Multimorbidity and Decision-Making Preferences Among Older Adults

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.