Journal of Gerontological Nursing

Feature Article 

The Consistency of Self-Reported Preferences for Everyday Living: Implications for Person-Centered Care Delivery

Kimberly Van Haitsma, PhD; Katherine M. Abbott, PhD; Allison R. Heid, PhD; Brian Carpenter, PhD; Kimberly Curyto, PhD; Morton Kleban, PhD; Karen Eshraghi, MSW; Christina I. Duntzee, BS; Abby Spector, MMHS

Abstract

Preferences are the expression of an individual’s basic psychosocial needs and are related to care outcomes. The current study tested the consistency of 87 individuals’ everyday preferences over 1 week, comparing responses of nursing home residents (n = 37; mean age = 82) and university students (n = 50; mean age = 20). Participants completed the Preferences for Everyday Living Inventory at baseline and 5 to 7 days later. Preference consistency was calculated three ways: (a) correlations (range = 0.11 to 0.90); (b) overall percent of exact agreement (e.g., response was “very important” at both time points) (66.1%); and (c) responses collapsed as “important” or “not important” (increase in percent agreement to 86.6%). Personal care preferences were more stable, whereas leisure activities were less stable. The groups did not have significant differences in consistency. Some preferences are more consistent than others; age and frailty do not appear to be related to preference instability. [Journal of Gerontological Nursing, 40(10), 34–46.]

Dr. Van Haitsma is Associate Professor, College of Nursing, The Pennsylvania State University, University Park, Pennsylvania; Dr. Abbott is Assistant Professor, Department of Sociology and Gerontology, Miami University, Oxford, Ohio; Dr. Van Haitsma is Adjunct Senior Research Scientist, Dr. Heid is Post Doctoral Fellow, Dr. Kleban is Director of Psychometrics, Ms. Eshraghi is Project Manager, and Ms. Duntzee is Research Specialist, The Polisher Research Institute, The Madlyn and Leonard Abramson Center for Jewish Life, North Wales, Pennsylvania; Dr. Carpenter is Associate Professor, Department of Psychology, Washington University in St. Louis, St. Louis, Missouri; Dr. Curyto is Psychologist and Research Scientist, VA Western NY Healthcare System, Batavia, New York; and Ms. Spector is Consultant, Spector Consulting, Bala Cynwyd, Pennsylvania.

The authors have disclosed no potential conflicts of interest, financial or otherwise. This work was made possible by funding from the Harry Stern Family Center for Innovations in Alzheimer’s Care and a National Institute of Nursing Research grant (1R21NR011334: Principal investigator, K. Van Haitsma). The authors thank the older adults and the university students who made this project possible by generously volunteering their time to help explore these important research questions.

Address correspondence to Kimberly Van Haitsma, PhD, Adjunct Senior Research Scientist, The Polisher Research Institute, The Madlyn and Leonard Abramson Center for Jewish Life, 1425 Horsham Road, North Wales, PA 19454; e-mail: kvanhaitsma@abramsoncenter.org.

Received: May 01, 2014
Accepted: June 20, 2014
Posted Online: September 8, 2014

Abstract

Preferences are the expression of an individual’s basic psychosocial needs and are related to care outcomes. The current study tested the consistency of 87 individuals’ everyday preferences over 1 week, comparing responses of nursing home residents (n = 37; mean age = 82) and university students (n = 50; mean age = 20). Participants completed the Preferences for Everyday Living Inventory at baseline and 5 to 7 days later. Preference consistency was calculated three ways: (a) correlations (range = 0.11 to 0.90); (b) overall percent of exact agreement (e.g., response was “very important” at both time points) (66.1%); and (c) responses collapsed as “important” or “not important” (increase in percent agreement to 86.6%). Personal care preferences were more stable, whereas leisure activities were less stable. The groups did not have significant differences in consistency. Some preferences are more consistent than others; age and frailty do not appear to be related to preference instability. [Journal of Gerontological Nursing, 40(10), 34–46.]

Dr. Van Haitsma is Associate Professor, College of Nursing, The Pennsylvania State University, University Park, Pennsylvania; Dr. Abbott is Assistant Professor, Department of Sociology and Gerontology, Miami University, Oxford, Ohio; Dr. Van Haitsma is Adjunct Senior Research Scientist, Dr. Heid is Post Doctoral Fellow, Dr. Kleban is Director of Psychometrics, Ms. Eshraghi is Project Manager, and Ms. Duntzee is Research Specialist, The Polisher Research Institute, The Madlyn and Leonard Abramson Center for Jewish Life, North Wales, Pennsylvania; Dr. Carpenter is Associate Professor, Department of Psychology, Washington University in St. Louis, St. Louis, Missouri; Dr. Curyto is Psychologist and Research Scientist, VA Western NY Healthcare System, Batavia, New York; and Ms. Spector is Consultant, Spector Consulting, Bala Cynwyd, Pennsylvania.

