Patient autonomy and informed consent--individual preferences of senior study participants in Germany

The majority of therapeutic decision-making takes place between therapists and elderly people. The present study sought to determine the individual preferences of elderly people in the therapist-patient interaction. From October 2010 to January 2011, data from elderly students (n = 297, mean age  > 60) were collected at three different university sites in Germany (Halle-Wittenberg, Cologne and Munich). The study used a structured questionnaire. Younger students (n = 182, mean age = 20.5) at the University of Halle-Wittenberg were questioned as well, in order to show age-specific differences. None of the participants was hospitalised. At the University of Munich, elderly students (n = 42) were given interaction-skill training for patients prior to taking part in the study. The effect of the intervention was measured in the study. Elderly participants and especially those with higher morbidity and a poorer state of information about their state of health refused to get involved in the process of medical decision-making. A group of elderly participants who received special interaction-skill training for patients afterwards preferred an equal therapist-patient relationship as well as shared decision-making. Younger participants favored an informative-participative interaction. The guidelines of therapeutic decision-making that are applied in practise do not always meet the individual needs of the elderly. Interaction-skill training for patients has great potential to both: encourage patients to get involved in the process of medical decision-making and to assume more autonomy. Hence, the aim should be to compound autonomy-empowerment and interaction-skill training for elderly people.