Article Figures & Data
Tables
Characteristic All Column % Active Row % Passive Row % Passive OR (95% CI) P Value Age, y 65–74 54.4 86.2 13.8 1 [Reference] … 75–84 33.4 82.7 17.3 1.29 (0.91–1.84) .15 ≥85 12.2 71.8 28.2 2.39 (1.65–3.47) <.01 Sex Female 57.2 85.2 14.8 1 [Reference] … Male 42.8 80.8 19.2 1.35 (0.98–1.85) .06 Race/ethnicity White, non-Hispanic 81.1 84.0 16.0 1 [Reference] … Black, non-Hispanic 8.1 79.8 20.2 1.32 (0.91–1.92) .14 Hispanic 6.1 86.3 13.7 0.84 (0.42–1.67) .61 Others 4.7 73.0 27.0 1.92 (0.90–4.08) .09 Education ≥High school diploma 78.7 86.3 13.7 1 [Reference] … <High school 21.3 72.0 28.0 2.40 (1.72–3.36) <.01 Annual household income ≥ 300% of FPL 33.6 88.6 11.4 1 [Reference] … 200% to 299% of FPL 23.2 83.1 16.9 1.56 (1.06–2.28) .02 100% to 199% of FPL 23.1 80.3 19.7 1.89 (1.18–3.00) <.01 <100% of FPL 20.1 78.0 22.0 2.16 (1.47–3.17) <.01 Marital status Married or living with a partner 57.4 85.9 14.1 1 [Reference] … Widowed 25.9 79.5 20.5 1.56 (1.14–2.12) <.01 Separated, divorced, never married 16.7 80.3 19.7 1.48 (0.99–2.19) .05 Length of residence US born 89.5 83.6 16.4 1 [Reference] … Move to US at age <45 y 8.4 85.3 14.7 0.88 (0.49–1.56) .65 Move to US at age ≥45 y 2.1 64.2 35.8 2.7 (1.78–6.79) .04 English proficiency Yesa 97.8 83.9 16.1 1 [Reference] … Noa 2.2 56.0 44.0 4.02 (1.51–10.66) <.01 Functional status No self-care limitationb 75.7 86.4 13.6 1 [Reference] … Self-care limitationb 24.3 73.6 26.4 2.23 (1.61–3.09) <.01 No mobility limitationb 70.8 87.4 12.6 1 [Reference] Mobility limitationb 29.2 73.2 26.8 2.48 (1.81–3.40) <.01 No household limitationc 65.7 87.5 12.5 1 [Reference] Household activities limitationc 34.3 75.2 24.8 2.27 (1.79–2.88) <.01 Physician relationship No usual source of care 4.3 88.0 12.0 1 [Reference] … Have usual source of care 95.7 83.1 16.9 1.52 (0.74–3.10) .25 Did not see usual source of care last year 6.5 85.1 14.9 1 [Reference] … Saw usual source of care last year 93.5 83.2 16.8 1.15 (0.57–2.33) .70 No informal caregiver sit in medical visits 64.6 86.3 13.7 1 [Reference] … Informal caregiver sit in medical visit 35.4 77.8 22.2 1.78 (1.40–2.25) <.01 FPL = 2001 Federal poverty level.
Note: Unweighted random sample of 2,017 respondents. All numbers in the table are weighted estimates and not adjusted for covariates. Odds ratio estimates and corresponding P values were based on simple logistic regression models (ie, bivariate analyses) using svy command in Stata to adjust for sampling design.
↵a Survey respondents who spoke English only or who spoke English very well or well were considered as having English proficiency; those who spoke English not well or not at all were considered as not having English proficiency.
↵b Survey respondents were asked how often they perform self-care activities (eating, getting cleaned up, using toilet, and getting dressed) and mobility (getting inside, outside of house, and getting out of bed) without help in the last month. Survey respondents were considered to have limitation in self-care activities or mobility if they reported having problems performing at least 1 activity in self-care activities or mobility, respectively, without help of any person.
↵c Survey respondents also were asked whether they had help doing household activities including doing laundry, shopping, preparing hot meals, handling banking and bills, and tracking medications in the last month. Household activities limitation was identified if a respondent reported having difficulty doing at least 1 household activity independently or having someone to do for/with for at least 1 household activity because of health reasons.
Characteristic Active % Passive % Passive OR (95% CI) P Value Passive AOR (95% CI) P Value No multimorbidity 91.1 8.9 1 [Reference] … … … Multimorbidity 81.1 18.9 2.35 (1.55–3.54) <.01 1.77 (1.15–2.71) .01 Number of conditions in categories ≤1 91.1 8.9 1 [Reference] … … … 2 88.3 11.7 1.35 (0.75–2.41) .31 1.31 (0.72–2.37) .37 3 84.3 15.7 1.88 (1.17–3.02) .01 1.47 (0.88–2.43) .14 4 75.5 24.5 3.23 (1.97–5.28) <.01 2.61 (1.58–4.31) <.01 ≥5 73.9 26.1 3.51 (2.26–5.44) <.01 2.21 (1.38–3.52) <.01 Number of condition clusters in categories ≤1 90.3 9.7 1 [Reference] … … … 2 84.4 15.6 1.71 (1.26–2.33) <.01 1.58 (1.11–2.24) .01 3 77.5 22.5 2.65 (1.85–3.79) <.01 2.05 (1.39–3.03) <.01 ≥4 70.4 29.6 3.81 (2.45–5.93) <.01 2.19 (1.35–3.56) <.01 AOR=adjusted odds ratio.
Note: Unweighted n = 2,017 survey respondents. All numbers in the table are weighted estimates.
a Three parallel multiple logistic regression models were used, 1 for each of 3 multimorbidity profiles.
b Covariates adjusted in multiple regression models included age (≤85 years as reference group), sex (female as reference group), educational attainment (high school or higher as reference group), English proficiency (proficient in English as reference group), and mobility limitation (no mobility limitation as reference group).
Additional Files
Supplemental Appendixes 1-2
Supplemental Appendixes
Files in this Data Supplement:
- Supplemental data: Appendixes 1-2 - PDF file
The Article in Brief
Multimorbidity and Decision-Making Preferences Among Older Adults
Winnie C. Chi , and colleagues
Background Shared decision-making, which is important in caring for people with multiple medical conditions, requires participation from both patient and clinician. This study explores preferences for health care decision-making among older adults and identifies multimorbidity profiles for those who prefer less active roles in decision-making.
What This Study Found Although most older Americans prefer to actively participate in making health care decisions, those with four or more chronic conditions are less likely to prefer active decision making. Researchers analyzed a random sample of 2,017 older adults who, with sample weights, represented approximately 33 million Medicare beneficiaries aged 65 and older. They found that eighty-five percent of older Americans in a community setting preferred to actively participate in medical decision making, but approximately one in every seven older Americans preferred a passive role, leaving health care decisions to doctors (15 percent, n=4.9 million). Approximately one quarter of older adults with four or more chronic conditions preferred a passive role, which was more than twice the odds of those that did not have multiple conditions after controlling for socio-demographic characteristics. Older adults with multiple condition clusters were relatively less likely to prefer active decision-making compared to those with none or a single condition cluster.
Implications
- The authors encourage primary care clinicians to invite older adults with four or more conditions or multiple condition clusters to participate in decision-making and to elicit goals and outcome preferences in those older adults who prefer less active participation.
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