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Written on April 6th, 2011 by tasha
I was recently doing some research on adherence and ran across this “old friend,” a favorite study (Bogardus and colleagues, 2004) that demonstrated the value of getting the family caregiver on board.
We all know that non-adherence is a big issue in elder care. This was formerly referred to as “non-compliance,” but the term smacked of paternalism and has since been replaced with “non-adherence,” recognizing that the patient’s role is much more active than that of a compliant servant to the whims of medicine.
This Yale University study was conducted with 176 patient/family caregiver dyads at a geriatric assessment center. The focus was to specifically understand the family caregiver’s impact on adherence and presumably outcomes over the course of a year. Patient/family dyads went through the clinic’s standard assessment procedure, after which the family caregiver was asked to participate in a phone interview a week later and then a year later.
As might be expected in a geriatric care center, the assessments covered a range of issues. A common thread, however, was that roughly 60% of the elders exhibited some degree of dementia (Mini-mental scores of 24 or less). The facility focuses on “patient/family-centered care” meaning that wherever possible the care plan is set up to reflect the priorities of the patient and the family, as well as the concerns of the professional staff. If the patient’s dementia makes it not feasible to engage him/her, the family caregiver is enlisted as the proxy.
Assessment recommendations ran the gamut, but included suggestions in the following categories:
One week after the assessment, participating family caregivers were interviewed by phone and asked several questions:
1) How much they agreed with each recommendation (completely, mostly, partly, and not at all)
2) Which of 6 clinical goals was top on their priority list:
A year later, the family caregivers were interviewed again. They were asked to comment on the degree they were able to adhere to the center’s recommendations. They were also asked if their top priority goal had been achieved.
Adhering to recommendations
Achieving clinical goals
Why is this study germain? Clearly family member concordance with the care plan is a central element to successful implementation. This would seem like a no-brainer, but it apparently is not. To hear family caregivers speak, their perspective is often discounted. This is not to say that there aren’t self-absorbed family members. But still, given that family caregivers often ARE the continuity across care settings, their observations and priorities are not trivial. And we see by this study, their impact on adherence is not small.
Drawing on my background as a behavioral scientist, here’s what these findings say to me:
What do you see in these findings that can help you improve adherence?
Citation: Bogardus Jr., S.T., Bradley, E.H., Williams, C.S., Maciejewski, P.K.,, Gallo, W.T., & Inouye, S.K. (2004). Achieving goals in geriatric assessment: role of caregiver agreement and adherence to recommendations. Journal of American Geriatrics Society, 52, 99-105.