The authors have disclosed no potential conflicts of interest, financial or otherwise. This work was made possible by funding from the Harry Stern Family Center for Innovations in Alzheimer’s Care and a National Institute of Nursing Research grant (1R21NR011334: Principal investigator, K. Van Haitsma). The authors thank the older adults and the university students who made this project possible by generously volunteering their time to help explore these important research questions.

Address correspondence to Kimberly Van Haitsma, PhD, Adjunct Senior Research Scientist, The Polisher Research Institute, The Madlyn and Leonard Abramson Center for Jewish Life, 1425 Horsham Road, North Wales, PA 19454; e-mail: kvanhaitsma@abramsoncenter.org.

Received: May 01, 2014
Accepted: June 20, 2014
Posted Online: September 8, 2014

Health care reform legislation, specifically the Patient Protection and Affordable Care Act (2010), has called for a focus on the “Triple Aim” in care (i.e., improved population health, reduced costs, and improved patient experience), whereas the Centers for Medicare & Medicaid Services (CMS) has released guidelines that mandate nursing homes to assess and monitor the delivery of high quality, patient-centered care (CMS, 2012; Mollot & Butler, 2012). As a result, recent efforts in the field of gerontology have focused on understanding how to assess and deliver person-centered care that recognizes the individual as the center of care processes.

Person-centered care is a process that empowers older adults to maximize their potential for retaining relationships, capabilities, interests, and skills developed over the course of a lifetime (Edvardsson, Varrailhon, & Edvardsson, 2014). A primary tenet of person-centered care is understanding an individual’s values and preferences for daily care routines and activities. Knowing an individual’s everyday preferences can inform care goals and care planning, and it can ultimately allow for a match, or congruence, between an individual’s wishes and care (i.e., including an individual in a specific activity that he or she prefers) (Cvengros, Christensen, Cunningham, Hillis, & Kaboli, 2009; Jahng, Martin, Golin, & DiMatteo, 2005; Van Haitsma et al., 2014). The integration of knowledge about individuals’ preferences into care is related to improved care outcomes (Applebaum, Straker, & Geron, 2000; Gerdner, 2000; Lawton et al., 1998; Simmons & Schnelle, 2004; Thompson & Smith, 1998; Whitlatch, Judge, Zarit, & Femia, 2006). However, a significant gap remains in understanding how frequently an individual’s preferences in care must be assessed, as well as the consistency in reports over time. To maximize the delivery of person-centered, preference-congruent care, it is vital to understand how consistent individuals are in how they rate the importance of everyday preferences. If preferences change within short periods of time, strategies are needed to assess preferences more frequently; if residents report consistent preferences, less frequent assessments may be appropriate.

Recent evidence indicates that older adults, including those with mild to moderate dementia, can consistently report on state-dependent questions, preferences, choices, quality of life, and involvement in care over short test–retest periods of time (Carpenter, Kissel, & Lee, 2007; Clark, Tucke, & Whitlatch, 2008; Feinberg & Whitlatch, 2001; Thorgrimsen et al., 2003; Whitlatch, Feinberg, & Tucke, 2005a,b). However, limited research has extensively examined the consistency of how individuals rate the importance of everyday preferences, such as personal care preferences related to bathing or eating, as well as recreational preferences (Housen et al., 2009). Cohen-Mansfield and Jensen (2007) found that a small group of cognitively capable, community-dwelling older adults were able to rate their self-care preferences reliably within a 1- to 2-week interval. They found that exact reliability was 73%, whereas close/partial reliability (i.e., agreement within one unit) increased to 93%.

Self-determination theory maintains that all individuals possess the innate psychosocial needs of autonomy, relatedness, and competence to maximize well-being (Deci & Ryan, 2000). These needs can fluctuate in importance based on an individual’s circumstances, environment, or past experiences, such that when one need is threatened, its satisfaction is highly sought after. Preferences are a major way individuals can meet their changing needs. As a result, it is likely that some preferences may also fluctuate based on circumstantial characteristics. Recent qualitative evidence details within-person, environmental, and interpersonal reasons for why a preference could change in importance (Heid et al., 2014). Furthermore, theory and research document that preferences can change over longer periods of time, particularly as an individual approaches death or experiences health concerns (Winter & Parker, 2007), when conceptualizing end-of-life decisions (Ditto et al., 2003) or in long-term care (Wolff, Kasper, & Shore, 2008). As a result, some everyday preferences may change more rapidly than others.

