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Background: This study identifies the prevalence and correlates of physician-geriatric patient discussions about physical activity and nutrition lifestyle behaviors., Methods: Between August 1998 and July 2000, 423 older patient visits to 36 physicians were videotaped in three different primary care settings. The patient sample was primarily white, female, well-educated, and financially sufficient, although 12.7% of the encounters occurred in an inner city clinic. The major dependent variable-lifestyle discussion-is based on observations of physician behavior. Descriptive and multivariate logistic regression analyses were conducted in 2004., Results: Nutrition talk was most prevalent, occurring in almost half the encounters (48.2%) followed by physical activity discussions (39.2%) then conjoint mention (22%). Discussions were significantly less likely to occur in acute visits. While ethnicity, gender, and length of visit were not significantly related, physician interaction style and patient vitality and education were significant predictors in the multivariate analyses., Conclusions: Given the impact of lifestyle behaviors on myriad health outcomes, the current prevalence rates of physician discussion, while higher than in many previous studies, remain sub-optimal. Practical assessment tools, training in behavioral counseling, and reimbursement incentives are recommended strategies for raising physical activity and nutrition discussion prevalence in primary care settings.

Background: The lack of instruments and methodologies designed specifically for assessing doctor-elderly patient interactions has constricted research on effective communication in the medical care of older adults., Purpose: This article reports on the development, qualitative analyses, and psychometric testing of the Assessment of Doctor-Elderly Patient Transactions (ADEPT), an instrument for assessing interactions between doctors and their elderly patients., Methods: The ADEPT was based on the recommendations of an expert panel and designed around the three-function model of the medical interview. The ADEPT is meant to operationalize the research findings of interactional analysis studies of doctor-patient interaction. Following preliminary testing with standardized patients, the ADEPT was applied to videotaped visits of 433 patients 65 years of age and older to the doctor (n = 40) identified as their primary source of care., Results: Four final scales derived from exploratory and confirmatory factor analyses were scored: Supporting, comprised of the 12 items from the first factor; Eliciting Needs, containing the 5 items from the second factor; and Informing, based on the final 6-item factor. Individual Cronbach's alphas across raters for this sample ranged from .71 to .79 for the first scale, from .83 to .88 for the second scale, and from .64 to .81 for the third scale. The reliability estimates for the total scale (23 items) ranged from .80 to .86 across raters. A fifth summed index composed of 46 binary checklist items also was computed., Conclusions: The findings indicate that credible scales can be developed for assessing communication behaviors.

OBJECTIVES: To assess how care is delivered for mental disorders using videotapes of office visits involving elderly patients. DESIGN: Mixed-method observational analysis of the nature of the topics discussed, content of discussion, and the time spent on mental health. SETTINGS: Three types of settings: an academic medical center, a managed care group, and fee-for-service solo practitioners. PARTICIPANTS: Thirty-five primary care physicians and 366 of their elderly patients. MEASUREMENTS: Videotapes of 385 visits covering 2,472 diverse topics were analyzed. Coding of the videotapes identified topics, determined talk time, and coded the dynamics of talk. RESULTS: Mental health topics occurred in 22% of visits, although patient survey indicated that 50% of the patients were depressed. A typical mental health discussion lasted approximately 2 minutes. Qualitative analysis suggested wide variations in physician effort in providing mental health care. Referrals to mental health specialists were rare even for severely depressed and suicidal patients. CONCLUSION: Little time is spent on mental health care for elderly patients despite heavy disease burdens. Standards of care based on a count of visits “during which a mental health problem is discussed” may need to be supplemented with guidelines about what should happen during the visit. System-level interventions are needed. [ABSTRACT FROM AUTHOR]

Abstract: Objective: There are several measurement tools to assess verbal dimensions in clinical encounters; in contrast, there is no established tool to evaluate physical nonverbal dimensions in geriatric encounters. The present paper describes the development of a tool to assess the physical context of exam rooms in doctor–older patient visits. Method: Salient features of the tool were derived from the medical literature and systematic observations of videotapes and refined during current research. Results: The tool consists of two main dimensions of exam rooms: (1) physical dimensions comprising static and dynamic attributes that become operational through the spatial configuration and can influence the manifestation of (2) kinesic attributes. Conclusion: Details of the coding form and inter-rater reliability are presented. The usefulness of the tool is demonstrated through an analysis of 50 National Institute of Aging videotapes. Physicians in exam rooms with no desk in the interaction, no height difference and optimal interaction distance were observed to have greater eye contact and touch than physicians’ in exam rooms with a desk, similar height difference and interaction distance. Practice implications: The tool can enable physicians to assess the spatial configuration of exam rooms (through Parts A and B) and thus facilitate the structuring of kinesic attributes (Part C). [Copyright &y& Elsevier]