Feasibility and Acceptability of the “About Me” Care Card as a Tool for Engaging Older Adults in Conversations About Cognitive Impairment

Dear Editor,

We have read with keen interest the recent article by Grande et al. entitled “Feasibility and Acceptability of the ‘About Me’ Care Card as a Tool for Engaging Older Adults in Conversations About Cognitive Impairment” (1). As Spanish family physician researchers, we find this study highly relevant to current challenges in primary care, especially considering the growing burden of cognitive disorders in aging populations worldwide. The paper describes the creation and initial testing of a simple paper-based conversation tool designed to promote deeper patient-clinician discussions about goals, fears, and concerns related to cognitive health. This approach offers an interesting departure from purely biomedical frameworks that often overlook the broader psychosocial context in which cognitive impairment emerges.

We would like to situate Grande et al.’s findings in the context of our work within Spain’s National Health System, where the number of older adults continues to rise, and where family physicians face significant time constraints in daily practice. The authors’ emphasis on slow and deliberate conversations resonates with the existing literature on patient-centered care, which highlights how tools that “disrupt” routine clinical flow may help clinicians refocus on what truly matters to patients (2). Indeed, the idea of granting permission to both patients and clinicians to explore personal goals and concerns is consistent with the concept of shared decision making (SDM), as outlined by recent contributions in this journal (3,4). Early detection of cognitive issues, alongside a comprehensive understanding of individual and family concerns, is a recognized priority in our primary care settings, particularly when facing the stigma and underreporting of memory problems (5). By integrating a conversation card, it seems feasible to reduce missed opportunities to address early cognitive symptoms, a point especially salient in Spain, where the prevalence of undiagnosed dementia remains a serious concern (6).

From our vantage point as family physician researchers, one of the most notable strengths of the “About Me” Care Card is that it fosters what Reuben and Tinetti have termed “goal-oriented patient care,” where patient-defined priorities guide clinical decision making rather than mere disease control targets (2). In day-to-day practice, we frequently rely on validated cognitive tools such as the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA), yet these instruments often fail to capture the emotional, social, and existential dimensions of cognitive decline. Integrating a reflective card that directs attention to personal objectives may counterbalance the limitations of standardized measures and encourage more personalized discussions. This aligns with systematic reviews indicating that communication aids that encourage patient reflection can lead to more meaningful exchanges in the limited timeframe of a primary care consultation (7,8).

Another valuable aspect of this study is the breadth of settings in which the authors tested their prototype, including neurology units, primary care clinics, and community-based services. We observe a parallel in Spanish primary care, where the resource constraints and time pressures often curtail detailed conversations about aging-related fears. Indeed, payment models and organizational structures in many health systems prioritize throughput over depth (9). By using a small paper tool that patients can complete prior to or during a visit, clinicians can circumvent certain barriers inherent to electronic medical records (EMR). While EMRs have proven instrumental in aggregating patient data, research has shown they can sometimes depersonalize the clinical encounter (9). A paper card might serve as a tangible artifact that prompts conversation about nonmedical needs, addressing an important gap noted by the World Health Organization (WHO), which advises that prevention and holistic approaches are critical to mitigate the global burden of dementia (10). In our view, the simplicity of the “About Me” Care Card underscores a key strength: it neither requires elaborate infrastructure nor extensive staff retraining.

Nevertheless, integrating this card into a standard EMR could be beneficial for continuity of care, particularly in Spain’s public health settings, where multidisciplinary teams share a single unified record. We believe that designing a digital template that preserves the reflective character of the paper version would enable seamless retrieval by nurses, social workers, and geriatricians, thus supporting more cohesive, multiprofessional care. A pilot integration might adapt the tool into an EMR module dedicated to patients’ personal goals and values, complementing existing clinical data with patient-reported concerns. While the friction of adopting new tools can be considerable, particularly for older physicians accustomed to traditional workflows, the authors’ pilot data show that such a card can actually streamline encounters by clarifying what the patient wishes to address.

