Extensive new research shows better outcomes and lower costs result when providers consider patient preferences in care plans. Diving into LeadingAge LTSS Center @UMass Boston’s quantitative and qualitative work, we learn key takeaways and actionable insights.
“I was trying to explain to the doctor… [that the] meds that I was taking… caused my ankles to swell… and that I don’t want to take them. He just joked about it like, “[You’re] not a doctor. It might be other things. It might not be the medication,” and I didn’t feel respected… and I walked away feeling small and insignificant, like I wasn’t important.” — Patient Focus Group Participant
For older adults and providers, the current system of care is often centered around volume and efficiency. Interactions can be short, rushed and full of jargon. This dynamic makes it harder to build meaningful relationships where individual care preferences are collaboratively discussed. According to new research from the LeadingAge LTSS Center @UMass Boston and Community Catalyst, one in three older adults say their care preferences are rarely or never considered by their clinicians, and it’s even worse for older adults of color and those with lower incomes. This happens even though we know that taking patients’ health care preferences into account improves care quality and health outcomes.
At The SCAN Foundation, we believe policy and programs should elevate older adults’ care preferences so that people age well, how and where they want. That’s why I sat down with the team leading this new research for my “Three Questions With” video series to better understand how ignoring older adult care preferences impacts patients, providers, and the broader health system.
Ignoring patient preferences is costly
Everyone has goals as they age—like remaining physically active, staying in their home and being socially connected. Care plans should reflect and support these goals. When patent preferences are ignored, the financial costs are steep.
Over an eight-year study period, researchers estimate $45 billion in unnecessary Medicare spending resulted from providers not taking patient preferences into account. Older adults who felt their preferences weren’t considered were less likely to receive routine care and more likely to visit emergency rooms for their care, which is expensive, stressful and often unnecessary.
Listen to LeadingAge researcher Jane Tavares on the cost of ignoring care preferences:
Deep disparities exist in whose preferences are honored
Research shows that Black and Hispanic older adults and older adults with lower incomes are less likely to have care preferences addressed than their white counterparts. This results in higher health care costs and a widening of health and economic disparities. The differences extend to end-of-life care, where older adults of color are less likely to feel they’ve had sufficient input into their care.
Listen to Community Catalyst’s Alhelí Herrera on racial, ethnic, and economic disparities in care preferences:
Providers face hurdles, too
While most providers say they want to meet their patients’ references, they face their own roadblocks to doing so. Researchers conducted focus groups with physicians, nurse practitioners and physician assistants to better understand obstacles and identify policies and practices to help. Here’s what they suggest:
- Increase access to coordinated and preventive care
When older adults have greater access to coordinated, preventive care, their health conditions are less likely to reach emergency levels, when it’s especially difficult to identify and act upon care preferences. Earlier interventions lead to better communication between patients and providers, and greater coordination of overall health and care preferences.
- More time with patients
Administrative tasks like paperwork rob valuable time that providers could spend listening to patients and building trust.
- Less medical misinformation
Some providers find it difficult to balance patient preferences with the immediate medical treatment they require. This can be especially difficult when patients come armed with online medical misinformation, requiring providers to spend time correcting misinformation rather than asking about care preferences.
Hear from LeadingAge’s Claire Wickersham on the importance of coordinated care:
How listening leads to better, more cost-efficient care
Through this research, we discovered that when providers meet the care preferences of older adults, older adults are:
- More likely to seek preventive care, avoiding costly emergency room visits
- More likely to effectively manage chronic conditions, resulting in reduced hospital stays and costs
From the provider and health system perspective, meeting older adults’ care preferences leads to:
- Fewer inpatient hospitalizations
- Less utilization of costly services for emergency visits
- Narrowed racial, ethnic, and socioeconomic disparities in health care use and outcomes
Listen to lead researcher Marc Cohen of LeadingAge on how addressing patient preferences benefits everyone:
Do you hear what I hear? This research and The SCAN Foundation’s continued efforts to listen and act upon the experiences of older adults underscores that better care and lower costs result when providers consider patient preferences.