Content uploaded by Sebastiano Massaro
Author content
All content in this area was uploaded by Sebastiano Massaro on Apr 04, 2022
Content may be subject to copyright.
Citation: Tay, E.; Vlaev, I.; Massaro, S.
The Behavioral Factors That Influence
Person-Centered Social Care: A
Literature Review and Conceptual
Framework. Int. J. Environ. Res.
Public Health 2022,19, 4334. https://
doi.org/10.3390/ijerph19074334
Academic Editor: Paul B.
Tchounwou
Received: 25 February 2022
Accepted: 1 April 2022
Published: 4 April 2022
Publisher’s Note: MDPI stays neutral
with regard to jurisdictional claims in
published maps and institutional affil-
iations.
Copyright: © 2022 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
International Journal of
Environmental Research
and Public Health
Review
The Behavioral Factors That Influence Person-Centered Social
Care: A Literature Review and Conceptual Framework
Eugene Tay 1,*, Ivo Vlaev 2and Sebastiano Massaro 3
1NUS Care Unit, Office of the Senior Deputy President and Provost, National University of Singapore,
Singapore 119077, Singapore
2Department of Behavioural Science, Warwick Business School, University of Warwick,
Coventry CV4 7AL, UK; ivo.vlaev@wbs.ac.uk
3Surrey Business School, University of Surrey, Guildford GU2 7XH, UK; sebastiano.massaro@theonelab.org
*Correspondence: e.tay@nus.edu.sg; Tel.: +65-6601-6301
Abstract:
The last decade has seen numerous policy reforms to emplace person-centered social care.
Consequently, the public has been given more information, choice, and autonomy to decide how best
they want to be cared for later in life. Despite this, adults generally fail to plan or prepare effectively
for their future care needs. Understanding the behavioral antecedents of person-centered decision-
making is thus critical for addressing key gaps in the provision of quality social care. To this end, we
conducted a literature review of the psychological and health sciences with the aim of identifying
the aspects that influence person-centered decision-making in social care. Using an established
theoretical framework, we distilled nine behavioral factors—knowledge, competency, health, goal
clarity, time discounting, familiarity, cognitive biases, cognitive overload, and emotion—associated
with “Capability,” “Opportunity,” “Motivation,” and “Behavior” that explained person-centered
decision-making in social care. These factors exist to different degrees and change as a person ages,
gradually impacting their ability to obtain the care they want. We discuss the role of carers and the
promise of shared decision-making and conclude by advocating a shift from personal autonomy to
one that is shared with carers in the delivery of quality social care.
Keywords: elderly care; advance planning; decision-making; aging population; nudging
1. Introduction
Over the last decade, person-centeredness, or an emphasis on providing care that
is respectful and responsive to adults’ needs, has been at the forefront of many social
care policy reforms in the United States (US), United Kingdom (UK), Canada, and many
other countries (e.g., Germany, Australia). The US 2010 Affordable Care Act contains
multiple provisions to increase healthcare value, quality, and efficiency through choice and
information [
1
]. Likewise, the UK 2014 Care Act replaces a ‘one size fits all’ approach with
a ‘person-centered’ health and social care system that focuses on addressing individuals’
needs and wellbeing [
2
]. These reforms generally seek to enhance individuals’ autonomy
and responsibility in deciding how they want to be best cared for in the latter part of their
lives, including the type of support they may need (e.g., transport, home adaptations,
nursing staff), where they may want to receive care (e.g., home or hospice), and how they
may want to fund them (e.g., insurance). Studies suggest that advanced care planning
improves the receipt of person-centered care and increases satisfaction with care [
3
–
5
], and
may even lower the cost of care [6].
Yet, people who develop care needs often fail to plan and decide on a range of matters
earlier in their lives. Using data from the 2016 Empire State Poll conducted in New York,
researchers established a poor level of awareness among participants in being able to
define hospice care (83%) and palliative care (27%), and identified several common areas
of misconceptions, such as associating hospice care with end-of-life care (60%) [
7
]. In the
Int. J. Environ. Res. Public Health 2022,19, 4334. https://doi.org/10.3390/ijerph19074334 https://www.mdpi.com/journal/ijerph
Int. J. Environ. Res. Public Health 2022,19, 4334 2 of 14
UK, a 2017 survey suggested that about 47 percent of the population wrongly believe that
social care is free at the point of need, and only 35 percent had made financial plans for
their future care [
8
]. Even though aging and age-related changes affect everyone, people
tend to avoid the topic and only consider their potential care when the need arises. While
some may claim to be more risk-averse and be avid planners, most will simply react in
response to a certain event, such as a medical crisis or the passing of a close one [
9
]. This
is when people are least likely to cope with choice, information, and stress to make a
proper person-centered decision. Indeed, the current COVID-19 pandemic provides a
timely demonstration of how fear and paranoia in people, brought on by sudden changes
in an uncertain situation, can increase stigmatization of care professionals [10] or increase
susceptibility to misinformation [11,12].
Person-centered decisions about social care are rarely clear-cut. They involve multiple
factors and require considerable foresight about future needs. Thus, identifying and
addressing the behavioral antecedents of person-centered decision-making in social care
is a fundamental call for both public health and public policy. More insights on this will
surface the behavioral barriers and facilitators of advance care planning and highlight areas
in need of practical interventions to promote person-centered social care. In this work, we
aim to address this scenario by performing a literature review on the landscape of elderly
social care, with the goal of identifying which aspects and in what ways they can influence
person-centered decision-making about older care needs. Given the impetus to promote
person-centered decision-making in policy and practice in countries like the UK, US and
Canada, this review will mainly draw insights from these societies to inform research on
social care.
This paper contributes to knowledge in three main ways. Firstly, by adopting a
behavioral lens, we aim to systematize and synthetize the crucial factors that influence
decision-making about social care. In doing so, we incorporate insights from the behavioral
sciences to address possible limitations that exist at the individual-policy and individual-
practice interface. Secondly, we explore and reveal the importance of shared decision-
making in social care, which until recently has been largely confined to the health and
medical sciences. Thirdly, we present a novel framework for conceptualizing the behavioral
factors and the conditions under which they may be more (or less) crucial in promoting
person-centered social care. Altogether, this work provides a comprehensive toolkit for
policymakers and practitioners to consider a wide range of decision-making factors that
might influence the receipt of quality social care.
2. Methods
We performed a narrative review on the barriers and facilitators that affect person-
centered decision-making for elderly care needs. We focus on societies like the UK, US
and Canada where considerable headway has been made to emplace person-centered
social care in policy and practice. We adopted the COM-B framework [
13
,
14
] for the
purposes of guiding the identification and classification of key behavioral factors and
conceptualizing their interrelationships. The COM-B framework recognizes ‘behavior’ as
a system of multiple interacting components, comprising ‘capability,’ ‘opportunity,’ and
‘motivation’. The framework has been used extensively in healthcare to address unhealthy
eating habits, poor physical activity, and cigarette smoking in the general population [
13
,
15
].
Using a theory-driven approach to behavior change allowed us to identify 10 key factors
from the psychological and health sciences that could affect person-centered decision-
making in predictable ways. We abridge the findings from the retrieved literature into four
overarching components: (1) capability, (2) opportunity, (3) motivation, and (4) behavior. In
the following section, we explain the evidence behind these factors and elaborate on how
third parties, including government entities, formal carers, and informal carers play a role
in promoting person-centered elderly care.
