Helping Patients Set Goals for Better Health

It has long been recognized that setting realistic and achievable short-term goals can help people improve their health long-term. But does goal setting work for older adults with multiple health issues or cognitive impairment? Researchers from the University of Pittsburgh in Pennsylvania conducted a study to find out.

They asked 27 patients from the University of Pittsburgh Medical Center Benedum Geriatric Center, a multidisciplinary outpatient geriatric clinic, to use goal attainment scaling (GAS) to set 2 to 4 activity-based goals to work toward. Goal attainment scaling is a tool for setting quantifiable patient-centered goals, measuring improvement toward the goals, and facilitating communication of shared priorities between patient and provider, the researchers say. They note that although originally designed for use in mental health, GAS has been used effectively as an outcome measure with older adults in multiple settings.

Related: Infusing Gerontologic Practice Into PACT

In a guided hour-by-hour review of their typical day, patients were directed to choose activities from 3 major domains: self-care, productivity, and leisure. Using the GAS 5-point scale, the physicians helped patients specify goals and determine the criteria for attaining them. Physicians were asked to rate on a 5-point scale whether their patients’ goals were realistic. The physicians felt that 100% of the goals were realistic, and 93% of the goals were achievable.

The researchers also measured cognitive function, physical function, and disability. About half the patients had ≥ 10 medical diagnoses, and most had both medical and psychiatric diagnoses. Fourteen patients reported some form of caregiver support. Fifteen were evaluated as having cognitive impairment.

Related: Development and Evaluation of a Geriatric Mood Management Program

At baseline, 25 participants demonstrated the ability to set a minimum of 2 goals. One patient chose not to, and another, who had dementia, could not. In all, the participants set 60 goals, half of them addressing leisure activity, such as getting exercise, playing cards, and attending church. Thirty percent of goals reflected patients’ desires to improve their personal care, for example, improving functional mobility. The final 20% of goals addressed productivity, such as managing a budget and finances.

At the 8-week follow-up, patients evaluated their current performance of the goal activities in relation to the indicators for levels of goal attainment they had established at baseline. They were also asked to rate their satisfaction with the process on a 5-point scale.

At the follow-up, 21 participants reported gains in ≥ 1 of their goal areas, reflected in significant changes in their GAS scores (P < .001). The patients were also highly satisfied with the process and their progress. Interesting, and a bit surprising, the patients who had no caregiver support were more likely to achieve their goals.

Related: Mobility in the Elderly: Speed Counts Most

The researchers note that because they did not include any additional intervention beyond goal setting, their findings support existing research that suggests the process of personal goal setting is a strategy in and of itself for increasing motivation toward achieving goals.

Primary care has become the preferred setting for chronic disease management, the researchers say. A patient-centered model could help solve the “impending crisis” of a growing population with many chronic conditions. They suggest that using GAS might be a way to enhance patient engagement, motivation, and satisfaction; improve provider-patient communication; and foster collaborative or shared priorities between patients and health care providers.

Source
Toto PE, Skidmore ER, Terhorst L, Rosen J, Weiner DK. Arch Gerontol Geriatr. 2015;60(1):16-21.
doi: 10.1016/j.archger.2014.10.022.

It has long been recognized that setting realistic and achievable short-term goals can help people improve their health long-term. But does goal setting work for older adults with multiple health issues or cognitive impairment? Researchers from the University of Pittsburgh in Pennsylvania conducted a study to find out.

They asked 27 patients from the University of Pittsburgh Medical Center Benedum Geriatric Center, a multidisciplinary outpatient geriatric clinic, to use goal attainment scaling (GAS) to set 2 to 4 activity-based goals to work toward. Goal attainment scaling is a tool for setting quantifiable patient-centered goals, measuring improvement toward the goals, and facilitating communication of shared priorities between patient and provider, the researchers say. They note that although originally designed for use in mental health, GAS has been used effectively as an outcome measure with older adults in multiple settings.

Related: Infusing Gerontologic Practice Into PACT

In a guided hour-by-hour review of their typical day, patients were directed to choose activities from 3 major domains: self-care, productivity, and leisure. Using the GAS 5-point scale, the physicians helped patients specify goals and determine the criteria for attaining them. Physicians were asked to rate on a 5-point scale whether their patients’ goals were realistic. The physicians felt that 100% of the goals were realistic, and 93% of the goals were achievable.

The researchers also measured cognitive function, physical function, and disability. About half the patients had ≥ 10 medical diagnoses, and most had both medical and psychiatric diagnoses. Fourteen patients reported some form of caregiver support. Fifteen were evaluated as having cognitive impairment.