Furthermore, a bias in society presupposes that overall physical and cognitive frailty contributes to the instability in measures of daily preferences. Thus, the current project sought to directly explore this assumption by using a comparative sample of traditional college-age individuals and frail older adults residing in nursing homes. The purpose of the current study was to determine 1-week consistency of responses on the Preferences for Everyday Living Inventory (PELI; Van Haitsma et al., 2013) within a population of older adults living in a community nursing home and a sample of university students to determine the amount of change in the importance of preferences rated from 1 week to the next in either population. In addition, the current study explores whether particular preference categories are more consistent from one point in time to the next, as compared with other preferences.

Method

Participants

Eighty-seven participants consented to participate from two samples. Sample 1 included 37 residents ages 55 to 101 (mean age = 81.6, SD = 11.8 years) from a community nursing home. Sample 2 included 50 university students ages 18 to 22 (mean age = 19.8, SD = 1 year). Table 1 shows the participant demographic characteristics. The internal review boards of The Abramson Center for Jewish Life and the university where the college students attended approved this study.

Participant Demographics

Table 1:

Participant Demographics

Measures

Demographics. Participants self-reported age, sex, education, ethnicity, race, marital status, and religion for descriptive purposes (Table 1).

Preference Interview. The PELI (Van Haitsma et al., 2012) was used to ask participants about their preferences. Questions covered various everyday topics from food and dining to personal care preferences that fall into five domains: (a) social contact, (b) leisure and diversionary activities, (c) growth activities, (d) self-dominion, and (e) enlisting others in care. An 85-item version of the PELI was administered to the full sample; however, due to ongoing work revising the tool through cognitive interviewing, 19 items were dropped from the current report because they are no longer a part of the evolved PELI tool. Reasons items were dropped during the iterative tool development included concerns such as unclear wording or double-barreled items. As a result, 66 items were examined in the current study (Table 2). The PELI asked respondents to rate these items on “How important is it to you to…[insert preference],” with a 4-point Likert scale from 1 (very important) to 4 (not important at all).

Percent Agreement Between Time 1 and Time 2 Peli Items for Nursing Home Residents and University StudentsPercent Agreement Between Time 1 and Time 2 Peli Items for Nursing Home Residents and University StudentsPercent Agreement Between Time 1 and Time 2 Peli Items for Nursing Home Residents and University StudentsPercent Agreement Between Time 1 and Time 2 Peli Items for Nursing Home Residents and University Students

Table 2:

Percent Agreement Between Time 1 and Time 2 Peli Items for Nursing Home Residents and University Students

Procedures

Eligibility and recruitment procedures differed by group. The university sample (n = 50) comprised undergraduate students recruited from a psychology department research subject pool. Students received credit for completing Time 1 (T1) and Time 2 (T2) questionnaires. Participants came to the research laboratory for an initial session, at which they completed a paper-and-pencil survey of demographic questions and the PELI. At the conclusion of this session, participants were scheduled for a follow-up session 1 week later. Only one participant did not return for follow up. Respondents completed their retest an average of 7.1 days later (range = 7 to 8 days, SD = 0.3 days).

Nursing home participants were recruited from two nursing homes in the suburbs of a major metropolitan area. Social workers from each nursing home identified residents who were cognitively capable, English speaking, and had a length of stay of at least 1 week. Once these residents were identified, the attending physician verified that the older adults had the capacity to consent for themselves and were medically stable. Attending physicians approved 74 of the 86 residents identified by social services. After physician approval was obtained, social workers approached residents to gain their assent to be contacted by the research team and informed the residents’ responsible parties about the study. Informed consent was obtained using interactive questioning during the consenting process. If, at any time during the consenting process, the research assistant believed the resident was unable to give consent, the process was stopped and the resident was not included in this phase of the study. After a resident consented, the research assistant administered the Mini-Mental State Examination (MMSE; Folstein, Folstein, & McHugh, 1975) to confirm that the older adult was cognitively capable (MMSE score ≥22). Consenting residents who met study criteria completed a baseline (T1) interview consisting of the 66-item PELI. One week (5 to 7 days) after completing the baseline (T1) interview, residents were reinterviewed with the PELI (T2). The final sample comprised 37 participants.

