Preferences of older and younger adults with serious mental illness for involvement in decision-making in medical and psychiatric settings.
OBJECTIVE
There is a growing call for greater consumer participation in health care encounters. Prior research suggests that older age is associated with a greater preference for a more passive role in clinical decision-making, yet little is known about preferences for persons with mental illness. This pilot study compared preferences for involvement in decision-making between older and younger adults with serious mental illness.


METHODS
Cross-sectional observational survey.


METHODS
The authors surveyed 33 older adults (>or=50 years) and 32 younger adults (<50 years) with serious mental illness from two mental health center clinics and one residential facility for their preferences on decision-making with their psychiatrists and primary care providers.


METHODS
Measures included the Control Preferences Scale, the Autonomy Preference Index, and the Decision Self-Efficacy Scale.


RESULTS
Contrary to our primary hypothesis, older adults reported a stronger desire for involvement in decision-making compared with younger adults. However, both age groups were similar in their desire for information to aid in decision-making. The majority in both age groups also preferred a collaborative role with a psychiatrist for medication decisions, an autonomous role for decisions related to psychosocial interventions, and a passive role with their primary care provider. Older and younger adults expressed similar decision self-efficacy.


CONCLUSIONS
Our study suggests that older persons with serious mental illness have a stronger desire for involvement in decision-making than younger consumers. Additionally, role preference for involvement in decision-making varies across different clinical decisions and for psychopharmacological versus psychosocial interventions.
O'Neal
Erica L
EL
Dartmouth Psychiatric Research Center Lebanon, Lebanon, NH 03766, USA. Erica.L.O'Neal@Dartmouth.edu
Adams
Jared R
JR
McHugo
Gregory J
GJ
Van Citters
Aricca D
AD
Drake
Robert E
RE
Bartels
Stephen J
SJ
D000368:Aged; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003657:Decision Making; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D019964:Mood Disorders / Q000523:psychology; D009513:New Hampshire; D010358:Patient Participation / Q000523:psychology*; D010817:Physician-Patient Relations; D011618:Psychotic Disorders / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology