Communication StudyThe content of diet and physical activity consultations with older adults in primary care
Introduction
Healthy diet and sufficient physical activity have significant health and quality of life benefits across ages [1], [2] and generally result in lower healthcare utilization and associated costs [3]. While the benefits are greater if positive health behavior changes take place earlier in life, advantages still exist if changes begin in later years [4], [5]. Even small behavior improvements may result in significant health benefits [6].
As individuals reach age 65, women have an average of 20.3 and men an average of 17.6 years of life remaining, allowing for sufficient time for changes in dietary intake and physical activity levels to have an effect on functional status and quality of life [7]. Unfortunately, despite well documented benefits of engaging in healthy lifestyles, poor diet and physical inactivity are pervasive across ages, particularly among older adults. In the US, only 30.0% of adults ages 65 and older consume five or more fruits/vegetables a day [8] and 32.7% of adults ages 65 and over report no leisure time physical activity within the past 30 days [9]. Among older adults age 65 and over in the United States, self-reported rates of moderate physical activity participation range from 39.3% to 51.2%, depending on the criteria used [10], [11], and only 10% of adults over the age of 65 engage in any vigorous physical activity [12].
One potential venue for addressing these suboptimal health behaviors is through primary care providers. Primary care providers are particularly well situated to counsel older adults because older Americans are the largest consumers of health care services [7]. Adults between the ages of 65–74 average 6.5 physician office visits per person per year; adults ages 75 and over make 7.7 visits per person per year [13]. In 2008, 44% of visits for adults ages 65 and over were to primary care providers [14]. While fewer than 8% of these visits are dedicated preventive care visits, this frequent contact creates opportunities for lifestyle counseling [13].
Prior research indicates that provider counseling has the potential to help patients with dietary and physical activity changes [15], [16]. Currently however, there is very little research that documents how often these discussions occur with older patients or the nature of the counseling that occurs. The scant existing research indicates that diet and physical activity discussions occur in less than a quarter of primary care visits [17], though these estimates pertain to a general adult population rather than to older adults. Stange et al. (2002) found that the average duration of diet and physical activity discussions was 1.35 min, reduced to only .7 min when also taking into account visits during which prevention counseling did not occur [18]. Eaton, Goodwin, and Stange (2002) found that the average duration of dietary counseling was 55 s, ranging from less than 20 s to over 6 min [19]. Preventive service delivery is often associated with related signs or symptoms, suggesting that illneses care may present opportunities for prevention [20]. Flocke, Kelly, and Highland (2009) found that most prevention discussions occurred in the context of structured routines (e.g., checklists) or opportunistic triggers (symptoms or conditions) [21]. Anis and colleagues (2004) determined that most (61%) lifestyle counseling was physician-initiated [22].
Surprisingly little research has examined the actual content of lifestyle counseling. Sciamanna and colleagues (2004) conducted a study where all participating physicians were instructed to counsel their patients on physical activity, but the content of that counseling was left up to them [23]. The most common topics physicians counseled on were type of activity recommended, reasons to become active, and past experiences with activity. Action items – such as written plans or making plans for future discussion – were very uncommon. To rectify this sparse knowledge base regarding provider lifestyle counseling, we seek to describe whether and how diet and physical activity are discussed during older adults’ primary care visits.
Section snippets
Eligibility and recruitment
Providers and patients from the departments of Internal Medicine and Family and Community Medicine in an academic medical center were recruited and consented to have their visits audio-taped. The consent form indicated that the research study was focused on lifestyle behaviors, but did not specify diet and physical activity. Providers included attending physicians, nurse practitioners, physician assistants, resident physicians, and medical students. Patients over the age of 65 were identified
Description of the care context
Patients spent an average of 11.5 min with the provider with whom their visit was scheduled and an average of 26.6 min when including resident physicians with whom the visit was not scheduled and medical students. Twenty-eight percent of patients were accompanied during their visit, typically by spouses or adult children. Patients reported being very satisfied with the quality of their care, providing an average quality rating of 9.5 out of 10. Patients reported seeing their providers on average
Discussion
We designed this study to fill the gaps in our understanding of the frequency and nature of health behavior recommendations with older adults in the primary care setting. The findings indicate that diet and physical activity discussions between older adults and their primary care providers occur much more frequently than suggested by prior research. This nearly three-fold greater rate of diet and physical activity discussion may, in part, reflect our more inclusive identification process.
References (42)
- et al.
Direct observation and patient recall of health behavior advice
Prev Med
(2004) - et al.
One minute for prevention: the power of leveraging to fulfill the promise of health behavior counseling
Am J Prev Med
(2002) - et al.
Direct observation of nutrition counseling in community family practice
Am J Prev Med
(2002) - et al.
Initiation of health behavior discussions during primary care outpatient visits
Patient Educ Couns
(2009) - et al.
Direct observation of physician counseling on dietary habits and exercise: Patient, physician, and office correlates
Prev Med
(2004) - et al.
Accuracy of recall of exercise counseling among primary care patients
Prev Med
(2004) - et al.
Dietary fat intake and quality of life: the SUN project
Nutr J
(2011) - et al.
Health benefits of physical activity: the evidence
Can Med Assoc J
(2006) - et al.
Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association
Circulation
(2007) Nutrition and health promotion in older adults
J Gerontol A Biol Sci Med Sci
(2001)
Exercise and older patients: guidelines for the clinician
J Am Geriatr Soc
Fish consumption and stroke risk in elderly individuals: the Cardiovascular Health Study
Arch Intern Med
Health, United States, 2009: with special feature on medical technology. Hyattsville, MD2010
What is your average frequency of fruit and vegetable consumption per day? 2007
U.S. Physical Activity Statistics. Atlanta, GA2010
Prevalence of self-reported physically active adults—United States, 2007
Morb Mortal Wkly Rep
Prevalence of self-reported physically active adults—United States, 2007
Morb Mortal Wkly Rep
Motivators and barriers to exercise in an older community-dwelling population
J Aging Phys Act
Retooling for an Aging America: Building the Health Care Workforce
Patient-centered care for older adults with multiple chronic conditions: a stepwise approach from the American Geriatrics Society
J Am Geriatr Soc
Physician Involvement in the Management of Obesity as a Primary Medical Condition
Obesity
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2020, International Journal of Environmental Research and Public HealthMoving healthcare professionals - A whole system approach to embed physical activity in clinical practice
2019, BMC Medical EducationDiscussing lifestyle behaviors: perspectives and experiences of general practitioners
2019, Health Psychology and Behavioral Medicine