Analyses

Consistency was calculated three ways. Pearson correlations were conducted between the T1 and T2 preference importance ratings, and significant differences between the two samples were tested using Fisher’s z test. The percent exact agreement was then calculated between T1 and T2 for each sample. Exact agreement meant that the respondent reported the exact same level of importance at each time period (e.g., the resident said choosing what time to bathe was very important at T1 and very important at T2). A z test of proportions was used to examine significant differences between the groups. Finally, because the ultimate disposition to use this tool will be its use in tailoring care to frail older adults, consistency was examined through a more clinical lens. Overall, consistency was determined from the perspective of whether a respondent reported a preference as either very or somewhat important, in contrast to reporting a preference as not very or not at all important. From a measurement perspective, those individuals who only changed one point over the 1 week—going from 1 (very important) to 2 (somewhat important) or vice versa (2 to 1) in rating preference importance—were considered consistent. These individuals reported that a preference was important, but simply shifted slightly in level of that importance. The same was true regarding reports of not very or not at all important. These individuals were consistent in reporting that a preference was not important, but simply shifted in degree of unimportance.

Results

Descriptive tests of demographic characteristics (Table 1) demonstrate that the nursing home sample is significantly older (t = 36.8, p < 0.001), comprises more women (χ2 = 47.2, p < 0.001), is less educated (χ2 = 5.7, p = 0.02), includes more Caucasians (χ2 = 12.0, p = 0.01), is less likely to never be married (χ2 = 68.4, p < 0.001), and is more likely to ascribe to the Jewish faith (χ2 = 42.3, p < 0.001), when compared with the university students.

Differences in Average Importance Ratings Between Samples

Overall, the two samples differed in terms of their overall importance ratings for various preferences (Table 2). In the majority of instances, older adults rated their preferences as being more important than the younger university sample. This finding is not surprising given that the portfolio of preferences was developed specifically with an older adult population in mind. The only exceptions for which the university sample rated preferences as more important than the nursing home sample were on items that could be considered more cohort-specific to university students (e.g., “drinking alcohol on occasion,” “doing things with groups of people,” “using the computer,” “watching movies with other people”).

Overall Test–Retest Consistency Between Groups

Central to the question posed in the current study (i.e., whether frail older adults were less consistent than the younger sample), no differences were found between groups in regard to stability of reporting preferences over 1 week. This finding held across the three ways consistency was examined (i.e., Pearson correlation, percent exact agreement, and percent agreement that the preference was important or not important). Frail older adults were no more or less likely to be consistent in reporting their preferences compared with young adults.

When examining the correlations between T1 and T2 preference responses, only 10 (15%) of 66 of the preference items showed differences between nursing home residents (n = 4 inconsistent items) and university students (n = 6 inconsistent items). For nursing home residents, the type of inconsistent responses centered on personal care (e.g., choosing time of bathing, where to eat, caring for one’s nails, choosing who should be involved in discussions about care). For university students, the type of inconsistent responses were more varied, ranging from caring for personal belongings, tobacco use, and privacy, to regular contact with family.

Percent exact agreement demonstrated a similar level of overall consistency between the groups. University students were perfectly consistent 66.2% of the time, whereas nursing home residents had an exact consistency percentage of 65.9%. Using this measure of consistency, only three (4.5%) of the 66 preference items emerged as significantly different between the two groups. University students were more inconsistent in choosing “method of bathing,” whereas nursing home residents were more likely to change their responses about “time of day to bathe” and performing their favorite activity.

Percent agreement regarding whether a preference remained important versus not important demonstrated a significantly higher level of consistency overall. University students remained consistent 85.9% of the time, whereas nursing home residents remained consistent 87.3% of the time. Using this measure of consistency, eight (12.1%) of the 66 preference items emerged as significantly different between the groups. Again, the pattern of inconsistency was split between the groups. University students were less consistent in the importance of “choosing your own bedtime,” “having staff show they care about you,” and “drinking alcohol upon occasion.” Nursing home residents showed more inconsistency when reporting preferences for “listening to music you like,” “volunteering your time,” “doing gardening activities,” “using the computer,” and “doing your favorite hobbies.”

