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How to Promote Patient Engagement by Supporting the Three Domains

How to Promote Patient Engagement by Supporting the Three Domains

As we age, we’re constantly experiencing change. Some of us manage this change better than others, but we all go through it. Our bodies respond differently as we request the same performance. Our minds take us instantly to our first date, but lose track of the most recent location of our keys. Our peers face the same things, though at different rates, with the common consequence of making our social networks smaller and more distant. Patient engagement in care can be challenging upon the presentation of one or more of these changes. But by understanding the three domains of successful aging, you’ll be able to craft a care plan to keep your patient supported through all of life’s changes. And, you’ll have an engaged patient as a partner in the process.

A Focus on Successful Aging

Recently, new research by Young, Fan, Parrish and Frick found that existing strengths, or extra support in one domain of successful aging could improve a patient’s sense of overall well-being, even when a second domain may be in grave condition. They’d explored the interplay of the three domains earlier, arriving at the following definition of successful aging:

“A state wherein an individual is able to invoke adaptive psychological and social mechanisms to compensate for physiological limitations to achieve a sense of well-being, high self-assessed quality of life, and a sense of personal fulfillment even in the context of illness and disability.”

You should be able to categorize each aging-related challenge as belonging to the physiological domain, the psychological domain, or the sociological domain. Philips Lifeline’s ebook, The Changing Keys to Successful Aging, provides a tool devised in the above research to assess your patient’s fitness in each of the three domains. Once you’ve got a baseline, you’ll have a better idea where to start making interventions.

This work can be especially valuable when dealing with low levels of patient engagement. Often, poor patient engagement flows from a patient feeling burdensome, worthless, useless, etc. Helping your patients relate to their conditions and manage their feelings can go a long way towards building the doctor-patient partnership that will serve your patients best.

The Physiological Domain

“Josh” is an elderly gentleman whose degenerative hip condition has recently confined him to a wheelchair. He’s a poor candidate for surgery, and it’s unlikely that he will regain the ability to walk. Josh is having a hard time dealing with the restrictions, and has fallen a few times while trying to move around without his wheelchair. He’s generally not receptive to his family’s attempts to have him see a therapist to discuss his feelings about his condition.

Using the assessment tool linked above, it’s evident that Josh has difficulty with many of the physiological performance variables such as stooping, bending and kneeling, ascending or descending stairs, and walking short or long distances. He’s also facing Osteoarthritis and disk disease. His physiological domain score will work out to a zero. Psychologically, it seems that his cognitive function is excellent, though he’s experiencing situational depression. But socially, Josh is floundering. When asked the five questions in the assessment, Josh revealed that he had volunteered as a little league baseball coach for many years, and since his retirement he’d been the commissioner of the league. He’d emcee the annual banquet and pass out jerseys to kids each spring. Now that he could no longer walk, he’d felt forced to give up his little league responsibilities.

Losing the strengths of both his physiological and sociological domains all at once had left Josh feeling worthless and disconnected. Helping Josh reconnect with his little league community and find a new way to give his time and energy will help him relate to his physical limitations differently. He’ll improve his successful aging score, and be more likely to engage in his care plan. Since low successful aging scores are predictive of eventual nursing home confinement, this is work well worth doing.

How to Promote Patient Engagement by Supporting the Three Domains

The Psychological Domain

Patients registering low successful aging scores for the psychological section of the assessment have scored low on the Mini-Mental State Evaluation (MMSE), or shown a poor emotional vitality – calculated via depression score (GDS) and the Hopkins symptom checklist (4Qs). Depending on the nature of the condition facing the patient, you may find that boosting physical activity could help the patient improve his or her results.

In a prior post, we looked at some recent work being done on brain fitness. Activities such as puzzle solving and even some “brain training” computer-based options delivered measurable benefits not only to the patient’s cognitive condition, but also to some physiological abilities such as achieving an increased gait speed when walking while talking. These sorts of activities can also have benefits for the social interactions of the patient, which has been shown to help speed physical recovery and slow cognitive decline.

“Alice” recently moved to an assisted living facility after a period in which she’d struggled to take care of herself while living alone. Her family gradually came to understand that Alice would sometimes go a day or more before remembering to eat. When she did remember, she’d start preparing a meal, but often lose track of what she was doing. Then, she’d later discover the half-prepared meal on the kitchen counter and remember what she had been doing hours earlier. Her once-proud gardens had fallen into disrepair a year earlier after a lifelong friend and neighbor with whom she’d spent years gardening had suffered a stroke. Alice was very resistant to moving out of her home, and lashed out in anger at the staff of the assisted living facility. Though she’s physically fit, she scores poorly on both the psychological and sociological sections of the assessment.

As Alice transitions to the assisted living facility, she’s at risk of becoming more sedentary and withdrawn. Work with the kitchen to ensure Alice’s diet is rich in the types of foods that will help slow her cognitive decline. Research suggests nuts, berries and fish oils can all serve this purpose. A 2009 study in The Journal of Neuroscience demonstrated that these foods can support motor function as well as cognition. Make sure she’s engaged in a regular regimen of physical activity. Maybe the facility has a garden in which Alice could return to planting flowers. And, help Alice identify social opportunities that she may enjoy. Assisted living facilities often have a variety of structured and informal groups. Though they won’t replace her lifelong gardening buddy, they may give her a group of peers with whom to share her fears, hopes and dreams.

With a supportive diet, a new friend and some time to spend in the garden, Alice should be much more engaged in her care plan.

The Sociological Domain

With just five questions, the assessment draws out a patient’s view of how engaged he or she is with life. It’s sometimes the case that patients minimize or exaggerate their answers, depending on whether or not an underlying mental health condition is present, but the quick tool can give you a sense of how the patients view their social engagement.

“Kareem” retired from his 35-year career as a high school teacher last year. He had decided to quit smoking at the same time, but the damage had already been done. He suffered a heart attack just a month after his retirement, and has been struggling to recover. Kareem’s primary motivation in life had been to help and teach others, but he now believes he’s unable to be of any use to anyone. Fiercely independent, he also finds accepting help to be demeaning and embarrassing. Even his wife, who is still a teacher, has been pushed away when she tries to help.

Kareem would have had some difficulty with retirement even if he didn’t suffer the heart attack. He dedicated himself to his work, and didn’t consider the letdown he’d feel when that work was over. His depression and social disengagement is a major barrier to healing his heart, as he hasn’t been motivated to participate in his care plan.

Kareem’s doctor made sure that Kareem was following the protocols she’d provided for physical recovery, and then spent some time helping Kareem find new ways to engage in teaching. Since his career was spent teaching math to adolescents (a subject few adolescents master on the first try), his doctor suggested Kareem offer his expertise as a volunteer tutor. He’d be able to spend as little as a half-hour at a time doing one-on-one or small-group sessions, and then increase the time he had for tutoring as his physical condition improved. Best of all, he could do this from his own home. Another option was for Kareem to teach one class at the local community college. Since Kareem was part of the technology team at the high school, he might even consider developing an online course.

No matter which of the options he chooses, he’ll once again feel he’s needed and important to others – which will improve his patient engagement as he strives to continue his life’s work.

A Complete Picture

Remember, your patients are going through much more than the presenting issue that brings them into your office. Sometimes, doing some work on one of these other areas can help your patients experience dramatic improvements across their overall health. Take them through the assessment tool, and repeat the test periodically to track their progress. Over time, you’ll find out what works, and help your patients stay connected and engaged in their care.

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