What influences older adults' preferences for care?

We all know that family and friends are important, and that the people close to us have a big impact on our health. Now, a team of researchers has found that family support is also important when older people with advanced illnesses think about how the type of care they would prefer as they age.

Understanding how we would prefer to be cared for as we age is vital to providing person-centered care. Person-centered care puts individual values and preferences at the heart of care decisions. It focuses attention on the health and life goals we have individually. Person-centered care is considered a gold standard for health care.

Until now, we haven't had a good understanding of how older adults form care preferences. To learn more about care preferences and how they might be influenced for older adults with advanced illnesses, a team of researchers from the United Kingdom searched for existing medical studies about the topic and collected the results. They published their findings in the Journal of the American Geriatrics Society.

The research team looked at 57 studies about the preferences of older adults with advanced illness. They included research that investigated preferences for where people wanted to be cared for, the kinds of communication and decision-making they wanted, and what quality of life they hoped to have over time.

The researchers found that support from family was the most important influence on care preferences for older adults. But people also usually formed their preferences based on a variety of factors. They also discovered that it was unusual for older adults to know their care preferences or to have a clear understanding of how they formed their preferences.

The key findings of this study were:

• The level of support from families was the most important influence on care preferences. Often, older adults changed their preferences based on the concerns of family members or a wish to avoid "being a burden" to others. This was especially true for preferences regarding the places where people wished to receive care (for example, at home versus in a healthcare facility).
• Older adults' experiences of previous illness and of caring for others also influenced preferences about their own future care.
• Being more seriously ill strongly influenced care preferences, especially for older adults who were aware that they were unwell.

While this study tells us more about what influences people's preferences, the researchers noted that we still know very little about how people's preferences may change over time. Understanding this is important so that we can receive care in line with our preferences over the course of an illness.

The researchers concluded that healthcare practitioners should take these influences into account when considering an older adult's care preferences, and that they should make sure that family members or other caregivers important to an individual are included in discussions about preferences.