Finally, focusing only on preferences of the nursing home residents, the overall consistency of specific types of preferences over a 1-week period were examined. Table 3 presents preferences ordered from most consistent to least consistent, as reported by nursing home residents over a 1-week period. Twenty-six (39.4%) of 66 items were >90% consistently reported, 28 (42.4%) of 66 were >80% consistently reported, and only 12 (18.2%) of 66 were <79% consistently reported. In general, “enlisting others in care” preferences (4 [67%] of 6) were most highly proportionally represented in the most consistent preferences (>90%), followed by self-dominion preferences (11 [46%] of 24), social contact preferences (4 [33%] of 12), leisure and diversionary activities (3 [30%] of 10), and growth activities (4 [29%] of 14).

Ranking of Percent Agreement that a Preference Remains Important or Not Important between Time 1 and Time 2 for Nursing Home ResidentsRanking of Percent Agreement that a Preference Remains Important or Not Important between Time 1 and Time 2 for Nursing Home Residents

Table 3:

Ranking of Percent Agreement that a Preference Remains Important or Not Important between Time 1 and Time 2 for Nursing Home Residents

Discussion

Honoring preferences is the foundation of person-centered care (Brooker, 2007) and represents a journey toward honoring the rich contributions that individuals have made in their lifetimes. Understanding whether preference importance ratings are static or dynamic informs clinical care and promotes efficiency through assessments at appropriate intervals. The goal of the current study was to have older adults living in nursing homes and a sample of university students report the preferences that are important to them at two points in time 1-week apart to determine the consistency of common preferences. Results demonstrate that frail older adults are just as (in) consistent as younger adults. Overall, the level of inconsistency in reporting preferences by young and old alike points to the need for a closer examination as to why individuals preferences change over time. The authors’ previous work (Heid et al., 2014) suggests that countless reasons exist as to why individuals change their minds about what is important to them in their daily lives (e.g., mood, facility schedule, quality of social interactions, weather). More research is needed to examine both personal and environmental reasons for these changes.

The current study’s findings are consistent with theory that purports preferences as a reflection of dynamic psychological needs (Deci & Ryan, 2000). As suggested and found herein, preference expression is inherently an idiographic process unique to each individual. Individuals can differ on how many important preferences they hold dear and can differ on the extent to which those preferences are fulfilled at any given point in time (Van Haitsma et al., 2014). However, each reported preference stands in its own right as a reflection of a specific aspect of an individual’s ever-changing reaction as a living system (Ford, 2014), which places the PELI tool in the camp of idiographic, not nomothetic, measurement. From this perspective, it may not be appropriate to refer to reliability in a traditional test–retest reliability frame. The authors explored the use of a more clinically meaningful measure of consistency, which looks at whether the respondent remained consistent in reporting a preference as important or not important over time. In this framework, inconsistency reflects a fundamental change of mind about the valence of a preference to a given individual. Being rated as “inconsistent” in this schema means that the individual has “crossed a line” in reporting that a previously important reference is now not important, or vice versa. Using this clinically meaningful indicator, a significant increase (from 66% to 88%) was found in the level of consistency in reporting preferences over time for nursing home residents and university students. These findings are consistent with Cohen-Mansfield and Jensen’s (2007) findings with self-care preferences of community-dwelling older adults that demonstrate intraperson reliability when allowing 1-point fluctuations in reporting. However, the current study’s findings extend this work in articulating the possible need for a clinically meaningful distinction of a 1-point change based on a valence scale.

These findings raise several implications for care delivery. In a care environment, a fundamental change of mind about the importance of a daily preference should signal a reevaluation of how care is delivered, especially when a preference shifts across the scale from important to not important. This shift has significant implications for the current assessment process in nursing homes. Currently, preference assessment has been built into the Minimum Data Set (MDS) 3.0 Section F (Housen et al., 2009) as a required element of a larger assessment process for nursing home residents in general (Saliba & Buchanan, 2008). Table 3 indicates the specific preference items of the MDS 3.0 Section F that are embedded within the PELI tool (items with superscript a). Current regulatory requirements dictate that the 16 items of Section F be administered on admission and then annually thereafter. However, the results of the current study imply that some preferences may meaningfully change more frequently than those of cognitively capable nursing home residents. It should be noted that a limitation of the current study is that the results do not speak to the frequency of assessments needed for less cognitively capable residents, who comprise a majority of the nursing home population (Alzheimer’s Association, 2013). Nonetheless, among cognitively capable residents, the current study’s results suggest that one half (eight of 16) of the Section F items are consistently reported by >90% of the residents. However, one half of the mandatory items in Section F and the majority of the PELI items assessed changed over a 1-week period, as reported by a significant subset of residents. Stability of these preferences over a longer period of time, such as the mandated 1-year window, is not known.

