Unmet and Unimportant Preferences Among Nursing Home Residents: What Are Key Resident and Facility Factors?

Yinfei Duan, Tetyana P. Shippee, Weiwen Ng, Odichinma Akosionu, Mark Woodhouse, Haitao Chu, Jasjit S. Ahluwalia, Joseph E. Gaugler, Beth A. Virnig, John R. Bowblis

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Objectives: The Preferences Assessment Tool (PAT) in the Minimum Data Set (MDS) 3.0 assesses 16 resident preferences for daily routines and activities. Although integrating important preferences into care planning is essential to provide person-centered care in nursing homes (NHs), preferences rated as important but unmet or unimportant may not receive much attention. This study aims to (1) identify the prevalence of unmet preferences and unimportant preferences, and (2) examine their associations with resident and facility-level characteristics. Design: This is a longitudinal study of residents in NHs. Settings and Participants: We used data from 2012–2017 MDS assessments of long-stay residents aged 65 or older in 295 Minnesota NHs. In total, 51,859 assessments from 25,668 residents were included. Methods: Generalized linear mixed models were used to analyze resident and facility-level characteristics associated with having any unmet preferences, and with the number of unimportant preferences. Results: Across all years for both daily routine preferences and activity preferences, 3.3% to 5.1% of residents reported that at least 1 or more preference was important but unmet, and 10.0% to 16.6% reported that 4 or more out of the 8 preferences were unimportant. Residents with higher depressive symptoms, and poorer physical and sensory function were more likely to report unmet preferences. Residents with poorer physical and sensory function, and living in rural facilities and facilities having fewer activity staff hours per resident day were more likely to report unimportant preferences. Conclusions and Implications: Residents with functional and sensory limitations and living in underresourced NHs are more likely to report that preferences are unimportant, or that they are important but unmet. It is important for staff to elicit preferences that truly matter for residents, and to enable residents to meet their preferences.

Original languageEnglish (US)
Pages (from-to)1712-1717
Number of pages6
JournalJournal of the American Medical Directors Association
Issue number11
StatePublished - Nov 2020

Bibliographical note

Funding Information:
The authors thank the National Institute on Minority Health Disparities for their support of this research (Grant 5R01MD010729-04 ).

Funding Information:
This work was supported by the National Institute on Minority Health and Health Disparities (Grant 100006545 ).

Publisher Copyright:
© 2020 AMDA — The Society for Post-Acute and Long-Term Care Medicine


  • Nursing homes
  • long-term care
  • older adults
  • person-centered care
  • quality of life
  • resident preferences


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