Journal of Gerontological Nursing

AGS Update 

How to Put Individuals at the Heart of Health Care: AGS Advances Definition of Person-Centered Care

Steven R. Counsell, MD, AGSF

Abstract

If you look to the AGS website for information on “who we are,” that is one of the first statements you will see. It is our vision for the future, supported by our mission to “improve the health, independence, and quality of life of all older people” (AGS, 2015b, para. 2). As precedent would suggest, it is also something we are committed to in theory and practice.

Because older adults have complex care needs that can affect daily life, person-centered care has become a particular priority for those 65 and older (Coulourides Kogan, Wilber, & Mosqueda, 2015b). Advanced practice nurses (APNs) and many others have applied the approach in long-term care, dementia care, transitional care, home-based care, and palliative/hospice care, with meaningful results for health outcomes and clinical best practices (AGS Expert Panel on Person-Centered Care, 2015; Coulourides Kogan et al., 2015b). But gaps remain—principal among them a lack of clarity when it comes to defining “person-centered care” as an approach we can share (AGS Expert Panel on Person-Centered Care, 2015; Coulourides Kogan et al., 2015b).

That is where geriatrics and the AGS are again leading the way, thanks to a new project that intended to better define what we mean when we talk about person-centered care.

A group of interprofessional experts convened by the AGS, in collaboration with a research and clinical team at the University of Southern California (USC) and with support from The SCAN Foundation, was tasked with this ambitious undertaking. As described across four recently released papers published in the Journal of the American Geriatrics Society (AGS Expert Panel on Person-Centered Care, 2015; Coulourides Kogan et al., 2015a,b; Westphal, Alkema, Seidel, & Chernof, 2015), the panel sifted through different definitions and practices to describe person-centered care as putting individual values and preferences at the heart of care decisions, measuring success by attention to individuals' health and life goals.

A person-centered approach begins by gathering specific information about personal preferences in light of health circumstances, with input from family members and other caregivers as desired (AGS Expert Panel on Person-Centered Care, 2015). Added to a comprehensive health and functional assessment, this information is used to help an individual shape and articulate his/her health care preferences (AGS Expert Panel on Person-Centered Care, 2015). These goals are driven first and foremost by the individual's priorities and preferences regarding health, function, and quality of life (AGS Expert Panel on Person-Centered Care, 2015).

To arrive at its definition, the expert panel reviewed research conducted by Laura Mosqueda, MD, FAAFP, AGSF, and Alexis M. Coulourides Kogan, PhD, from Keck School of Medicine, USC, and Kathleen Wilber, PhD, USC Davis School of Gerontology. A comprehensive literature review and interviews with leaders of health care and social service organizations that reported providing person-centered care led panelists to several important conclusions:

In describing the work of the expert panel, Dr. Mosqueda noted that, “[F]or too long, our medical system has focused on treatment of illnesses rather than on care of a person with illnesses…. We now have a clearer vision of how to translate the aspiration of person-centered care into a reality” (AGS, 2015a, para. 2). A consensus definition may seem like a small step in that context, but it is essential to building a firm foundation for the future. Already, the expert panel has taken its work one step further by describing eight characteristics of person-centered care that are essential to practice:

For geriatrics health professionals generally, but for APNs in particular, these are more than aspirational goals. They are principles that nursing has championed all along. With this new step forward for person-centered…

“Every older American will receive high-quality, person-centered care.” (American Geriatrics Society [AGS], 2015b, para. 3)

If you look to the AGS website for information on “who we are,” that is one of the first statements you will see. It is our vision for the future, supported by our mission to “improve the health, independence, and quality of life of all older people” (AGS, 2015b, para. 2). As precedent would suggest, it is also something we are committed to in theory and practice.

Because older adults have complex care needs that can affect daily life, person-centered care has become a particular priority for those 65 and older (Coulourides Kogan, Wilber, & Mosqueda, 2015b). Advanced practice nurses (APNs) and many others have applied the approach in long-term care, dementia care, transitional care, home-based care, and palliative/hospice care, with meaningful results for health outcomes and clinical best practices (AGS Expert Panel on Person-Centered Care, 2015; Coulourides Kogan et al., 2015b). But gaps remain—principal among them a lack of clarity when it comes to defining “person-centered care” as an approach we can share (AGS Expert Panel on Person-Centered Care, 2015; Coulourides Kogan et al., 2015b).

That is where geriatrics and the AGS are again leading the way, thanks to a new project that intended to better define what we mean when we talk about person-centered care.

A group of interprofessional experts convened by the AGS, in collaboration with a research and clinical team at the University of Southern California (USC) and with support from The SCAN Foundation, was tasked with this ambitious undertaking. As described across four recently released papers published in the Journal of the American Geriatrics Society (AGS Expert Panel on Person-Centered Care, 2015; Coulourides Kogan et al., 2015a,b; Westphal, Alkema, Seidel, & Chernof, 2015), the panel sifted through different definitions and practices to describe person-centered care as putting individual values and preferences at the heart of care decisions, measuring success by attention to individuals' health and life goals.