Int. J. Environ. Res. Public Health 2022,19, 4334 3 of 14
3. Results
3.1. Capability
Capability refers to a person’s decisional capacities to reason and deliberate, express
preferences and values, understand one’s circumstances, comprehend given information,
and communicate a choice [
16
]. Hence, this section examines factors that affect person-
centered decision-making well before people lose the capacity to decide their own best
interests.
3.1.1. Knowledge
Knowledge about the ways in which the social care system operates is one of the
greatest hurdles in getting people to consider their potential care needs. Using nation-
ally representative data from the Health and Retirement Study (n= 1504), Bakk and
Cadet [
17
] found significant differences in knowledge about the Medicare Low-Income
Subsidy scheme, such that compared to older non-Hispanic Whites, older non-Hispanic
blacks and Hispanics, as well as those with a Spanish-speaking preference, were much
less likely to know about it. Some hints of poor public knowledge about social care are
also evident in the 2018 British Social Attitudes (BSA) survey [
18
]. The BSA survey, which
recruited a nationally representative sample of 2926 people between July and October
2018, asked about satisfaction with health and social care and found a relatively high
proportion of ‘don’t knows’ and ‘neither satisfied not dissatisfied’ related to social care (9%
and 31%, respectively) compared to GPs (<1% and 13%) and outpatient services (3% and
15%) [
18
]. This points to a poor level of public awareness regarding social care and that
such deficiencies may be greater along racial and cultural lines. Crucially, poor awareness
may hinder those with the greatest needs to benefit from any targeted policy.
Educational programs could be one effective means for promoting person-centered
decision-making in social care. For example, Detering et al. [
19
] studied the effects of ad-
vanced end-of-life care planning by randomizing 309 legally competent medical inpatients,
aged 80 and above, into either a control group (n= 155) that underwent usual care or an
intervention group (n= 154) that received usual care plus information and support on
advance planning. After six months, the researchers found that among the patients who
had passed away, those belonging to the intervention group were much more likely to
receive the end-of-life care that they had wanted than those who had been assigned to the
control group. Alternatively, making advance planning seminars available to the public
could help individuals understand the importance of preparing ahead of time. Studies
show that individuals who attend financial preparation seminars tend to develop a more
favorable attitude towards retirement, acquire more knowledge on the basics of financial
planning, engage in financial preparation [
20
] and contribute more to their own retirement
fund [
21
]. Knowledge about the social care system, including how it works, who funds
it, and who provides it, is thus an important aspect in promoting person-centered care.
Exposing people to these pieces of information, preferably at an earlier rather than later
age, may not only reduce the awareness gap in social care, but also drive up commitment
towards advanced planning, thereby increasing a person’s likelihood of getting the care
they want.
3.1.2. Competency
Current policies on social care stress the importance of informed decision-making
in person-centered care. Yet, such a cognitive exercise usually requires a set of decision-
making skills for people to effectively understand complex information, appreciate risks
and uncertainties, weigh the tradeoffs involved, and make rational choices.
Literacy—the ability to read, write and understand information—and numeracy—the
ability to comprehend and apply numerical concepts—are critical skills for making objective
assessments [
22
–
24
]. In an examination of 1400 patients at a public health system in San
Francisco, Nouri et al. [
25
], established a negative association linking health literacy to
knowledge about advanced care planning. Likewise, a large survey of 784 adults aged
Int. J. Environ. Res. Public Health 2022,19, 4334 4 of 14
55 to 74 sampled from the Chicago area showed that individuals low in literacy were
much less likely (about 0.45 times) than those with high literacy to possess an advance care
directive [
26
]. These findings suggest that decision-making skills may have motivational
properties in person-centered social care. Without intervention, adults with poorer decision-
making competencies may be at greater risk of being ‘left behind’ by recent policy changes.
A competency gap can be addressed through tailored communication, including the
use of non-technical terms, absolute numbers (3 of 1000 people) instead of percentages
(0.3%), and graphical illustrations instead of text [
27
]. Such strategies have been shown to
improve individuals’ understanding and satisfaction in complex care decisions, even for
those with poorer decision-making skills [
28
]. This suggests that the way in which third
parties share information may be an influential determinant of quality in person-centered
care. Despite this, little is known about the current state of literacy and numeracy among
those considering social care options, or if these competencies affect decision-making in
different ways, like the desire for involvement, gains in knowledge, risk aversion, and
health outcomes. More research is needed to elucidate the relationship between quality
decision-making and quality social care.
3.2. Opportunity
Opportunity are factors beyond the direct control of the individual that can prompt or
make a specific behavior possible. In social care, the opportunity to make a person-centered
decision will usually rise and fall depending on the situation.
Health
Aging brings significant changes to a person’s health status and care needs. It affects
sensory (e.g., vision, hearing, and smell) and physical functions (e.g., motor ability), both of
which may develop differently depending on a person’s medical condition (e.g., diabetes,
dementia) and lifestyle (e.g., exercise, diet, and tobacco and alcohol use). For these reasons, a
person’s entry and journey through the social care system rarely unfolds in a predetermined
manner. For some, the desire to make home adaptations and maintain independence may
arise when people anticipate, fear, or suffer minor mobility issues [
29
]. Individuals in these
situations are arguably in a good position to make person-centered decisions. They are
legally competent to make their own choices and are in a relatively low-stress state.
For some others, planning begins when they feel or are told that they might be
losing their decisional capacity (e.g., dementia) [
29
], or when they start to suffer major
mobility issues that hinder instrumental daily activities, such as cooking, showering, and
housekeeping [
30
]. According to some health experts [
31
], age-related changes can threaten
a person’s dignity and ability to secure their own wellbeing and thus, motivate protective
actions. For instance, a decline in mental functioning may increase a person’s dependence
on others to learn, manage, and fulfill their personal care needs. An interview with family
carers of older adults who had been hospitalized for mental health-related issues revealed
that the carer’s involvement in decision-making, in which they gathered information,
consulted preferences, and communicated with care professionals about treatment plans,
helped ensure that older patients got the care they wanted [32].
Finally, there are people who react to unplanned emergencies (e.g., falls). Medical
crises are among the most complex and challenging ways for people to enter the social care
system in that they would have very limited time to consider all available information and
choices, nor be in a calm and composed state to make a rational decision. In cases of mental
incapacitation, individuals may not even get the opportunity to express their preferences
beforehand and so the next-of-kin becomes their medical proxy or surrogate for enabling
person-centered care [
33
]. According to one study relying on data from the National Health
Interview Survey (2009–2011; n= 16,720), the risk of delayed care due to cost or lack of
transportation was greatest for older people living alone or with unrelated others [
34
].
Age-related health decline appears to bring opportunities for others to collaborate and
deliver responsive care.
Int. J. Environ. Res. Public Health 2022,19, 4334 5 of 14
Overall, the evidence suggests that deciding in good health gives people ample time
to plan, prepare, and even prevent mishaps, whereas deciding in poor health generally
compels one to satisfy their most immediate care needs with little real choice and freedom
to get what they want. Deciding in good health increases one’s chances of attaining
person-centered care.
3.3. Motivation
Motivation can be intrinsic (e.g., goals) or extrinsic (e.g., incentives), but is generally a
process that energizes and directs behavior.
3.3.1. Goal Clarity
Planning for a potential decline in health is a challenging and unpleasant process [
30
].
