver agreement with recommendations predicted adherence to recommendations (adjusted relative risk (ARR)=1.99, 95% confidence interval (CI)=1.04-5.92) after adjusting for available clinical and demographic factors. In addition, adherence to recommendations predicted goal attainment in adjusted analyses (ARR=1.70, 95% CI=1.09-2.64).


CONCLUSIONS
This study revealed a broad range of treatment recommendations in geriatric assessment and suggests that agreeing with recommendations can promote adherence and that adherence can promote goal attainment. Taken together, the results imply that articulating shared treatment recommendations may improve the quality of health care.
Bogardus
Sidney T
ST
Departments ofInternal Medicine Epidemiology and Public Health, Yale University School of Medicine, New Haven Connecticut 06504, USA. bogardus@ynhh.com
Bradley
Elizabeth H
EH
Williams
Christianna S
CS
Maciejewski
Paul K
PK
Gallo
William T
WT
Inouye
Sharon K
SK
D000368:Aged; D017028:Caregivers; D005260:Female; D015577:Geriatric Assessment; D006040:Goals; D019983:Guideline Adherence; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D011446:Prospective Studies; D012044:Regression Analysis