title: Family meetings for older adults in intermediate care settings: the impact of patient cognitive impairment and other characteristics on shared decision making.
abstract: BACKGROUND
  Clinicians, older adults and caregivers frequently meet to make decisions around treatment and lifestyle during an acute hospital admission. Patient age, psychological status and health locus of control (HLC) influence patient preference for consultation involvement and information but overall, a shared-decision-making (SDM) approach is favoured. However, it is not known whether these characteristics and the presence of cognitive impairment influence SDM competency during family meetings.
  
  
  OBJECTIVE
  To describe meetings between older adults, caregivers and geriatricians in intermediate care and explore patient and meeting characteristics associated with a SDM communication style.
  
  
  METHODS
  Fifty-nine family meetings involving geriatricians, patients in an intermediate care setting following an acute hospital admission and their caregivers were rated using the OPTION system for measuring clinician SDM behaviour. The geriatric depression scale and multidimensional HLC scale were completed by patients. The mini-mental state exam (MMSE) assessed patient's level of cognitive impairment.
  
  
  RESULTS
  Meetings lasted 38 min (SD 13) and scored 41 (SD 17) of 100 on the OPTION scale. Nine (SD 2.2) topics were discussed during each meeting, and most were initiated by the geriatrician. Meeting length was an important determinant of OPTION score, with higher SDM competency displayed in longer meetings. Patient characteristics, including MMSE, HLC and depression did not explain SDM competency.
  
  
  CONCLUSIONS
  Whilst SDM can be achieved during consultations frail older patients and their caregivers, an increased consultation time is a consequence of this approach.
authors.affiliation: Department of Rehabilitation and Aged Care, Repatriation General Hospital, Flinders University, Adelaide, SA, Australia.|Clinical Effectiveness Cluster, Flinders University, Adelaide, SA, Australia.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Milte
authors.affiliation: Clinical Effectiveness Cluster, Flinders University, Adelaide, SA, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Ratcliffe
authors.affiliation: Department of Rehabilitation and Aged Care, Repatriation General Hospital, Flinders University, Adelaide, SA, Australia.|Clinical Effectiveness Cluster, Flinders University, Adelaide, SA, Australia.
authors.forename: Owen
authors.initials: O
authors.lastname: Davies
authors.affiliation: Department of Rehabilitation and Aged Care, Repatriation General Hospital, Flinders University, Adelaide, SA, Australia.|Clinical Effectiveness Cluster, Flinders University, Adelaide, SA, Australia.
authors.forename: Craig
authors.initials: C
authors.lastname: Whitehead
authors.affiliation: Discipline of General Practice, Flinders University, Adelaide, SA, Australia.
authors.forename: Stacey
authors.initials: S
authors.lastname: Masters
authors.affiliation: Department of Rehabilitation and Aged Care, Repatriation General Hospital, Flinders University, Adelaide, SA, Australia.|Clinical Effectiveness Cluster, Flinders University, Adelaide, SA, Australia.
authors.forename: Maria
authors.initials: M
authors.lastname: Crotty
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D003072:Cognition Disorders / Q000523:psychology*; D003657:Decision Making; D005190:Family; D005260:Female; D016330:Frail Elderly; D005853:Geriatrics; D006801:Humans; D007380:Intermediate Care Facilities; D007389:Internal-External Control; D008297:Male; D010358:Patient Participation
keywords: decision making; frail elderly; health services for aged; physician-patient relations