Such thoughts can trigger strong aversive feelings in people and put them off from consider-
ing future care needs in the first place [
35
]. In one investigation, Powell and colleagues [
36
]
found that some older adults tended to regard minor home adaptations, like handrails and
ramps, as attempts to medicalize their own homes. These physical installations become an
indication of weakness and thus represent a threat to a person’s self-esteem and dignity.
Because these attitudes and perceptions can be off-putting [
37
], having sufficient goal
clarity to overcome these negative stereotypes is critical for people to consider their older
care needs.
Individuals with a clear intention about what they want are more likely to overcome
psychological barriers and take necessary actions to achieve those ends [
38
,
39
]. Research
has shown that individuals with a clear goal, a future time perspective (i.e., preference
for the long-term view as opposed to focusing on the past or present), and a long-term
planning orientation tend to prepare for their future finances and contribute more towards
their retirement [
40
,
41
]. For example, Jacobs-Lawson and Hershey [
40
] attempted to iden-
tify the psychological determinants of retirement planning in 270 middle-aged
(M = 36.2)
working Americans, stratified by geographical region. The researchers found that indi-
viduals’ knowledge of retirement planning, future time perspective, and financial risk
tolerance influenced retirement saving behavior. These factors interacted with one another,
which suggests that goal clarity may be one of several systems (e.g., knowledge and risk
preferences) motivating early engagement with the care system.
3.3.2. Time Discounting
An absence of cognitive load (i.e., stress and pressure) is generally more conducive
for rational decision-making [
42
,
43
]. However, a lack of urgency can similarly demotivate
people from advance planning. Researchers explain that people typically discount the
value of future choices at different rates, depending on their age, level of self-control, and
the cost of time spent waiting [
44
,
45
]. Hershfield [
46
] attributed this behavior to a lack of
physiological connection to a person’s future self, in which he showed that experimental
participants placed in a future state, through imagination or simulation, tended to allocate
more of their current money to a savings account. While this points to intertemporal
decision-making as being an individually motivated process, some recent works have
begun to explore the influence of others on this, such as whether close ones help or hinder
advance planning.
Delaying gratification, or the acceptance of small short-term costs in exchange for
larger long-term gains, is difficult but predictive of many important life outcomes (e.g.,
retirement savings and physical wellbeing) [
47
,
48
]. Yet, delaying gratification also depends
on individuals’ trust in people to deliver those future gains, especially in the context of
managing older care needs. Michaelson et al. [
49
] investigated the causal role of social trust
in delaying gratification and showed that participants (n= 250) were less likely to wait for
delayed rewards from less reliable personas and that perceived trustworthiness predicted
the extent to which participants delayed gratification. Furthermore, in Henning-Smith and
Shippee’s [
50
] analysis of the 2012 National Health Interview Survey in the US, expectations
Int. J. Environ. Res. Public Health 2022,19, 4334 6 of 14
about future care needs and support in adults varied significantly by their current living
arrangement, such that those living with young children were least likely to expect any
form of long-term care or support, while those living alone were most likely to expect
some form of help in future. This hints that social trust, or the belief in others’ ability to
meet personal older care needs, may be a critical dimension in motivating (and enabling)
person-centered care.
3.3.3. Familiarity
The performance of certain everyday tasks can become so routine and repetitive that
they require little or no conscious effort to execute. Over time, individuals may develop a
mental script on how to execute them (e.g., daily commute to the local community center),
and mental schemas for categorizing, interpreting, and generalizing issues (e.g., residents
from this neighborhood are nicer) [
51
]. Familiarity may explain why people prefer to
stay comfortably at home and adjust (e.g., making home adaptations), rather than move
into other types of sheltered care [
52
]. Efforts to promote familiarity in stay-home care
are also evident in the Community Ageing in Place—Advancing Better Living for Elders
(CAPABLE) program that is currently underway in the US [
53
]. The CAPABLE program
addresses personal and environmental factors that contribute to disability by using a
person-directed approach to help older adults manage pain, mental health, communication
with health professionals, and other daily activities of their choice, whilst living in their
homes. In a randomized trial comprising 300 low-income adults with a disability, the
researchers showed that compared to the control group, those assigned to CAPABLE were
more likely to report that the program helped them take care of themselves and increased
their confidence in managing daily challenges [54].
On the other hand, individuals are likely to find the management of novel tasks, like
navigating the social care system for the first time, especially complex and challenging.
Studies show that older adults tend to find new technology (e.g., tablet device, video-
conferencing) complicated to learn and use [
55
], even if it may be beneficial to their health
and well-being, for example in battling social isolation during the COVID-19 pandemic [
56
].
Since learning requires controlled, deliberative processes [
57
,
58
], some individuals may shy
away from difficult but essential matters (e.g., getting a mobility aid, teleconsultation) [
59
].
Hence, the expansion of telehealth and other tech-facilitated services must account for the
different needs and capabilities of older adults. Otherwise, technology may exacerbate
health disparities in underserved communities, rather than reducing them.
3.4. Behavior
Behavior is the amalgamation of capability, opportunity, and motivation to make social
care decisions that are based on the best available information and centered on individuals’
preferences. However, even when individuals do decide to engage in decision-making, they
normally possess limited attention span to process all available information in an objective
manner [
43
,
60
,
61
]. The following summarizes some of the biases that can undermine
rational decision-making in the context of person-centered care.
3.4.1. Cognitive Biases
Individuals’ preferences are usually reference-dependent and averse to losses in that
there is a greater motivation to avoid losses than to secure the same amount of gains [
62
].
As it applies to social care, people in good health may value future losses to illness and
aging much more than those who are already in poor health, thereby predisposing the
former to take precautionary measures, such as searching for information and getting
health insurance [
63
]. Conversely, an optimism bias may cause people to underestimate
the probability of an adverse event. For example, older adults may perceive their odds of
tripping and needing emergency attention as much lower than what objective data may
suggest otherwise. Such biases can affect objective assessments of care needs and hamper
advance planning.
Int. J. Environ. Res. Public Health 2022,19, 4334 7 of 14
Furthermore, aging appears to trigger negative stereotypes in people [
64
]. Aging
stereotypes in Western cultures are primarily negative, depicting later life as a period of
ill health, loneliness, and mental and physical decline [
64
]. Auman and associates [
65
]
investigated the relationship between aging-related stereotypes and anxiety and cardio-
vascular reactivity by using a mixture of self-reported and physiological measures. In a
sample of 122 patients, randomized to either receive health-related primes (e.g., sickness,
helplessness, dependence) or leisure-related primes (e.g., leisure activities), those in the
health condition reported significantly higher levels of anxiety and blood pressure than
those in the leisure condition. In explaining this phenomenon, Auman et al. [
65
], argued
that aging triggers fears of frailty and illness, which discourages people from seeking medi-
cal attention before needs begin to develop. Similarly, Levy and colleagues [
66
] studied
whether stereotypes of aging might affect decisions about when to die by recruiting a
sample of 64 participants, evenly split between old adults (n= 32, M
age
= 74 years) and
young adults (n= 32,
Mage = 25 years).
They found that old adults exposed to negative
stereotypes frequently declined life-prolonging procedures, while old adults exposed to
positive stereotypes often accepted them. No such effect was observed in young adults.
This suggests that stereotypes about aging may be particularly influential in the elderly.
