Older adults receiving assistance with physician visits and prescribed medications and their family caregivers: prevalence, characteristics, and hours of care.

OBJECTIVES To profile older adults receiving assistance with physician visits and prescribed medications and the time demands associated with their care. METHODS Observational study of 7,197 community-dwelling adults ages 65+ responding to the 2011 National Health and Aging Trends Study. RESULTS More than one third of older adults receive assistance with either physician visits or prescribed medications (26.3%), or both (9.9%). The 3.3 million older adults who receive assistance with both physician visits and prescribed medications are a high-need subgroup: 3 in 5 have possible (16.5%) or probable (46.1%) dementia and three quarters (76.6%) receive help with mobility, self-care, or household activities. These 3.3 million older adults receive more than twice as many weekly hours of help with all activities (60.5 hr) as those receiving help with either physician visits or prescribed medications (26.5 hr), or neither (18.6 hr). Older adults receiving help with both physician visits and prescribed medications are assisted by 7.2 million helpers, most often adult children (46.6%), or spouses (23.6%). The 3.1 million helpers who assist with both physician visits and prescribed medications provide an average of 45.4 hr of help per week; nearly two thirds (64.3%) also assist with mobility or self-care. DISCUSSION Older adults receiving help with both physician visits and prescribed medications typically have high health and functioning needs that involve significant time demands for caregivers.

[1]  Jia-Rong Wu,et al.  Family member accompaniment to routine medical visits is associated with better self-care in heart failure patients , 2015, Chronic illness.

[2]  M. Harrington,et al.  Family caregivers: a shadow workforce in the geriatric health care system? , 2007, Journal of health politics, policy and law.

[3]  Naihua Duan,et al.  The Effect of a Disease Management Intervention on Quality and Outcomes of Dementia Care , 2006, Annals of Internal Medicine.

[4]  J. Morris,et al.  Validity and reliability of the AD8 informant interview in dementia , 2006, Neurology.

[5]  C. Boult,et al.  Construct validity of the Work Productivity and Activity Impairment questionnaire across informal caregivers of chronically ill older patients. , 2009, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[6]  S. Scholle,et al.  Engaging Patients and Families in the Medical Home , 2010 .

[7]  W. Clyne,et al.  Developing consensus-based policy solutions for medicines adherence for Europe: a delphi study , 2012, BMC Health Services Research.

[8]  M. Elliott,et al.  Physician Recognition of Cognitive Impairment: Evaluating the Need for Improvement , 2004, Journal of the American Geriatrics Society.

[9]  Cathleen M Connell,et al.  Current and potential support for chronic disease management in the United States: the perspective of family and friends of chronically ill adults. , 2013, Families, systems & health : the journal of collaborative family healthcare.

[10]  Sujuan Gao,et al.  Medication adherence in older adults with cognitive impairment: a systematic evidence-based review. , 2012, The American journal of geriatric pharmacotherapy.

[11]  A. Wu,et al.  Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. , 2005, JAMA.

[12]  R. Golden,et al.  Strong social support services, such as transportation and help for caregivers, can lead to lower health care use and costs. , 2013, Health affairs.

[13]  V. Moyer,et al.  Screening for cognitive impairment in older adults: U.S. Preventive Services Task Force recommendation statement. , 2014, Annals of internal medicine.

[14]  R. Spitzer,et al.  The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener , 2003, Medical care.

[15]  Stephen M Shortell,et al.  Bridging the divide between health and health care. , 2013, JAMA.

[16]  J. Wolff,et al.  Caregivers of frail elders: updating a national profile. , 2006, The Gerontologist.

[17]  Martin Pinquart,et al.  Spouses, adult children, and children-in-law as caregivers of older adults: a meta-analytic comparison. , 2011, Psychology and aging.

[18]  Susan A. Flocke,et al.  Defining and Measuring the Patient-Centered Medical Home , 2010, Journal of General Internal Medicine.

[19]  J. Hartford Retooling for an Aging America : Building the Health Care Workforce Committee on the Future Health Care Workforce for Older Americans , 2008 .

[20]  Clifford Goodman,et al.  American Medical Association Council on Scientific Affairs , 1988 .

[21]  A. Bindman,et al.  Medicare's transitional care payment--a step toward the medical home. , 2013, The New England journal of medicine.

[22]  D. Roter,et al.  Hidden in plain sight: medical visit companions as a resource for vulnerable older adults. , 2008, Archives of internal medicine.

[23]  S. Douglas,et al.  Work productivity and health of informal caregivers of persons with advanced cancer. , 2011, Research in nursing & health.

[24]  M. Laplante,et al.  Estimating paid and unpaid hours of personal assistance services in activities of daily living provided to adults living at home. , 2002, Health services research.

[25]  I. McRae,et al.  Health work by older people with chronic illness: how much time does it take? , 2013, Chronic illness.

[26]  A. Edwards,et al.  Interventions before consultations to help patients address their information needs by encouraging question asking: systematic review , 2008, BMJ : British Medical Journal.

[27]  H. Hashimoto,et al.  Patients' perceptions of visit companions' helpfulness during Japanese geriatric medical visits. , 2006, Patient education and counseling.

[28]  Karen R. Sepucha,et al.  Toward the 'tipping point': decision aids and informed patient choice. , 2007, Health affairs.

[29]  Robert J. Willis,et al.  National estimates of the quantity and cost of informal caregiving for the elderly with dementia , 2001, Journal of General Internal Medicine.

[30]  Jennifer L. Wolff,et al.  Family presence in routine medical visits: a meta-analytical review. , 2011, Social science & medicine.

[31]  A Gafni,et al.  Physician-patient-companion communication and decision-making: a systematic review of triadic medical consultations. , 2013, Patient education and counseling.

[32]  R. Schulz,et al.  Preventive health behaviors among spousal caregivers. , 1997, Preventive medicine.

[33]  Carol Levine,et al.  Bridging troubled waters: family caregivers, transitions, and long-term care. , 2010, Health affairs.

[34]  Paco Martorell,et al.  Monetary costs of dementia in the United States. , 2013, The New England journal of medicine.

[35]  Youngmee Kim,et al.  Time costs associated with informal caregiving for cancer survivors , 2009, Cancer.

[36]  D. Roter,et al.  Going It Together: Persistence of Older Adults’ Accompaniment to Physician Visits by a Family Companion , 2012, Journal of the American Geriatrics Society.

[37]  J. Wolff,et al.  Cross-survey differences in national estimates of numbers of caregivers of disabled older adults. , 2010, The Milbank quarterly.

[38]  Hwajung Choi,et al.  Family and Friend Participation in Primary Care Visits of Patients With Diabetes or Heart Failure: Patient and Physician Determinants and Experiences , 2011, Medical care.

[39]  P. Rabins,et al.  A Tool to Strengthen the Older Patient–Companion Partnership in Primary Care: Results from a Pilot Study , 2014, Journal of the American Geriatrics Society.