Older adults are more likely to suffer from medical problems and face more frequent decisions about their health care. This could mean anything from deciding whether to receive a flu vaccine to choosing among cancer treatments.
Medical decision-making can present unique challenges for older adults. As people age, they process information more slowly compared to their younger years. At the same time, they can draw on a wider range of experiences and may have better insights into their own preferences. What does all of this mean for medical decision making?
A new training module, published by the Gerontological Society of America, offers advice on the most appropriate ways to present health care choices to older adults. This information is useful not only to help people understand their own biases, but also for caregivers who are helping loved ones navigate choices, and for health care providers who guide their patients in decision making.
“Aging brings both strengths and weaknesses in decision making,” said Corinna E. Loeckenhoff, an associate professor of human development at Cornell University, one of the scientific advisers of the training module, and co-editor of a recent book on aging and decision making. “If we have a good understanding of these changes we can structure decision contexts to support good choices across the life span.”
With age, information processing becomes slower, and in some respects, less efficient. But the evidence also shows that the emotional aspects of decision making, such as understanding one’s own preferences and evaluating the benefits and shortcomings of a given option, are well-maintained with age. In addition, older adults have accumulated knowledge over decades, and this knowledge tends to condense into mental shortcuts, also known as heuristics.
Together, these changes may make older adults more likely to rely on their “gut feelings” or rather than synthesizing all available information to draw their conclusions. For instance, they may opt for a certain procedure because it has helped a friend with a similar problem, or choose a provider because he is part of a well-known medical system.
A substantial body of evidence also finds that older adults prefer options framed in a positive light. For example, in one recent study, participants were asked to track their walking steps. One group was encouraged through positive framing: “Walking is good for your heart.” The second group was encouraged through negative framing: “Not walking can lead to heart disease.” The younger participants in both groups walked a similar number of steps. But older participants who heard the positive message walked significantly farther compared to those who heard the negative message.
Older adults are also more likely to make decisions based on examples in the forefront of their minds. The most common example of this dynamic – called the availability heuristic – is a fear of flying. People are much more likely to be injured in a car crash. But because plane crashes receive more widespread and graphic news coverage, people tend to overestimate the risk of flying. Similar fears, such as concerns about rare but dramatic diseases like Ebola, can skew decisions in medical settings. To counteract such biases, it is important to acknowledge peoples’ initial fear, and then point to evidence that highlights the most likely outcomes.
For example, in a well-known study, participants were told about the risks of vaccinating a child. The vaccine came with a 5 in 10,000 risk of death. The risk of contracting and dying from the disease was 10 in 10,000 – double the risk of the vaccine. Nonetheless, participants were much less likely to choose the vaccine, even though it carried a lower risk of death. For an older adult, this bias towards inaction could mean opting out of a helpful treatment to avoid potential side effects. In these situations, it is helpful to offer concrete examples of the consequences of inaction. For example, for someone who is refusing a flu vaccine, explain the dangers and complications of the flu in older adults.
To sum up, there are some tangible steps that will help older adults make better decisions about their health care. Among them are:
- Frame health behaviors and treatment outcomes in a positive light rather than emphasizing negative consequences.
- Focus on all of the relevant information, not just what is at the forefront of the patient’s mind.
- Explain the consequences of inaction compared to the potential side effects of a treatment.
Taking into account these and other common biases will help people will make choices that maximize their well-being.