3.4.2. Cognitive Overload
Research has shown that excessive amounts of information can often overwhelm and
deter people from having to decide at all [
67
]. This paradox, where excessive information
paralyzes decision-making, is known as information overload [
68
]. Information overload
may be particularly disruptive for individuals as they begin to age and lose cognitive
capacity [
69
,
70
]. Older adults tend to consider fewer pieces of information before making a
decision, pay more attention to positive material rather than negative material [
71
], and
rely on simpler decision-making strategies that may lead to poorer outcomes (e.g., choosing
less profitable stocks) [
72
]. A pure informational approach puts older adults in a vulnerable
position and a reliance on third parties may be necessary to compensate for declines in
mental functioning.
Likewise, having more to choose from is not always better. Research suggests that
individuals encountering a large assortment of options are usually more ambivalent, less
satisfied, and less likely to make any choice at all than those with a smaller choice set [
73
–
75
]—a phenomenon known as choice overload [
75
]. In the US, a roll-out of more than
forty Medicare coverage plans reportedly overwhelmed people. Few senior US residents
found such “choice” helpful and a majority (about 73%) felt that the plans were “difficult
and confusing” to understand [
76
]. In a more telling experiment on the dangers of choice
overload, Hanoch et al. [
77
] recruited 192 healthy participants from California, half aged
18 and older, and half aged 65 or older, and randomized assigned them to one of three
conditions containing 3, 10 or 20 Medicare drug plans. The researchers found that old age
and a bigger choice set were responsible for fewer correct answers (i.e., deciding on a plan
that minimized total annual cost), which raises questions about the ability of older adults
in navigating the wide variety of social care options available to them.
3.4.3. Emotion
People are generally poor at predicting their ability to control visceral forces (e.g.,
anxiety, anger, hunger, pain) that may influence human behavior, especially when such
feelings transcend “hot–cold” emotional states [
78
–
80
]. According to Loewenstein [
81
],
people in a ‘cold’ state often fail to fully and accurately appreciate how ‘hot’ states might
affect their behavior, whereas people in a ‘hot’ state tend to overestimate their ability to
manage and control their current behavior. In social care, planning normally happens in
a ‘cold’ calculated state. As a result, people may delay critical decisions (e.g., checking
out nearby care homes) thinking that they can cope with crises as they come [
30
]. On
the other hand, extreme discomfort (e.g., pain), accidents, and other emotionally-charged
situations (e.g., fear, distress) can predispose people to make impulsive decisions [
78
,
82
,
83
].
Int. J. Environ. Res. Public Health 2022,19, 4334 8 of 14
Decisions under such circumstances are not only more likely to produce intense feelings
of regret in people [
84
], but are also more likely to undermine quality person-centered
care. Thus, finding ways to bridge the “hot–cold” empathy gap may be instrumental for
promoting person-centered outcomes in social care. In times of crisis, having an additional
decision-maker may help relieve some stress and encourage rational decision-making.
4. Discussion
Planning and informed decision-making can ensure individuals get the care they want,
well before the onset of a health decline or crisis that impairs their ability to make person-
centered decisions. Yet, getting people to seriously consider their future care needs is a
complex and massive undertaking. It will require them to have the capability, opportunity,
and motivation for considering such matters and even then, a host of cognitive and affective
biases may undermine the process of decision-making. For these reasons, third parties
such as informal carers (e.g., family, friends, neighbors) and formal carers (e.g., nursing
professionals) play a pivotal role in ensuring the delivery of person-centered care.
4.1. Promise of Shared Decision-Making
Shared decision-making is an attractive framework for enacting person-centered social
care. Shared decision-making recognizes that carers bring precious informational, emo-
tional, and relational value to an otherwise dull and stressful process. Figure 1illustrates
the ways and circumstances in which shared decision-making is most likely to improve the
quality of person-centered social care.
Int. J. Environ. Res. Public Health 2022, 19, x FOR PEER REVIEW 9 of 15
Figure 1. Impact model of shared decision-making in social care.
The model conceptualizes the potential benefit of shared decision-making as one that
is person and situation-specific. A person’s capability, opportunity, motivation, and be-
havior affect the extent to which shared decision-making functions as a crucial mechanism
for enabling person-centered outcomes. In addition, the model points to some inherent
tensions in the social care system. Conditions that are most attractive for quality person-
centered social care (e.g., highly literate, highly familiar) are also the very ones that render
shared decision-making less attractive. Conversely, conditions that are least ideal for qual-
ity person-centered social care, such as experiencing age-related declines in mental func-
tioning, make shared decision-making ever more important in delivering responsive care.
Therefore, how rapidly people shift from one extreme to the other is an important factor
in social care.
The impact model of shared decision-making recognizes person-centered social care
as a complex and dynamic process involving multiple factors and agents. More im-
portantly, it illustrates how shared decision-making with carers may help older adults get
the care they want. One prime example showcasing the benefit of carers can be found in
Braun and colleagues’ [85] randomized controlled trial, which compared the effects of
employing care managers to help Medicare beneficiaries navigate decision-making about
cancer screening against standard cancer education. They showed that by sharing the pro-
cess with Medicare beneficiaries, care managers were able to significantly increase various
cancer screening uptake (e.g., breast cancer, prostate cancer), even in groups with signifi-
cant disparities (e.g., Hawaiian, Filipino, Japanese) [85]. Likewise, informal carers are usu-
ally close acquaintances who live in close proximity or share a close relationship with the
older adult they care for. As a result, informal carers tend to have shared lived experience,
shared understanding of the situation, and shared expectations of the future, which make
them highly knowledgeable about the needs and preferences of those whom they care for
Figure 1. Impact model of shared decision-making in social care.
The model conceptualizes the potential benefit of shared decision-making as one that is
person and situation-specific. A person’s capability, opportunity, motivation, and behavior
Int. J. Environ. Res. Public Health 2022,19, 4334 9 of 14
affect the extent to which shared decision-making functions as a crucial mechanism for
enabling person-centered outcomes. In addition, the model points to some inherent tensions
in the social care system. Conditions that are most attractive for quality person-centered
social care (e.g., highly literate, highly familiar) are also the very ones that render shared
decision-making less attractive. Conversely, conditions that are least ideal for quality
person-centered social care, such as experiencing age-related declines in mental functioning,
make shared decision-making ever more important in delivering responsive care. Therefore,
how rapidly people shift from one extreme to the other is an important factor in social care.
The impact model of shared decision-making recognizes person-centered social care as
a complex and dynamic process involving multiple factors and agents. More importantly,
it illustrates how shared decision-making with carers may help older adults get the care
they want. One prime example showcasing the benefit of carers can be found in Braun and
colleagues’ [
85
] randomized controlled trial, which compared the effects of employing care
managers to help Medicare beneficiaries navigate decision-making about cancer screening
against standard cancer education. They showed that by sharing the process with Medicare
beneficiaries, care managers were able to significantly increase various cancer screening
uptake (e.g., breast cancer, prostate cancer), even in groups with significant disparities (e.g.,
Hawaiian, Filipino, Japanese) [
85
]. Likewise, informal carers are usually close acquaintances
who live in close proximity or share a close relationship with the older adult they care for. As
a result, informal carers tend to have shared lived experience, shared understanding of the
situation, and shared expectations of the future, which make them highly knowledgeable
about the needs and preferences of those whom they care for [
86
]. This puts informal carers
in a good position to enable person-centered social care as they can help older adults meet
physical and relational needs directly, and serve as surrogate decision-makers in end-of-life
care [87].
