Research on Aging

This article reviews research on older patients and their doctors, with particular attention to the medical encounter between an elderly patient and his or her physician. Major categories of variables affecting the medical encounter include provider and patient characteristics (age, gender, ethnicity, education, values) and the context or setting of the encounter (site, presence of a patient's companion, and whether the visit is an initial one for the physician-patient pair). The process and content of medical encounters are affected by participant characteristics and context variables, and these in turn affect outcome variables such as participant satisfaction, adherence to treatment regimens, and medical outcome. Process issues include transfer of information, medical decision making, and interpersonal relations. Methodological issues are discussed, including problems with theory generation, lack of standardized methodology, gaps in research knowledge, and prior emphasis on descriptive studies as opposed to testing of interventions to improve elderly patient-physician communication.

This article considers how physicians' and elderly patients' social and cultural backgrounds affect their interactions and how their power relationships can change the interactions. The author first examines how doctors establish power over elderly patients by using the patient's first name. Next, she identifies six elements to be used when assessing the physician-elderly patient relationship. She considers how the demographic backgrounds of both doctors and elderly patients can influence their understanding and expectations of each other and then explores the impact of the interaction location and the effects of the health of both participants. She discusses how patient caregivers can affect the physician-elderly patient relationship and how uncertainty about information exchanged can damage the relationship. Finally, the author projects how new technologies will be used to modify physician-elderly patient interactions in the future.

This study was designed to examine the role of the third person in the doctor-older patient-companion triad at three points in the medical care decision process of older patients: before the medical encounter, during the medical visit, and subsequent to the medical encounter. Older patients accompanied on the medical visit were compared with older patients who came alone regarding the roles and activities of family and others leading to the older patients' medical visit as well as immediate outcomes upon completion of the medical visit and short-term outcomes 2 months after the initial medical visit. Older patients accompanied to the medical visit also assessed roles and assistance provided by the third-person companion during the medical encounter. Older patients accompanied on the medical visit were usually accompanied by the same person across medical visits. The third person was likely to be a spouse and was viewed as an asset during and after the medical encounter. Older accompanied persons were more likely to have assistance both before and after the medical visit, although there were few differences between groups in terms of immediate and short-term outcomes. Findings suggest that the presence of the third person in the doctor-older patient medical encounter should be viewed as an opportunity for patient education and support for the companion who provides an ongoing role in care of the older patient.

The medical interview has become an increasingly important diagnostic and therapeutic tool in the era of managed care. This article reviews the current literature on the relationship between specific interviewing skills and outcomes of care. In the context of three clinical vignettes, these results are discussed in relationship to interviewing geriatric patients.

This article reviews the literature and presents some new preliminary findings on physician-older patient communication about psychosocial issues in primary care medical visits. The authors examine the importance of psychosocial talk in medical encounters, the barriers to these discussions, and the prevalence and specific content of psychosocial discussions in primary care medical encounters. The research suggests that the preponderance of talk in the medical encounter is biomedical, with little attention to psychosocial topics. The differential attention to the biomedical sphere may be more common and more problematic with the elderly. A research agenda in three areas is proposed. Investigations are needed on: (a) the determinants, outcomes, and nature of physician-older patient communication about psychosocial issues; (b) the psychosocial factors that are problematic in older patients' lives and have relevance for their medical care; and (c) the psychosocial issues that arise when the older patient is sick or disabled.

Currently, most research in the area of physician-elderly patient interactions relates to either outcome, context, or interaction styles. There are limited data in the area of intervention studies. The authors recognize five specific areas of interventional research to consider: communication during encounters, characteristics of older patients, physical impairments, physician attributes, and the team approach to health care. Also highlighted are recognition and evaluation of the special needs of elderly patients through geriatric assessment. The authors recognize the need for more intervention studies that attempt to change patient or physician behaviors and the applicability of the classic randomized controlled model of research. Overall, the authors contend that the formation of strong, meaningful relationships between elderly patients and their physicians is best achieved through effective medical communication and care, and thus should be the function of appropriate interventions.