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Elderly patients' satisfaction with doctor visits does not necessarily indicate quality of care

Elderly patients tend to be more satisfied with visits to the doctor than younger patients. Their initial visits with a doctor tend to be more polite and formal, with physicians more apt to chat with older than younger patients. However, this politeness may be at the expense of discussing more important health issues, since doctors are more likely to counsel younger patients and provide them with health education and prevention services than they are older patients.

The more superficial chatting may prevent older patients from having all of their health needs identified and addressed. In fact, elderly patients' satisfaction with medical care in general and with a specific visit may not necessarily indicate better quality of care, concludes a study supported by the Agency for Healthcare Research and Quality (HS08029).

Edward J. Callahan, Ph.D., and fellow researchers at the University of California, Davis, observed the interactions of physicians (second and third-year residents) and 509 new adult, nonpregnant patients at a university family medicine and general internal medicine clinic. They compared care for patients 65 and older, those 45 to 64 years, and those 18 to 44 years of age. After controlling for patient health status and demographics, they found that older patients had more return visits and reported higher levels of satisfaction than younger patients.

Although the oldest patients experienced more chatting in their longer visits, they were given less counseling, asked fewer questions, had less discussion about their families and their use of substances, were asked to change their health behavior habits less often, and were given less health education than the youngest patients. More of each visit with the oldest patients was spent checking on compliance with earlier treatment and developing treatment plans. Visit content for those aged 45 to 64 fell between the oldest and youngest groups.

Some of the observed differences in visit length and content may stem from social rules prescribing respect for older patients, resulting in less personal challenge to and education of older patients regarding their health habits and self-care. On the other hand, perhaps physicians choose to focus their health promotion messages on patients they feel are more likely to change.

See "The influence of patient age on primary care resident physician-patient interaction," by Dr. Callahan, Klea D. Bertakis, M.D., M.P.H., Rahman Azari, Ph.D., and others, in the January 2000 Journal of the American Geriatrics Society 48, pp. 30-35.

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