Overall, carers are a crucial and increasingly fundamental component of person-
centered social care. They are not only information agents (e.g., nudge advance planning,
help with information search), but can also contribute directly to a person’s wellbeing (e.g.,
assist with commutes to a hospital).
4.2. Theoretical Implications
Existing social care policies that promote choice and information in the system over-
look the barriers of engaging in the topic itself, much less the difficulty of navigating
through the myriad of care options, each with its own costs, benefits, and potential to
change over time. Efforts to promote quality social care should be both broad in tackling
the various behavioral factors as well as tailored in adapting interventions to suit the needs
of specific population groups. In so far as the individual is cognitively capable, these
nudges to support decision-making should improve the odds of obtaining care that is
aligned to their needs and preferences. On the flip side, carers are set to play a starring
role in quality social care as individuals begin to suffer losses in cognitive, sensory, and
motor functioning. Figure 1is the first conceptual model to indicate the areas and degrees
of responsibility wherein a shared relationship, as opposed to an autonomous one, might
be more beneficial for person-centered social care. Therefore, the ability of carers—both
formal and informal—is another important quality dimension in social care.
In addition, several factors allude to the role of perceived psychological safety in
motivating decision-making about social care. Health deterioration, a distrust in family
members, and a poor perception of nursing homes may threaten a person’s perceived sense
of safety and motivate preparation and planning. Relatedly, emotional regulation may be
another important factor in modulating a person’s response to threats concerning their
wellbeing. Many issues in social care can trigger negative and aversive feelings in people.
Studies suggest that people who can regulate their emotions effectively often make more
accurate risk perceptions [
88
], are more resourceful in coping with challenges [
89
], and are
more likely to voice problems [
90
]. Consequently, people with this ability stand to gain the
most from person-centered social care; they are not only better equipped to make objective
Int. J. Environ. Res. Public Health 2022,19, 4334 10 of 14
evaluations but are also more capable of doing so in times of uncertainty and duress. A
person’s ability to regulate their own emotion may be a crucial factor in person-centered
decision-making about social care.
4.3. Practical Implications
This review has shown that decision-making is susceptible to a range of behavioral
influences. At the same time, it has also highlighted the value of effective communication
in promoting person-centered decision-making. One such avenue would be to improve
the science behind information and choice presentation to lay individuals. A review,
commissioned by the Agency for Healthcare Research and Quality Effective Health Care
Program in the US, examined the use of decision aids for adult advance care planning
from the years 1990 to 2014 [
91
]. The review found that while most studies reported
improvements in individuals’ clarity of preferences, decision knowledge, and decision
confidence, the decision aids in these interventions tended to differ in terms of format,
layout, interactivity as well as accessibility. Given the demonstrable benefits of decision
aids, social care providers could leverage modern technology to make information more
accessible, comprehensible, and customizable. This would allow people to manage their
own cognitive load which could improve the quality of decision-making.
Furthermore, governments and organizations could regulate the structure and content
(e.g., facilities, quality, and costs) in decision aids. Using a clear, standardized format
may promote person-centered decision-making in people. Samanez-Larkin, Wagner, and
Knutson [
92
] studied the impact of aging on financial decision-making by using neuroimag-
ing techniques. The researchers found that using a simplified format to present critical
information reduced the effects of distracting information on participants’ decision quality
(i.e., optimal financial risk-taking), even for those older in age. Information transparency
and standardization are thus key dimensions in person-centered social care and more must
be done to foster such practices in existing providers.
Another possibility for promoting person-centered social care is to create dedicated
services that can help older adults navigate the system. In the UK, several local authorities
have developed ‘single points of access’, which are teams of specialists who are familiar
with the resources in the region and are able to assess and match older adults to the most
appropriate service, based on their needs and preferences [
93
]. Another initiative can be
found in the form of social prescribing, in which general practitioners and other frontline
staff have begun to recommend eligible patients to community-based services instead of
offering only medicalized options [
94
]. These are just some examples of how social care
organizations can help people overcome challenges associated with unfamiliar situations.
More importantly, they lend support to the growing role formal and informal carers play in
delivering social care.
4.4. Limitations
There are some limitations to this paper. Firstly, this literature review is not based on a
systematic search of any specific literature, which makes replication and updating difficult.
To mitigate a possible loss of relevant evidence, this paper relied on an established COM-B
framework in the psychological and health sciences to structure the search. Moreover,
the use of a theory-driven framework allows future researchers to extend beyond the
themes identified in this paper. Secondly, as noted in the review, psychological aspects in
decision-making are only one part of the equation necessary for promoting person-centered
social care. The other concerns the access, availability, costs, and quality of social care
services as well as their coordination in providing high-quality care. Whether psychological
factors or supply-side factors are more responsible for health and care outcomes in older
adults remains an open question, thus demanding further investigation. Thirdly, there is
limited understanding on which COM-B factor most predicts quality social care. While a
proper identification could facilitate policy analysis and refinement of interventions, more
Int. J. Environ. Res. Public Health 2022,19, 4334 11 of 14
randomized controlled trials are needed to advance the science of person-centered social
care.
5. Conclusions
The public is expected to play an increasingly active role in their own social care. In
enabling the general population to do so, considerable emphasis has been placed on giving
people more information, more choice, and more autonomy in deciding how they want to
be cared for. This implicitly assumes that people know what they want—that they have
clear, coherent preferences. It also assumes that people can do what they want—that they
have complete focus and willpower to follow through with action.
However, as this review found, person-centered decision-making in social care is
complex and difficult. Individuals are often unsure of what they want and even if they do,
most people will find that they lack the necessary attention to evaluate all the available
information and options in a careful manner. The aversive nature of social care normally
deters planning and decision-making and as a result, decisions tend to be reactive, rather
than the result of careful forethought.
Shared decision-making is a promising framework for addressing these issues and
promoting person-centered social care. This review has shown how gaps in a person’s capa-
bility, opportunity, motivation, and behavior could be addressed with the involvement of
others in decision-making. In this respect, governments, local authorities, service providers,
and informal carers all form an invaluable part of a person’s ‘social care organization.’ They
offer not just informational aid, but also relational and functional support in overcoming
the various behavioral barriers that impede person-centered social care. For people to get
the care they want, more emphasis should be placed on how decision-making unfolds,
which usually necessitates (or could at least benefit from) the involvement of others. Only
by appreciating the behavioral factors involved can quality person-centered social care be
achieved.
Author Contributions: Conceptualization, E.T., I.V. and S.M.; Methodology, E.T.; Analysis, E.T. and
I.V.; Writing—Original Draft Preparation, E.T.; Writing—Review and Editing, E.T., I.V. and S.M.;
Supervision, I.V. and S.M.; Funding Acquisition, I.V. and S.M. All authors have read and agreed to
the published version of the manuscript.
Funding: This research was partly supported by the UK Consumer Rights Association.
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Data Availability Statement: Not applicable.
Acknowledgments:
We thank Sue Dobson, Daniel Read, and Nick Chater for their insights and
guidance. We would also like to thank the UK Consumer Rights Association for their input and
advice on the topic of social care.
Conflicts of Interest:
The authors declare no conflict of interest. The funders had no role in the design
of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or
in the decision to publish the results.
References
1.
Rosenbaum, S. The Patient Protection and Affordable Care Act: Implications for Public Health Policy and Practice. Public Health
Rep. 2011,126, 130–135. [CrossRef] [PubMed]
2.
