3-TRACK CARE - OLDER PATIENT, FAMILY MEMBER, AND PHYSICIAN IN THE MEDICAL VISIT

When older patients come to medical appointments accompanied by a family member, patterns of interaction ensue that reflect uncertainties about the capabilities and responsibilities of each person in this triad. In this study, ongoing discourse from 40 transcribed medical visits with an elderly patient, family caregiver, and physician were analyzed. Interactive behaviors that support patient self care capabilities and those that support dependency are identified and described, and patterns of interaction related to the patients' cognitive or sensory impairments are explored. The presence of a family member at an older patient's medical visit-in combination with the authoritarian traditions of medical care, assumptions about frailty and aging, and true impairment-appears to trigger behaviors that marginalized the patient and that are supportive of dependent self care. Behaviors that support independent self care are less evident. An awareness of this tendency toward dependent supportive interactions may enable physicians, family members, and patients to change this pattern, breaking the cycle of increasing dependence and supporting instead the patient's adult independent status in the clinic setting.