Related: Development and Evaluation of a Geriatric Mood Management Program

At baseline, 25 participants demonstrated the ability to set a minimum of 2 goals. One patient chose not to, and another, who had dementia, could not. In all, the participants set 60 goals, half of them addressing leisure activity, such as getting exercise, playing cards, and attending church. Thirty percent of goals reflected patients’ desires to improve their personal care, for example, improving functional mobility. The final 20% of goals addressed productivity, such as managing a budget and finances.

At the 8-week follow-up, patients evaluated their current performance of the goal activities in relation to the indicators for levels of goal attainment they had established at baseline. They were also asked to rate their satisfaction with the process on a 5-point scale.

At the follow-up, 21 participants reported gains in ≥ 1 of their goal areas, reflected in significant changes in their GAS scores (P < .001). The patients were also highly satisfied with the process and their progress. Interesting, and a bit surprising, the patients who had no caregiver support were more likely to achieve their goals.

Related: Mobility in the Elderly: Speed Counts Most

The researchers note that because they did not include any additional intervention beyond goal setting, their findings support existing research that suggests the process of personal goal setting is a strategy in and of itself for increasing motivation toward achieving goals.

Primary care has become the preferred setting for chronic disease management, the researchers say. A patient-centered model could help solve the “impending crisis” of a growing population with many chronic conditions. They suggest that using GAS might be a way to enhance patient engagement, motivation, and satisfaction; improve provider-patient communication; and foster collaborative or shared priorities between patients and health care providers.

Source
Toto PE, Skidmore ER, Terhorst L, Rosen J, Weiner DK. Arch Gerontol Geriatr. 2015;60(1):16-21.
doi: 10.1016/j.archger.2014.10.022.

It has long been recognized that setting realistic and achievable short-term goals can help people improve their health long-term. But does goal setting work for older adults with multiple health issues or cognitive impairment? Researchers from the University of Pittsburgh in Pennsylvania conducted a study to find out.

They asked 27 patients from the University of Pittsburgh Medical Center Benedum Geriatric Center, a multidisciplinary outpatient geriatric clinic, to use goal attainment scaling (GAS) to set 2 to 4 activity-based goals to work toward. Goal attainment scaling is a tool for setting quantifiable patient-centered goals, measuring improvement toward the goals, and facilitating communication of shared priorities between patient and provider, the researchers say. They note that although originally designed for use in mental health, GAS has been used effectively as an outcome measure with older adults in multiple settings.

Related: Infusing Gerontologic Practice Into PACT

In a guided hour-by-hour review of their typical day, patients were directed to choose activities from 3 major domains: self-care, productivity, and leisure. Using the GAS 5-point scale, the physicians helped patients specify goals and determine the criteria for attaining them. Physicians were asked to rate on a 5-point scale whether their patients’ goals were realistic. The physicians felt that 100% of the goals were realistic, and 93% of the goals were achievable.

The researchers also measured cognitive function, physical function, and disability. About half the patients had ≥ 10 medical diagnoses, and most had both medical and psychiatric diagnoses. Fourteen patients reported some form of caregiver support. Fifteen were evaluated as having cognitive impairment.

Related: Development and Evaluation of a Geriatric Mood Management Program

At baseline, 25 participants demonstrated the ability to set a minimum of 2 goals. One patient chose not to, and another, who had dementia, could not. In all, the participants set 60 goals, half of them addressing leisure activity, such as getting exercise, playing cards, and attending church. Thirty percent of goals reflected patients’ desires to improve their personal care, for example, improving functional mobility. The final 20% of goals addressed productivity, such as managing a budget and finances.

At the 8-week follow-up, patients evaluated their current performance of the goal activities in relation to the indicators for levels of goal attainment they had established at baseline. They were also asked to rate their satisfaction with the process on a 5-point scale.

At the follow-up, 21 participants reported gains in ≥ 1 of their goal areas, reflected in significant changes in their GAS scores (P < .001). The patients were also highly satisfied with the process and their progress. Interesting, and a bit surprising, the patients who had no caregiver support were more likely to achieve their goals.

Related: Mobility in the Elderly: Speed Counts Most

The researchers note that because they did not include any additional intervention beyond goal setting, their findings support existing research that suggests the process of personal goal setting is a strategy in and of itself for increasing motivation toward achieving goals.

Primary care has become the preferred setting for chronic disease management, the researchers say. A patient-centered model could help solve the “impending crisis” of a growing population with many chronic conditions. They suggest that using GAS might be a way to enhance patient engagement, motivation, and satisfaction; improve provider-patient communication; and foster collaborative or shared priorities between patients and health care providers.

Source
Toto PE, Skidmore ER, Terhorst L, Rosen J, Weiner DK. Arch Gerontol Geriatr. 2015;60(1):16-21.
doi: 10.1016/j.archger.2014.10.022.