Department of Health and Social Care. Care Act Factsheets—GOV.UK. Personal Social Services Adult Social Care Survey.
Available online: https://www.gov.uk/government/publications/care-act-2014- part-1-factsheets/care-act- factsheets#factsheet-
1-general-responsibilities-of-local-authorities-prevention-information-and-advice-and-shaping-the-market-of-care-and-
support-services (accessed on 17 May 2018).
3.
Sudore, R.L.; Schillinger, D.; Katen, M.T.; Shi, Y.; Boscardin, W.J.; Osua, S.; Barnes, D.E. Engaging Diverse English- and Spanish-
Speaking Older Adults in Advance Care Planning: The PREPARE Randomized Clinical Trial. JAMA Intern. Med.
2018
,178,
1616–1625. [CrossRef] [PubMed]
Int. J. Environ. Res. Public Health 2022,19, 4334 12 of 14
4.
Silveira, M.J.; Kim, S.Y.H.; Langa, K.M. Advance Directives and Outcomes of Surrogate Decision Making before Death. N. Engl. J.
Med. 2010,362, 1211–1218. [CrossRef] [PubMed]
5.
Wright, A.A.; Zhang, B.; Ray, A.; Mack, J.W.; Trice, E.; Balboni, T.; Mitchell, S.L.; Jackson, V.A.; Block, S.D.; Maciejewski, P.K.;
et al. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement
adjustment. JAMA J. Am. Med. Assoc. 2008,300, 1665–1673. [CrossRef] [PubMed]
6.
Klingler, C.; In Der Schmitten, J.; Marckmann, G. Does facilitated Advance Care Planning reduce the costs of care near the end of
life? Systematic review and ethical considerations. Palliat. Med. 2016,30, 423–433. [CrossRef]
7.
Shalev, A.; Phongtankuel, V.; Kozlov, E.; Shen, M.J.; Adelman, R.D.; Reid, M.C. Awareness and Misperceptions of Hospice and
Palliative Care: A Population-Based Survey Study. Am. J. Hosp. Palliat. Med. 2017,35, 431–439. [CrossRef]
8.
Ipsos MORI. Public Perceptions of Austerity, Social Care and Personal Data. The State of the State 2017–2018. 2017. Available
online: https://www.ipsos.com/ipsos-mori/en- uk/public-perceptions-austerity-social- care-and-personal-data (accessed on 6
June 2018).
9.
Stein, J.; Löbner, M.; Pabst, A.; König, H.H.; Riedel-Heller, S.G. Unmet care needs in the oldest old with social loss experiences:
Results of a representative survey. BMC Geriatr. 2020,20, 1–11. [CrossRef]
10.
Lintern, S. Nurses Treating Coronavirus Spat at and Called ‘Disease Spreaders.’ Indep. 2020. Available online: https://www.
independent.co.uk/news/health/nurses-coronavirus-nhs-spitting-rcn-covid-19-a9414416.html (accessed on 4 April 2020).
11.
WHO. Coronavirus Disease (COVID-19) Advice for the Public: Mythbusters. Available online: https://www.who.int/
emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters (accessed on 27 July 2021).
12.
Maertens, R.; Roozenbeek, J.; Basol, M.; van der Linden, S. Long-term effectiveness of inoculation against misinformation: Three
longitudinal experiments. J. Exp. Psychol. Appl. 2021,27, 1–16. [CrossRef]
13.
Michie, S.; Atkins, L.; West, R. The Behaviour Change Wheel: A Guide to Designing Interventions; Silverback Publishing: Surrey, UK,
2014.
14. Michie, S.; Johnston, M.; Abraham, C.; Lawton, R.; Parker, D.; Walker, A. Making psychological theory useful for implementing
evidence based practice: A consensus approach. Qual. Saf. Health Care 2005,14, 26–33. [CrossRef]
15.
Michie, S.; West, R.; Sheals, K.; Godinho, C.A. Evaluating the effectiveness of behavior change techniques in health-related
behavior: A scoping review of methods used. Transl. Behav. Med. 2018,8, 212–224. [CrossRef]
16. Buchanan, A. Mental capacity, legal competence and consent to treatment. J. R. Soc. Med. 2004,97, 415. [CrossRef]
17.
Bakk, L.; Cadet, T.J. Awareness of the Medicare Part D Low-Income Subsidy among Older non-Hispanic Blacks and Hispanics.
Soc. Work Public Health 2018,33, 250–258. [CrossRef]
18.
NatCen Social Research. Public satisfaction with the NHS and social care in 2018: Results from the British Social Attitudes
survey. Available online: https://www.nuffieldtrust.org.uk/research/public-satisfaction-with-the-nhs-and-social-care-in-2018.
(accessed on 15 January 2020).
19.
Detering, K.M.; Hancock, A.D.; Reade, M.C.; Silvester, W. The impact of advance care planning on end of life care in elderly
patients: Randomised controlled trial. BMJ 2010,340, c1345. [CrossRef]
20.
Adams, G.A.; Rau, B.L. Putting off tomorrow to do what you want today: Planning for retirement. Am. Psychol.
2011
,66, 180–192.
[CrossRef]
21.
Bayer, P.; Bernheim, B.D.; Scholz, J.K. The Effects of Financial Education in the Workplace: Evidence from a Survey of Employers.
Econ. Inq. 1996,47, 605–624. [CrossRef]
22.
Protheroe, J.; Nutbeam, D.; Rowlands, G. Health literacy: A necessity for increasing participation in health care. Br. J. Gen. Pract.
2009,59, 721–723. [CrossRef]
23.
Montori, V.M.; Rothman, R.L. Weakness in numbers: The challenge of numeracy in health care. J. Gen. Intern. Med.
2005
,20,
1071–1072. [CrossRef]
24.
Peters, E.; Hibbard, J.; Slovic, P.; Dieckmann, N. Numeracy skill and the communication, comprehension, and use of risk-benefit
information. Health Aff. 2007,26, 741–748. [CrossRef]
25.
Nouri, S.S.; Barnes, D.E.; Volow, A.M.; McMahan, R.D.; Kushel, M.; Jin, C.; Boscardin, J.; Sudore, R.L. Health Literacy Matters
More Than Experience for Advance Care Planning Knowledge Among Older Adults. J. Am. Geriatr. Soc.
2019
,67, 2151–2156.
[CrossRef]
26.
Waite, K.R.; Federman, A.D.; McCarthy, D.M.; Sudore, R.; Curtis, L.M.; Baker, D.W.; Wilson, E.A.H.; Hasnain-Wynia, R.; Wolf,
M.S.; Paasche-Orlow, M. Literacy and race as risk factors for low rates of advance directives in older adults. J. Am. Geriatr. Soc.
2013,61, 403–406. [CrossRef]
27.
McCaffery, K.J.; Holmes-Rovner, M.; Smith, S.K.; Rovner, D.; Nutbeam, D.; Clayman, M.L.; Kelly-Blake, K.; Wolf, M.S.; Sheridan,
S.L. Addressing health literacy in patient decision aids. BMC Med. Inform. Decis. Mak. 2013,13, S10. [CrossRef]
28.
Stacey, D.; Légaré, F.; Lewis, K.; Barry, M.J.; Bennett, C.L.; Eden, K.B.; Holmes-Rovner, M.; Llewellyn-Thomas, H.; Lyddiatt, A.;
Thomson, R.; et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst. Rev.