The results of the current study also suggest that preference consistency may be related to the type of preference being reported. In the current sample of nursing home residents, participants consistently reported preferences from each domain of the PELI (i.e., enlisting others in care, self-dominion, social contact, leisure and diversionary activities, and growth activities). However, proportionally speaking, consistency in preference reporting was more strongly represented in the domains of enlisting others in care and self-dominion, whereas those representing social contact, leisure and diversionary activities, and growth activities were more variable. This variation suggests that personal care preferences may be more stable than other preferences. This finding could reflect the well-known processes of institutionalization of individuals living in residential care environments (Goffman, 1961), where individuals internalize the rigid schedules of the system to the point where they become part of the individuals’ definition of self.

Alternatively, structuring preferences into domains using classical measurement techniques is complicated because people are complicated. The same preference could fulfill a need for relatedness in one individual, autonomy in another, and competency in yet another. For example, volunteer work could fulfill a need for relatedness (i.e., social contact) in one individual, but could fulfill a need for competency (i.e., doing something within their capacity) for another. Furthermore, in a third individual, volunteer work could fulfill a need for autonomy, which limits the ability to discuss the PELI measure using traditional reliability (test–retest) terms. However, the authors believe that this is a starting point for a more robust discussion regarding measuring preferences, consistency of preferences, and preference congruence.

Implications for Nursing

The results of the current study suggest that nurses should consider more frequent reassessment of preferences for residents who experience major health and functional changes. For these residents, the current standard of an annual assessment may not be sufficient to capture resident preferences accurately. Accuracy of preference assessment is of paramount concern for the development of person-centered care plans that are used to guide daily care activities.

Conclusion

The results of the current study demonstrate similar consistency in reporting of everyday preferences by older adults in nursing homes as compared to university students. However, inconsistencies in reports are prevalent. More research is needed to help clarify the optimal frequency of preference assessment in nursing homes, as well as what personal and environmental variables may be predictive of changing one’s mind about preference importance even over a short period of time. Answers to these questions will have significant implications for demands on staff time to assess preferences and will deepen the understanding about how to provide quality, person-centered care.

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Participant Demographics

n (%) Significance
Variable University Students (n = 50) Nursing Home Residents (n = 37) t/Chi-Squarea p Value
Age (years) 19.8 (1)b 81.6 (11.8)b 36.8 0.00
Sex (male) 17 (34) 12 (32.4) 47.2 0.00
Education (% completed high school) 50 (100) 33 (89.1) 5.7 0.02
Ethnicity
  Not Hispanic or Latino 49 (98) 37 (100)
  Hispanic or Latino 1 (2)
Race 12.0 0.01
  Caucasian 34 (68) 36 (97.3)
  African American 6 (12) 1 (2.7)
  Asian 9 (18)
  Other 1 (2)
Marital status 68.4 0.00
  Married 2 (5.4)
  Divorced/separated 4 (10.8)
  Widowed 26 (70.3)
  Never married 50 (100) 5 (13.5)
Religion 42.3 0.00
  Protestant 11 (22) 1 (2.7)
  Jewish 9 (18) 32 (86.5)
  Catholic 7 (14) 2 (5.4)
  Other 6 (12) 2 (5.4)
  None 7 (15) 0

Percent Agreement Between Time 1 and Time 2 Peli Items for Nursing Home Residents and University Students

