title: Older adults' mental health function and patient-centered care: does the presence of a family companion help or hinder communication?
abstract: 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.
  
  
  METHODS
  Observational study of accompanied (n = 80) and unaccompanied (n = 310) primary care patients ages 65 and older.
  
  
  METHODS
  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.
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 692, Baltimore, MD 21205, USA. jwolff@jhsph.edu
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Wolff
authors.forename: Debra L
authors.initials: DL
authors.lastname: Roter
mesh_terms: D000367:Age Factors; D000368:Aged; D003142:Communication; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D009819:Office Visits; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D011320:Primary Health Care; D011368:Professional-Family Relations; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States; D014705:Verbal Behavior