2017
,
2017, CD001431. [CrossRef]
29. Mullick, A.; Martin, J.; Sallnow, L. An introduction to advance care planning in practice. BMJ 2013,347, f6064. [CrossRef]
30.
Croucher, K. Housing Choices and Aspirations of Older People. Available online: https://housingcare.org/resources/housing-
choices-and-aspirations-of-older-people/ (accessed on 5 June 2018).
31. Steptoe, A.; Deaton, A.; Stone, A.A. Subjective wellbeing, health, and ageing. Lancet 2015,385, 640–648. [CrossRef]
Int. J. Environ. Res. Public Health 2022,19, 4334 13 of 14
32.
Clissett, P.; Porock, D.; Harwood, R.H.; Gladman, J.R.F. Experiences of family carers of older people with mental health problems
in the acute general hospital: A qualitative study. J. Adv. Nurs. 2013,69, 2707–2716. [CrossRef] [PubMed]
33.
Lyon, M.E.; Jacobs, S.; Briggs, L.; Cheng, Y.I.; Wang, J. Family-centered advance care planning for teens with cancer. JAMA Pediatr.
2013,167, 460–467. [CrossRef] [PubMed]
34.
Henning-Smith, C.E.; Gonzales, G.; Shippee, T.P. Barriers to Timely Medical Care for Older Adults by Disability Status and
Household Composition. J. Disabil. Policy Stud. 2016,27, 116–127. [CrossRef]
35.
Gross, J.J.; Levenson, R.W. Hiding feelings: The acute effects of inhibiting negative and positive emotion. J. Abnorm. Psychol.
1997
,
106, 95–103. [CrossRef]
36.
Powell, J.; Mackintosh, S.; Bird, E.; Ige, J.; Garrett, H.; Roys, M. The Role of Home Adaptations in Improving Later Life.
Available online: https://ageing-better.org.uk/sites/default/files/2017-12/The%20role%20of%20home%20adaptations%20
in%20improving%20later%20life.pdf (accessed on 3 July 2018).
37.
Festinger, L. A Theory of Cognitive Dissonance. Available online: https://psycnet.apa.org/record/1993-97948-000 (accessed on
27 May 2018).
38.
Sniehotta, F.F.; Scholz, U.; Schwarzer, R. Bridging the intention–behaviour gap: Planning, self-efficacy, and action control in the
adoption and maintenance of physical exercise. Psychol. Health 2005,20, 143–160. [CrossRef]
39. Ajzen, I. The theory of planned behavior. Organ. Behav. Hum. Decis. Process. 1991,50, 179–211. [CrossRef]
40.
Jacobs-Lawson, J.M.; Hershey, D.A. Influence of future time perspective, financial knowledge, and financial risk tolerance on
retirement saving behaviors. Financ. Serv. Rev. 2005,14, 331–344.
41.
Stawski, R.S.; Hershey, D.A.; Jacobs-Lawson, J.M. Goal clarity and financial planning activities as determinants of retirement
savings contributions. Int. J. Aging Hum. Dev. 2007,64, 13–32. [CrossRef]
42. Kahneman, D.; Tversky, A. The Psychology of Preferences. Sci. Am. 1982,246, 160–173. [CrossRef]
43. Kahneman, D. Thinking, Fast and Slow; Farrar, Straus and Giroux: New York, NY, USA, 2011.
44. Read, D.; Read, N.L. Time discounting over the lifespan. Organ. Behav. Hum. Decis. Process. 2004,94, 22–32. [CrossRef]
45.
Loewenstein, G.; Read, D.; Baumeister, R.F. Time and Decision: Economic and Psychological Perspectives on Intertemporal Choice;
Russell Sage Foundation: New York, NY, USA, 2003.
46.
Hershfield, H.E. Future self-continuity: How conceptions of the future self transform intertemporal choice. Ann. N. Y. Acad. Sci.
2011,1235, 30–43. [CrossRef]
47.
Schlam, T.R.; Wilson, N.L.; Shoda, Y.; Mischel, W.; Ayduk, O. Preschoolers’ delay of gratification predicts their body mass 30
years later. J. Pediatr. 2013,162, 90–93. [CrossRef]
48.
Laibson, D.I.; Repetto, A.; Tobacman, J.; Hall, R.E.; Gale, W.G.; Akerlof, G.A. Self-Control and Saving for Retirement. Brook. Pap.
Econ. Act. 1998,1998, 91–196. [CrossRef]
49.
Michaelson, L.; de la Vega, A.; Chatham, C.H.; Munakata, Y. Delaying gratification depends on social trust. Front. Psychol.
2013
,4,
355. [CrossRef]
50.
Henning-Smith, C.E.; Shippee, T.P. Expectations about future use of long-term services and supports vary by current living
arrangement. Health Aff. 2015,34, 39–47. [CrossRef]
51. Reyna, V.F.; Brainerd, C.J. Fuzzy-trace theory: An interim synthesis. Learn. Individ. Differ. 1995,7, 1–75. [CrossRef]
52.
Behavioural Insights Team. Helping People Make Better Decisions in the Care Home Market. Available online: https://assets.
publishing.service.gov.uk/media/5a1fd914ed915d458b922ec0/bit-cma-care-home-market-report.pdf (accessed on 18 May 2018).
53.
Szanton, S.L.; Wolff, J.W.; Leff, B.; Thorpe, R.J.; Tanner, E.K.; Boyd, C.; Xue, Q.; Guralnik, J.; Bishai, D.; Gitlin, L. CAPABLE trial: A
randomized controlled trial of nurse, occupational therapist and handyman to reduce disability among older adults: Rationale
and design. Contemp. Clin. Trials 2014,38, 102–112. [CrossRef]
54.
Szanton, S.L.; Xue, Q.-L.; Leff, B.; Guralnik, J.; Wolff, J.L.; Tanner, E.K.; Boyd, C.; Thorpe, R.J.; Bishai, D.; Gitlin, L.N. Effect of a
Biobehavioral Environmental Approach on Disability Among Low-Income Older Adults: A Randomized Clinical Trial. JAMA
Intern. Med. 2019,179, 204–211. [CrossRef]
55.
Vaportzis, E.; Giatsi Clausen, M.; Gow, A.J. Older Adults Perceptions of Technology and Barriers to Interacting with Tablet
Computers: A Focus Group Study. Front. Psychol. 2017,8, 1687. [CrossRef]
56.
Steinman, M.A.; Perry, L.; Perissinotto, C.M. Meeting the Care Needs of Older Adults Isolated at Home During the COVID-19
Pandemic. JAMA Intern. Med. 2020,180, 819–820. [CrossRef]
57. Johnson, E.J.; Russo, J.E. Product Familiarity and Learning New Information. J. Consum. Res. 1984,11, 542–550. [CrossRef]
58.
Wood, S.L.; Lynch, J.G. Prior Knowledge and Complacency in New Product Learning. J. Consum. Res.
2002
,29, 416–426.
[CrossRef]
59.
Fulmer, T.; Reuben, D.B.; Auerbach, J.; Fick, D.M.; Galambos, C.; Johnson, K.S. Actualizing Better Health and Health Care for
Older Adults. Health Aff. 2021,40, 219–225. [CrossRef]
60. Simon, H.A. A Behavioral Model of Rational Choice. Q. J. Econ. 1955,69, 99–118. [CrossRef]
61. Tversky, A.; Kahneman, D. The framing of decisions and the psychology of choice. Science 1981,211, 453–458. [CrossRef]
62. Kahneman, D.; Tversky, A. Prospect Theory: An Analysis of Decision under Risk. Econometrica 1979,47, 263–292. [CrossRef]
63.
