Discussing Age-related Functional Decline in Family Medicine

A Qualitative Study That Explores Both Patient and Physician Perceptions

Ophélie Viret; Joëlle Schwarz; Nicolas Senn; Yolanda Mueller

Disclosures

Age Ageing. 2020;49(2):292-299. 

In This Article

Abstract and Introduction

Abstract

Background: evaluating a patient's functional status and screening for geriatric syndromes by general practitioners (GPs) are increasingly encouraged. This study aimed to explore how older people and GPs define and perceive autonomy and functional decline, patients' propensity to discuss age-related issues and integration of such topics into routine medical consultations.

Methods: this qualitative study was conducted in Western Switzerland with older people followed in primary care practices and who participated in a trial assessing the effectiveness of a screening and management tool for geriatric syndromes to prevent functional decline. We interviewed 15 participants (patients ≥75 years old) and five GPs about their screening experience. We used semi-structured grids for data collection and an inductive thematic approach for data analysis.

Results: participants gave several definitions of autonomy, directly depending on their health status and functional limitations. Implementing various coping strategies, participants also expressed contrasted feelings related to functional decline such as fear, inability to accept and resilience. Functional decline was often perceived as normal ageing; participants were therefore not prompt at discussing age-related issues with their GP. However, screening was perceived positively by both participants and GPs, making addressing sensitive issues and detecting new problems possible.

Conclusions: a geriatric syndrome-screening intervention was well accepted by both patients and physicians. This type of initiative may be an opportunity to address various age-related issues and to inform patients of existing solutions.

Introduction

Whilst being a positive outcome of increasing life expectancy, worldwide population ageing is a phenomenon that challenges health systems globally. Public health systems are responding to the changing demography by adapting services that contribute to helping older people live independently in their own homes as long as possible.[1,2] Indeed, as developed in the socio-medical model of disablement by Verbrugge and Jette,[3] an accumulation of chronic and acute conditions over time can limit individuals in their physical and mental activities and, depending on personal and environmental factors, may lead to loss of independence and disablement. Until recently, health systems tried to address age-related functional decline through health assessments conducted during hospitalisation, rehabilitation after hospitalisation or within the context of home-based care.[4] These initiatives usually target individuals already impaired functionally or at high-risk of becoming so in the very near future. In order to intervene earlier in the disablement process, recent initiatives have aimed at screening for geriatric syndromes and functional decline in primary care settings, integrating assessment of functional status of patients in their usual environment.[5–10] General practitioners (GPs) are the main—and sometimes only—contact of the healthy older community-dwellers to the health system. Screening initiatives for geriatric syndromes further respond to the paradigm shift in medicine that evolved from a disease-centred to a patient-centred approach, by taking into account patients' health needs, goals and preferences.[11,12]

The Active Geriatric Evaluation (AGE) project was started in 2011 aiming to develop a screening and management tool for geriatric syndromes in family medicine (AGE tool) to prevent functional decline and improve quality of life in older patients in Western Switzerland.[5,13,14] The tool is currently being tested in a randomised controlled trial (AGE intervention trial) in which a usual care control arm is being compared with an intervention arm where GPs screen their patients during routine consultations for eight geriatric syndromes (see Table 1), with a targeted care plan for each syndrome detected. We hypothesised that the AGE tool could potentially be at odds with a patient-centred approach because of its standardised and syndrome-based nature and because it changes the routine consultation dynamics (screening initiated by GPs rather than on a patient's expressed demand). Based on this postulate, we integrated a qualitative study into the clinical trial to assess how the screening tool was perceived and accepted by patients and GPs. Our study aimed to explore the following: (i) how older people and GPs respectively define and perceive autonomy and functional decline, (ii) how older people discuss age-related issues with their GP and vice-versa and (iii) how the screening tool fits into the routine medical consultation.

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