Pearson Correlations Fisher’s Difference Among r % Exact Agreement Test of Proportions % Agreement of Important or Not Important Test of Proportions
How important is it to you to… Univ NH Z(df) Univ NH z Univ NH z
SELF DOMINION
Choose when to get up in the morning? 0.45 0.36 61.7 50 87.5 80.6
Follow a routine when you wake up in the morning? 0.60 0.54 54 48.6 72 73
Take care of your personal belongings or things? 0.42 0.72 –2.04 (81)* 72 83.8 92 100
Choose between a tub bath, shower, bed bath, or sponge bath? 0.69 0.65 48.9 73 –2.1* 87.2 97.3
Choose how often to bathe? 0.64 0.49 69.4 73 95.9 100
Choose what time of day to bathe? 0.74 0.11 3.70 (79)* 68.8 40.5 2.6** 79.2 78.4
Choose what clothes to wear? 0.68 0.63 70 62.2 92 89.2
Take a nap when you wish? 0.56 0.61 55.6 37.8 80.9 67.6
Choose what to eat? 0.48 0.31 71.4 58.3 91.8 88.9
Choose when to eat? 0.69 0.50 61.2 40 81.6 77.1
Choose where to eat? 0.65 0.30 2.04 (79)* 67.3 50 81.6 69.4
Choose your own bedtime? 0.29 0.38 51.1 73 87.5 91.9 –3.8***
Follow a routine when you go to bed? 0.49 0.48 39.6 54.1 70.8 83.8
Choose how to care for your mouth? 0.60 0.68 57.1 91.9 93.9 100
Choose how often to care for your nails? 0.82 0.58 2.17 (79)* 71.4 63.9 87.8 91.7
Be able to use the phone in private? 0.49 0.62 66 56.8 92 86.5
Lock things up to keep them safe? 0.74 0.70 63.3 73 63.3 83.8
Have privacy? 0.28 0.86 –4.47 (81)* 68 83.8 92 91.9
Keep your room at a certain temperature? 0.63 0.64 72.9 63.9 91.8 86.1
Keep the lighting in your room at a certain level? 0.44 0.46 55.3 56.8 72.9 83.8
Set up your room the way you want? 0.59 0.39 64.6 73 85.4 94.6
Set up your bed for comfort? 0.69 0.76 73.5 83.8 95.9 100
Do certain things to feel better when you are upset? 0.46 0.44 66 66.7 88 91.7
Go outside to get fresh air when the weather is good? 0.68 0.84 73.5 83.8 91.8 94.6
LEISURE AND DIVERSIONARY ACTIVITIES
Have snacks available between meals? 0.72 0.62 54.2 51.4 72.9 78.4
Drink alcohol on occasion? 0.82 0.69 70 64.9 84 97.3 –2.0*
Watch television? 0.80 0.66 68 70.3 80 94.6
Watch movies with other people? 0.59 0.81 –2.00 (81)* 58 70.3 84 86.5
Eat at restaurants? 0.69 0.76 75.5 66.7 83.7 82.4
Be involved in cooking? 0.80 0.61 69.4 63.9 82 72.2
Use tobacco products? 0.71 0.90 –2.59 (80)* 87.8 97.3 98 97.3
Do outdoor tasks? 0.59 0.58 38 55.6 70 88.9
Order take-out food? 0.65 0.64 56 60 53.1 66.7
Do things away from here? 0.40 0.60 59.2 42.9 80 88.6
ENLISTING OTHERS IN CARE
Choose the gender of your caregiver? 0.75 0.82 62.8 69.4 84.1 80.6
Have staff show they care about you? 0.79 0.66 67.4 83.8 83 97.3 –2.1*
Have staff show you respect? 0.72 0.47 68.1 83.8 85.4 97.3
Be involved in discussions about your care? 0.69 0.16 3.04 (80)* 67.3 81.1 87.8 94.6
Have family or close friends involved in discussions about your care? 0.66 0.83 63.3 83.3 89.8 94.6
Talk to a professional if you are sad or worried? 0.72 0.43 59.2 62.2 79.6 78.4
SOCIAL CONTACT
Have regular contact with family and friends? 0.73 0.89 –2.17 (80)* 86 86.1 96 97.3
Participate in religious services or practices? 0.81 0.79 71.4 67.6 90 81.1
Do things with groups of people? 0.47 0.74 62 70.3 92 83.8
Meet new people? 0.61 0.75 70 64.9 84 89.2
Spend time one-on-one with someone? 0.54 0.33 76 67.6 94 94.6
Spend time by yourself? 0.65 0.59 76 56.8 90 89.2
Be involved in choosing your roommate? 0.64 0.80 77.6 66.7 94 96.9
Volunteer your time? 0.84 0.67 75 59.5 93.9 89.2 2.7**
Reminisce about the past? 0.70 0.67 66 64.9 88 81.1
Be a member of a club? 0.54 0.74 54 55.6 80 83.3
Give gifts? 0.65 0.66 67.3 69.4 87.8 91.7
Be around children? 0.83 0.64 63.3 62.2 84 81.1
GROWTH ACTIVITIES
Have books, magazines, and newspapers to read? 0.60 0.32 58 56.8 80 78.4
Listen to music you like? 0.51 0.35 68 62.2 98 83.8 2.4*
Be around animals such as pets? 0.82 0.88 65.2 67.6 81.3 91.9
Keep up with the news? 0.81 0.84 76 86.5 88 97.3
Attend activities such as concerts or plays? 0.67 0.31 57.1 48.6 80 78.4
Participate in your ethnic traditions? 0.77 0.81 73.5 63.9 86 89.2
Do gardening activities? 0.77 0.65 72.3 56.8 100 83.8 2.9**
Use the computer? 0.48 0.86 –3.42 (81)* 72 73 100 89.2 2.4*
Go shopping? 0.76 0.87 68 75 80 91.7
Do your favorite hobbies? 0.51 0.73 77.6 63.9 98 83.3 2.4*
Watch/play sports? 0.87 0.87 70 72.2 86 88.9
Exercise? 0.74 0.65 72 54.1 92 81.1
Play games? 0.63 0.71 56 61.1 74 72.2
Do your favorite activities? 0.68 0.46 91.8 70.3 2.6** 98 94.6
Total Mean 0.64 0.62 66.2 65.9 85.9 87.3