Winter, L.; Moss, M.S.; Hoffman, C. Affective forecasting and advance care planning: Anticipating quality of life in future health
statuses. J. Health Psychol. 2009,14, 447–456. [CrossRef] [PubMed]
64. Dionigi, R.A. Stereotypes of Aging: Their Effects on the Health of Older Adults. J. Geriatr. 2015,2015, 954027. [CrossRef]
Int. J. Environ. Res. Public Health 2022,19, 4334 14 of 14
65.
Auman, C.; Bosworth, H.B.; Hess, T.M. Effect of health-related stereotypes on physiological responses of hypertensive middle-
aged and older men. J. Gerontol. Ser. B 2005,60, 3–10. [CrossRef] [PubMed]
66.
Levy, B.; Ashman, O.; Dror, I. To be of not to be: The effects of aging stereotypes on the will to live. Omega
2000
,40, 409–420.
[CrossRef]
67.
Eppler, M.J.; Mengis, J. The Concept of Information Overload: A Review of Literature from Organization Science, Accounting,
Marketing, MIS, and Related Disciplines. Inf. Soc. 2004,20, 325–344. [CrossRef]
68. Jacoby, J. Comments Perspectives on Information Overload. J. Consum. Res. 1984,10, 432–435. [CrossRef]
69.
Besede
ˆ
s, T.; Deck, C.; Sarangi, S.; Shor, M. Age effects and heuristics in decision making. Rev. Econ. Stat.
2012
,94, 580–595.
[CrossRef]
70.
Mata, R.; Pachur, T.; von Helversen, B.; Hertwig, R.; Rieskamp, J.; Schooler, L. Ecological Rationality: A Framework for
Understanding and Aiding the Aging Decision Maker. Front. Neurosci. 2012,6, 19. [CrossRef]
71.
Shamaskin, A.M.; Mikels, J.A.; Reed, A.E. Getting the message across: Age differences in the positive and negative framing of
health care messages. Psychol. Aging 2010,25, 746–751. [CrossRef]
72.
Mata, R.; Nunes, L. When Less Is Enough: Cognitive Aging, Information Search, and Decision Quality in Consumer Choice.
Psychol. Aging 2010,25, 289–298. [CrossRef]
73.
Botti, S.; Iyengar, S.S. The Dark Side of Choice: When Choice Impairs Social Welfare. J. Public Policy Mark.
2006
,25, 24–38.
[CrossRef]
74.
Iyengar, S.S.; Lepper, M.R. When Choice is Demotivating: Can One Desire Too Much of a Good Thing? J. Pers. Soc. Psychol.
2000
,
79, 995–1006. [CrossRef]
75.
Schwartz, B.; Ward, A.; Monterosso, J.; Lyubomirsky, S.; White, K.; Lehman, D.R. Maximizing versus satisficing: Happiness is a
matter of choice. J. Pers. Soc. Psychol. 2002,83, 1178–1197. [CrossRef]
76.
Kaiser Family Foundation. Kaiser Health Poll Report Survey—Selected Findings on Seniors’ Views of the Medicare Prescrip-
tion Drug Benefit. Available online: https://www.kff.org/medicare/poll-finding/kaiser-health-poll-report-survey-selected-
findings/ (accessed on 17 May 2018).
77.
Hanoch, Y.; Rice, T.; Cummings, J.; Wood, S. How much choice is too much? the case of the medicare prescription drug benefit.
Health Serv. Res. 2009,44, 1157–1168. [CrossRef]
78.
Loewenstein, G. Out of control: Visceral influences on behavior. Organ. Behav. Hum. Decis. Process.
1996
,65, 272–292. [CrossRef]
79.
Nordgren, L.F.; van der Pligt, J.; van Harreveld, F. The instability of health cognitions: Visceral states influence self-efficacy and
related health beliefs. Health Psychol. 2008,27, 722–727. [CrossRef]
80.
Ariely, D.; Loewenstein, G. The heat of the moment: The effect of sexual arousal on sexual decision making. J. Behav. Decis. Mak.
2006,19, 87–98. [CrossRef]
81. Loewenstein, G. Hot-cold empathy gaps and medical decision making. Health Psychol. 2005,24, S49–S56. [CrossRef]
82.
Van Boven, L.; Loewenstein, G. Social projection of transient drive states. Pers. Soc. Psychol. Bull.
2003
,29, 1159–1168. [CrossRef]
83. Ariely, D. Predictably Irrational: The Hidden Forces That Shape Our Decisions; Harper: London, UK, 2010.
84. Zeelenberg, M.; Pieters, R. A Theory of Regret Regulation 1.0. J. Consum. Psychol. 2007,17, 3–18. [CrossRef]
85.
Braun, K.L.; Thomas, W.L.; Domingo, J.L.B.; Allison, A.L.; Ponce, A.; Haunani Kamakana, P.; Brazzel, S.S.; Aluli, N.E.; Tsark, J.U.
Reducing cancer screening disparities in medicare beneficiaries through cancer patient navigation. J. Am. Geriatr. Soc.
2015
,63,
365–370. [CrossRef]
86.
Sudore, R.L.; Fried, T.R. Redefining the “planning” in advance care planning: Preparing for end-of-life decision making. Ann.
Intern. Med. 2010,153, 256–261. [CrossRef]
87.
Song, M.-K.; Ward, S.E.; Fine, J.P.; Hanson, L.C.; Lin, F.-C.; Hladik, G.A.; Hamilton, J.B.; Bridgman, J.C. Advance Care Planning
and End-of-Life Decision Making in Dialysis: A Randomized Controlled Trial Targeting Patients and Their Surrogates. Am. J.
Kidney Dis. 2015,66, 813–822. [CrossRef]
88.
Heilman, R.M.; Cri¸san, L.G.; Houser, D.; Miclea, M.; Miu, A.C. Emotion Regulation and Decision Making Under Risk and
Uncertainty. Emotion 2010,10, 257–265. [CrossRef]
89.
Huy, Q.; Zott, C. Exploring the affective underpinnings of dynamic managerial capabilities: How managers’ emotion regulation
behaviors mobilize resources for their firms. Strat. Manag. J. 2019,40, 28–54. [CrossRef]
90.
Grant, A.M. Rocking the Boat but Keeping It Steady: The Role of Emotion Regulation in Employee Voice. Acad. Manag. J.
2013
,56,
1703–1723. [CrossRef]
91.
Butler, M.; Ratner, E.; McCreedy, E.; Shippee, N.; Kane, R.L. Decision aids for advance care planning: An overview of the state of
the science. Ann. Intern. Med. 2014,161, 408–418. [CrossRef]
92.
Samanez-Larkin, G.R.; Wagner, A.D.; Knutson, B. Expected value information improves financial risk taking across the adult life
span. Soc. Cogn. Affect. Neurosci. 2011,6, 207–217. [CrossRef]
93.
NHS Improvement. Referrals and Single Points of Access 2019. Available online: https://improvement.nhs.uk/resources/
referrals-and-single-points-access/ (accessed on 4 February 2020).
94.
The King’s Fund. What is Social Prescribing? Available online: https://www.kingsfund.org.uk/publications/social-prescribing
(accessed on 2 February 2020).
