Important Care and Activity Preferences in a Nationally Representative Sample of Nursing Home Residents

J Am Med Dir Assoc. 2018 Jan;19(1):25-32. doi: 10.1016/j.jamda.2017.06.028. Epub 2017 Aug 23.


Objectives: Person-centered care (PCC), which considers nursing home resident preferences in care delivery, has been linked to important outcomes such as improved quality of life, resident satisfaction with care, and mood and reduced behavioral symptoms for residents with dementia. Delivery of PCC fundamentally relies on knowledge of resident preferences. The Minimum Data Set (MDS) 3.0 Preference Assessment Tool (PAT) is a standardized, abbreviated assessment that facilitates systematic examination of preferences from a population of nursing home residents. However, it is unknown how well the PAT discriminates preferences across residents or items. The purpose of this study was to use MDS 3.0 PAT data to describe (1) overall resident preferences, (2) variation in preferences across items, and (3) variation in preferences across residents.

Data: Data from admission MDS assessments between October 1, 2011 and December 31, 2011 were used for this study.

Sample: A nationally representative sample of 244,718 residents over the age of 65 years who were able to complete the resident interview version of preference, cognition, and depression assessments were included.

Measurements: Importance ratings of 16 daily care and activity preferences were the primary outcome measures. Resident factors including function (MDS Activities of Daily Living-Long Form), depression (Patient Health Questionnaire-9), cognitive impairment (Brief Interview for Mental Status), and sociodemographics (age, race, sex, and marital status) were used as predictors of important preferences.

Analysis: Overall preferences were examined using descriptive statistics. Proportional differences tests were used to describe variation across items. Logistic regression was used to describe variation in preferences across residents.

Results: The majority of residents rated all 16 preferences important. However, there was variation across items and residents. Involvement of family in care and individualizing daily care and activities were rated important by the largest proportion of residents. Several resident factors including cognitive impairment, depression, sex, and race were significant predictors of preferences.

Conclusions: Findings demonstrate the PAT captures variation in preferences across items and residents. Residents with possible depression and cognitive impairment were less likely to rate preferences important than residents without those conditions. Non-Caucasian and male residents reported some preferences differently than Caucasian and female residents. Additional assessment and care planning may be important for these residents. More research is needed to determine the factors that influence preferences and the ways to incorporate them into care.

Keywords: Nursing homes; culture change; older adults; patient preference; patient-centered care; resident-centered care.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Activities of Daily Living*
  • Aged
  • Aged, 80 and over
  • Alzheimer Disease / diagnosis
  • Alzheimer Disease / epidemiology*
  • Cognition Disorders / diagnosis
  • Cognition Disorders / epidemiology
  • Cross-Sectional Studies
  • Depression / diagnosis
  • Depression / epidemiology
  • Female
  • Geriatric Assessment / methods
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Nursing Homes / statistics & numerical data*
  • Patient-Centered Care / methods*
  • Physical Fitness / physiology*
  • Quality of Life*
  • Risk Assessment
  • Sampling Studies
  • United States