Equally essential is the notion that the card can be used universally for older adults, irrespective of a confirmed diagnosis of cognitive impairment. This inclusivity counters the risk of selectively targeting only those with overt or suspected dementia. As Ferri et al. note in their Delphi consensus study, earlier detection and patient engagement can reduce both the personal and societal costs of dementia (11). Furthermore, families in Spain commonly participate in medical encounters, especially when an older adult begins to exhibit cognitive symptoms. The presence of a simple written prompt can facilitate family involvement in a more organized manner, leading to a shared understanding of the patient’s preferences. This is particularly relevant because familial caregiving remains a cornerstone of dementia care in Mediterranean cultures, and harnessing family input effectively could enhance adherence to management plans—a central theme in long-term therapies (12).

Of particular interest to us as family physician researchers is the study’s implication for innovative technologies. The authors mention the importance of eliciting deeper reflections about cognitive health, but their methodology primarily relied on paper-based tools. We propose that, in tandem with such reflective materials, artificial intelligence (AI) tools could be incorporated to analyze subtle changes in speech patterns or linguistic complexity over time (13). Recent systematic literature reviews, such as that by Petti et al., have shown that speech-based AI detection systems may offer promise in identifying early Alzheimer’s disease by analyzing spontaneous conversation (14). The synergy between a conversational card that draws out narratives and an AI application that quantifies language-based biomarkers could assist clinicians in recognizing early neurodegenerative changes while still honoring the importance of patient-centered dialogue. We acknowledge, however, that further research is needed to ensure these AI methodologies are reliable, ethically sound, and seamlessly integrated into a traditional consultation model (15). At present, many Spanish clinics lack the technological infrastructure to implement advanced audio recording or speech analysis, yet pilot initiatives in specialized memory units could yield crucial insights.

Beyond technology, we also applaud the authors’ attention to the emotional dimensions of living with dementia or cognitive impairment. It appears that the “About Me” Care Card enabled conversations that might not typically occur in time-limited encounters, helping families and patients voice previously unspoken fears about loss of independence or identity. This finding is supported by Alzheimer’s Disease International, which has advocated for community-wide interventions that encourage open conversation about dementia to reduce stigma and isolation (16). By facilitating a more holistic conversation about lifestyle, preferences, and psychosocial needs, the card aligns with WHO guidelines that highlight the importance of addressing both modifiable risk factors and supportive environments to improve well-being in older adults (10). Indeed, any effort to slow cognitive decline should combine medical strategies—like blood pressure control and physical exercise—with broader person-centered support. The research by Grande et al. indicates that prompting patients to reflect on these aspects in writing could be a strategic first step.

We see multiple areas for future exploration in Spain. A structured study could test the tool in diverse regions, including rural health centers where older adults often experience limited access to specialist care. Another priority would be to investigate how the card fits into the workflow of family medicine residents, who might be more open to incorporating novel communication strategies. Evaluating longer-term outcomes—such as whether these dialogues translate into proactive engagement with preventive measures—would be highly informative. As some local health authorities in Spain move toward implementing digital health agendas, there may also be an opportunity to pair the “About Me” Care Card with teleconsultations, offering patients the chance to reflect on their goals from home and subsequently discuss them in a virtual appointment. This could be particularly relevant for older adults with mobility constraints or those living in remote areas.

We commend Grande et al. for developing and testing a communication tool that addresses a significant gap in the daily reality of primary care. The “About Me” Care Card has the potential to encourage patient-centered, holistic conversations in ways that are both feasible and acceptable across different clinical settings. While the study demonstrates promising preliminary results, additional research is warranted to explore the card’s utility over time, its integration into EMRs, and its synergy with emergent technologies such as AI-based speech analysis. From our point of view in Spain, we believe this approach could complement established geriatric assessments and spark a cultural shift toward more nuanced, reflective dialogue about cognitive health. As family medicine researchers, we look forward to seeing how future studies will refine and expand upon this card-based intervention, possibly contributing to a more humanistic and evidence-informed standard of care for older adults.

REFERENCES

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