Shared decision-making preferences in mental health: does age matter? A systematic review

J Ment Health. 2021 Oct;30(5):634-645. doi: 10.1080/09638237.2020.1793124. Epub 2020 Jul 14.

Abstract

Background: Research to date suggests older adults prefer a passive involvement in the clinical decision-making process; however, the empirical evidence underlying this claim in the mental health context is yet to be reviewed systematically.

Aims: To understand whether older adults desire involvement in mental health-related clinical decisions.

Method: A systematic review was conducted to identify primary research that explored mental-health decision-making preferences of people with a mean age of over 55 from January 1990 through to December 2018.

Results: Three independent studies of varying design and quality were included. Study settings were in the USA, Germany, and the UK. A preference for shared decision-making was seen in two studies, while a preference for active decision-making was identified in one.

Conclusions: In contrast to other reviews on clinical decision-making, this review focused on mental health-related decisions of older adults. The evidence suggests older adults desire involvement in mental health-related clinical decisions. Given the political drive to empower patients and the need to ensure evidence-based clinical practice, more high-quality research regarding the shared decision-making preferences and outcomes of older adults with mental ill-health is needed. Systematic Review Registration PROSPERO: CRD42018102009.

Keywords: Shared decision-making; age; clinical decision-making; mental health; older adults.

Publication types

  • Systematic Review

MeSH terms

  • Aged
  • Aged, 80 and over
  • Clinical Decision-Making*
  • Community Mental Health Services / statistics & numerical data*
  • Decision Making
  • Female
  • Humans
  • Male
  • Mental Disorders / psychology
  • Mental Disorders / therapy*
  • Mental Health*
  • Middle Aged
  • Patient Participation*
  • Patient Preference*
  • Physician-Patient Relations