14. VALUES AND PRIORITIES OF OLDER ADULTS: CREATING COLLABORATIVE GOALS IN PSYCHIATRIC CARE

Abstract

Introduction

The number of older adults seeking psychiatric care is increasing exponentially and the pressure is on to create interventions that can increase the access of support for older adults and reach as many patients as possible. Positive psychological interventions that focus on the psychological wellbeing of older adults present an opportunity to address a range of factors that can impact the lives of older adults. Group interventions foster social connections while reducing cost and limited access to clinicians; the overall aim of this project was to conduct a program evaluation of an innovative, rotating psychological wellness group for older adults. In keeping with this, a needs assessment of patient values and priorities, including the What Matters Most tool, in older adults was performed.

Methods

This program includes a psychological wellness group offering for older adults with 8 modules covering a collection of topics that support optimal psychological wellness and promote health and resilience (i.e. digital tools and mobile apps, value-based behavioral activation to improve your mood, eating for a healthy brain, caring for the caregiver, introduction to mindfulness, improving your sleep, physical activity and strategies for managing anxiety) that are held weekly, ranging in duration from 2-4 weeks, over a 7 month period. Participants were referred from outpatient psychiatry clinics, geriatric medicine providers in medical center, and local community organizations servicing older adults. To be included, patients had to be 65+ years old, English speaking, open to group treatment, and without a diagnosis of dementia. Once participants were triaged and selected, a questionnaire was sent that addressed multiple aspects of their past medical history as well as their personal values and goals of care, prompting patients to identify what matters most to them in the domains of functionality, enjoyment, and connectivity as well as an open text question allowing them to expand on which three goals matter the most above all.

Results

Older adults (N=19) were enrolled in the psychological wellness group, including 9 males and 10 females. Nine of the participants reported that they lived alone. Survey results indicated that older adults greatly prioritize maintaining cognitive status as their greatest health priority. The perceived importance of maintaining social connectivity via relationships with family and friends was rated equally if not higher than several aspects of physical functionality. The following representative direct patient quotes encapsulate this sentiment well with one subject’s list “1. Connecting deeply with people. 2. Having confidence I can handle whatever comes my way. 3. I’d like to remove the fear that currently has a grip on me so that I am comfortable getting out and about without anxiety.” “[Be] able to take care of myself, have a clear mind and surrounded by close friends.” Relatedly, patients who indicated that mental cognition was not one of their most important health goals tended to respond positively to priorities centered around personal independence, such as travel, preserved sensory function, and ability to complete iADLs. However, ability to care for self and others was globally the least important priority.

Conclusions

Insights in the health priorities of older adults may allow for a better understanding of their treatment goals, allowing for greater alignment in the therapeutic alliance. Of the neurocognitive domains, social cognition is not routinely tested; this preliminary data underscores the importance of this domain to older adults along with engagement in pleasurable activities and exercise. Future work includes collecting additional surveys to create datasets large enough for examination across several cohorts so that modules employed will target areas most in line with patient goals.