A person-centered approach begins by gathering specific information about personal preferences in light of health circumstances, with input from family members and other caregivers as desired (AGS Expert Panel on Person-Centered Care, 2015). Added to a comprehensive health and functional assessment, this information is used to help an individual shape and articulate his/her health care preferences (AGS Expert Panel on Person-Centered Care, 2015). These goals are driven first and foremost by the individual's priorities and preferences regarding health, function, and quality of life (AGS Expert Panel on Person-Centered Care, 2015).

To arrive at its definition, the expert panel reviewed research conducted by Laura Mosqueda, MD, FAAFP, AGSF, and Alexis M. Coulourides Kogan, PhD, from Keck School of Medicine, USC, and Kathleen Wilber, PhD, USC Davis School of Gerontology. A comprehensive literature review and interviews with leaders of health care and social service organizations that reported providing person-centered care led panelists to several important conclusions:

  • First, organizations often define and operationalize person-centered care in unique ways. For some, it is focused on creating “individualized plans” to meet client and family needs. For others, it reflects the belief that person-centered care is “not just a program but a culture…embedded in practice and mission-driven” (Coulourides Kogan et al., 2015a, p. 3).
  • Second, organizations employing person-centered care remain strongly committed to the approach even in light of their differences. It requires, as several interviewees noted, significant time and resources, but the effects extend across the health system: “Staff are able to build trust and a relationship with clients, clients get better, staff feel good about client outcomes,” one interviewee observed (Coulourides Kogan et al., 2015a, p. 4).

In describing the work of the expert panel, Dr. Mosqueda noted that, “[F]or too long, our medical system has focused on treatment of illnesses rather than on care of a person with illnesses…. We now have a clearer vision of how to translate the aspiration of person-centered care into a reality” (AGS, 2015a, para. 2). A consensus definition may seem like a small step in that context, but it is essential to building a firm foundation for the future. Already, the expert panel has taken its work one step further by describing eight characteristics of person-centered care that are essential to practice:

  • An individualized, goal-oriented care plan based on the individual's preferences;
  • Ongoing review of the individual's goals and care plan;
  • Care supported by an inter-professional team in which the individual is an integral team member;
  • One primary point of contact on the health care team;
  • Active coordination among all health care and supportive service providers;
  • Continual information sharing and integrated communication;
  • Education and training for providers and, when appropriate, the individual and those important to the individual; and
  • Performance measurement and quality improvement using feedback from the individual and caregiver (AGS Expert Panel on Person-Centered Care, 2015).

For geriatrics health professionals generally, but for APNs in particular, these are more than aspirational goals. They are principles that nursing has championed all along. With this new step forward for person-centered care, nurses will continue to play a lead role in ensuring that care for the “health, independence, and quality of life of all older people” has individuals at its core (AGS, 2015b, para. 2).

The expert panel's findings are available for free and open access at GeriatricsCareOnline.org, the online home for AGS resources and publications. The Journal of Gerontological Nursing also has a new section on Person-Centered Care, led by Kimberly Van Haitsma, PhD, who has developed tools for assessing older adults' preferences in the context of health care.

References

  • American Geriatrics Society. (2015a). Putting people at the heart of health care, research from AGS advances definition of person-centered care. Retrieved from http://www.americangeriatrics.org/press/id:6007
  • American Geriatrics Society. (2015b). Who we are. Retrieved from http://www.americangeriatrics.org/about_us/who_we_are
  • American Geriatrics Society Expert Panel on Person-Centered Care. (2015). Person-centered care: A definition and essential elements. Journal of the American Geriatrics Society. Advance online publication. doi:10.1111/jgs.13866 [CrossRef]
  • Coulourides Kogan, A., Wilber, K. & Mosqueda, L. (2015a). Moving toward implementation of person-centered care for older adults in community-based medical and social service settings: “You only get things done when working in concert with clients.”Journal of the American Geriatrics Society. Advance online publication. doi:10.1111/jgs.13876 [CrossRef]
  • Coulourides Kogan, A., Wilber, K. & Mosqueda, L. (2015b). Person-centered care for older adults with chronic conditions and functional impairment: A systematic literature review. Journal of the American Geriatrics Society. Advance online publication. doi:10.1111/jgs.13873 [CrossRef]
  • Westphal, E.C., Alkema, G., Seidel, R. & Chernof, B. (2015). How to get better care with lower costs? See the person, not the patient. Journal of the American Geriatrics Society. Advance online publication. doi:10.1111/jgs.13867 [CrossRef]
Authors

The author has disclosed no potential conflicts of interest, financial or otherwise.

Copyright © 2016 American Geriatrics Society

Steven R. Counsell, MD, AGSF

President

American Geriatrics Society

10.3928/00989134-20151203-01

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