More than one-third of Medicare users over 65 years old are accompanied on their medical visits by family members of companions. These results, published in a report on July 14, 2008 in the Archives of Internal Medicine, one of the JAMA/Archives journals, also indicate that these companions could be associated with increased patient satisfaction.

Families can play an important role in the administration of health care — this idea has often been underrepresented in studies and health care but is gathering clout in recent years. However, the specific influences that families have through their involvement still need to be further explored.

To investigate the nature of the role that families play in this process, Jennifer L. Wolff, Ph.D., and Debra L. Roter, Dr. P.H., M.P.H., of the Johns Hopkins Bloomberg School of Public Health, Baltimore, and colleagues investigated a group of 12,018 Medicare beneficiaries 65 years or older in a survey in 2004.

The researchers found that over one-third (38.6%) of all participants were regularly accompanied to their medical visits by various types of companions. These companions included: 53.3% spouses; 31.9% adult children; 6.8% other relatives; 5.2% roommates, friends, and neighbors; 2.8% non-relatives; and less than 1% nurse aids or legal and financial officers.

The parts that these companions played varied. Primarily, they aided communication in the visit, with 63.8% of companions filling this role. Of these, 44.1% reported recording physician comments and instructions, 41.5% communicating information related to the patient’s medical conditions to a health professional, 41% asking questions, 29.7% explaining the instructions given by the physician, and 3.3% who translated the English language. Companions filled other roles as well, with 28.4% of all companions present for moral support and to provide company, 16.6% to help schedule appointments, and 8.4% to provide physical assistance.

Additionally, the elderly patients who regularly brought companions were more satisfied with their physicians’ services, including technical skills, information dissemination, and interpersonal skills. If their companions actively assisted with communications, the patients rated their physicians’ informational and interpersonal skills more highly. This trend became stronger in patients who reported themselves to be in worse health.

The authors indicate that companions are present and helpful: “Findings establish that visit companions, most often spouses and adult children, are commonly present in older adults’ routine medical encounters, actively engaged in the exchange of health information between patients and their physicians and influential in patients’ perceptions of physician interpersonal rapport and information giving,” they write. They subsequently point out that the patients who already bring companions are likely to be in poorer health and thus likely to benefit greatly from this companionship. “Moreover, visit companions tend to accompany patients who are especially vulnerable; in this study, accompanied patients were older, less educated and in worse health than their unaccompanied counterparts.”

The authors conclude that  by accompanying patients, companions are an important part of the patient care experience: “Results presented in this article suggest that patients’ visit companions, hidden, but in plain sight, are a valuable quality of care resource whose efforts, if further optimized, could enhance the experience of care for millions of vulnerable Americans.”

Hidden in Plain Sight: Medical Visit Companions as a Resource for Vulnerable Older Adults
Jennifer L. Wolff; Debra L. Roter
Arch Intern Med. 2008;168(13):1409-1415.
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Written by Anna Sophia McKenney