Understanding the impact of caregiver involvement in older adult healthcare visits: Opportunities for targeted interventions

Older adult and caregiver (family, friends, or aides who provide support) involvement in care planning contributes to improved patient and caregiver outcomes and quality of life. Caregivers frequently serve as the bridge between care plans developed in the clinic and care plans implemented at home, yet they rarely report being included in care planning and feel underprepared to help with care plans, largely due to existing barriers in care delivery including clinician time constraints and uncertainty around how to best include caregivers. One method to promote caregiver involvement in care planning is to include caregivers in older adult clinical appointments. Existing evidence reveals that caregiver inclusion can improve communication, result in better health management and is generally perceived as helpful by older adults. However, while caregiver inclusion in clinical appointments presents a promising method to optimize appointments, better prepare caregivers, and improve patient outcomes, less is known about the factors that influence their inclusion in clinical appointments or which approach for including caregivers results in the best patient outcomes. The current project will address this gap, leveraging nationally representative data to examine social factors that influence caregiver inclusion in clinical appointments and identify the type of caregiver inclusion that is associated with an optimal older adult health trajectory. Our interdisciplinary team will use an innovative person-centered analytic approach to conduct the necessary Stage 0 activities of the NIH Stage Model to provide a thorough characterization of social characteristics that contribute to caregiver attendance at older adult clinical appointments and identification of the type of caregiver inclusion approach(es) associated with a favorable older adult health trajectory. In Aim 1, we will employ a cross-sectional analysis, using nationally representative data from the National Health and Aging Trends Study (NHATS) to (1) describe social network characteristics for community-dwelling older adults and (2) evaluate the association between social network characteristics and caregiver inclusion in older adults’ clinical appointments. In Aim 2, we will use growth mixture modeling (GMM) with linked data from two national datasets (NHATS and the National Study of Caregiving (NSOC)) to characterize caregiver inclusion approaches used in older adult clinical appointments and examine the influence of the approach type on health status trajectory for older adults. The findings from Aims 1 and 2 address Stage 0 of the NIH stage model, providing a comprehensive understanding of the prevalence of caregiver inclusion approaches used during older adult clinical appointments, as well as impact of these approaches which will be relevant to future intervention development. This foundational research will inform the future development of a clinical tool to facilitate caregiver inclusion in older adult clinical appointments. Findings from this study address NIA goal B (Better understand the effects of personal, interpersonal, and societal factors on aging, including the mechanisms through which these factors exert their effects) and are critical for the next planned R-series grant proposal, addressing Stage 1A intervention development using a co-design approach and Stage 1B feasibility and pilot testing of an intervention/clinical tool that can facilitate the selection and implementation of an appropriate caregiver inclusion approach during older adult clinical appointments. This intervention/clinical tool will help tailor care delivery to meet older adult needs, while including caregivers which has the potential to increase caregiver well-being and preparedness while also optimizing health and service utilization outcomes for the older adults they support. Project Number: 1R03AG095328-01 | Fiscal Year: 2026 | NIH Institute/Center: National Institute on Aging (NIA) | Principal Investigator: Kate Perepezko | Institution: MIAMI UNIVERSITY OXFORD, OXFORD, OH | Award Amount: $144,500 | Activity Code: R03 | Study Section: Special Emphasis Panel[ZRG1 HSS-P (90)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11212909