Ranking of Percent Agreement that a Preference Remains Important or Not Important between Time 1 and Time 2 for Nursing Home Residents

Category of Preference Preference Item Percent Agreement Important/Not Important
SD Take care of your personal belongings or things?a 100
SD Choose how often to bathe? 100
SD Choose how to care for your mouth? 100
SD Set up your bed for comfort? 100
SD Choose between a tub bath, shower, bed bath, or sponge bath?a 97.3
EC Have staff show they care about you? 97.3
EC Have staff show you respect? 97.3
LD Drink alcohol on occasion? 97.3
LD Use tobacco products? 97.3
SC Have regular contact with family and friends? 97.3
GA Keep up with the news?a 97.3
SC Be involved in choosing your roommate? 96.9
SD Set up your room the way you want? 94.6
EC Be involved in discussions about your care? 94.6
EC Have family or close friends involved in discussions about your care?a 94.6
SC Spend time one-on-one with someone? 94.6
SD Go outside to get fresh air when the weather is good?a 94.6
LD Watch television? 94.6
GA Do your favorite activities?a 94.6
SD Choose your own bedtime?a 91.9
SD Have privacy? 91.9
GA Be around animals, such as pets?a 91.9
SD Choose how often to care for your nails? 91.7
SD Do certain things to feel better when you are upset? 91.7
GA Go shopping? 91.7
SC Give gifts? 91.7
SD Choose what clothes to wear?a 89.2
SC Meet new people? 89.2
SC Spend time by yourself? 89.2
SC Volunteer your time? 89.2
GA Participate in your ethnic traditions? 89.2
GA Use the computer? 89.2
SD Choose what to eat? 88.9
LD Do outdoor tasks? 88.9
GA Watch/play sports? 88.9
LD Do things away from here? 88.6
SD Be able to use the phone in private?a 86.5
LD Watch movies with other people? 86.5
SD Keep your room at a certain temperature? 86.1
SD Follow a routine when you go to bed? 83.8
SD Lock things up to keep them safe?a 83.8
SD Keep the lighting in your room at a certain level? 83.8
SC Do things with groups of people?a 83.8
GA Listen to music you like?a 83.8
GA Do gardening activities? 83.8
GA Do your favorite hobbies? 83.3
SC Be a member of a club? 83.3
LD Eat at restaurants? 82.4
SC Participate in religious services or practices?a 81.1
SC Reminisce about the past? 81.1
GA Exercise? 81.1
SC Be around children? 81.1
SD Choose when to get up in the morning? 80.6
EC Choose the gender of your caregiver? 80.6
SD Choose what time of day to bathe? 78.4
LD Have snacks available between meals?a 78.4
EC Talk to a professional if you are sad or worried? 78.4
GA Have books, magazines, and newspapers to read?a 78.4
GA Attend activities, such as concerts or plays? 78.4
SD Choose when to eat? 77.1
SD Follow a routine when you wake up in the morning? 73
LD Be involved in cooking? 72.2
GA Play games? 72.2
SD Choose where to eat? 69.4
SD Take a nap when you wish? 67.6
LD Order take-out food? 66.7

Keypoints

Van Haitsma, K., Abbott, K.M., Heid, A.R., Carpenter, B., Curyto, K., Kleban, M. & Spector, A. (2014). The Consistency of Self-Reported Preferences for Everyday Living: Implications for Person-Centered Care Delivery. Journal of Gerontological Nursing, 40(10), 34–46.

  1. Preferences are the expression of an individual’s basic needs and are related to care outcomes.

  2. Among nursing home residents, personal care preferences were found to be more stable, whereas leisure activity preferences were less stable over a 1-week period.

  3. No significant differences were found in the consistency of preferences between college students and nursing home residents.

  4. Age and frailty do not appear to be related to preference instability.

10.3928/00989134-20140820-01

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