Attending Alone Does Not Mean Managing Alone: A Cross-sectional Study of Treatment-related Challenges and Caregiver Needs among Older Adults in a Geriatric Outpatient Clinic

Technical Summary: Attending Alone Does Not Mean Managing Alone

Problem Statement
While the global population is aging rapidly, leading to increased demand for geriatric healthcare, there is a growing trend of older adults attending outpatient clinics independently due to changing family structures, urbanization, and shrinking household sizes. Although independent attendance may appear to reflect patient autonomy, it remains unclear whether these individuals possess the capacity to independently manage complex medical treatments without caregiver support. In the Indian context, where family involvement has traditionally been central to healthcare access, the implications of unaccompanied visits on treatment understanding, recall, and adherence are not well-documented. This study addresses the gap in evidence regarding the prevalence of unaccompanied geriatric outpatient visits and the associated medical, logistic, and treatment-related challenges faced by these patients.

Methodology
This was a hospital-based, cross-sectional observational study conducted at the Geriatric Outpatient Department of the National Centre for Ageing (NCA), All India Institute of Medical Sciences (AIIMS), New Delhi, between September 2025 and February 2026.

• Participants: The study included 400 older adults (aged ≥65 years) attending the outpatient department. Eligible participants were those capable of providing written informed consent and participating in face-to-face interviews. Exclusion criteria included critical illness, emergency referral requirements, severe cognitive impairment, or major communication difficulties.
• Sampling: Participants were recruited consecutively until the target sample size was reached, with approximately 10 eligible participants enrolled daily. Only the first outpatient encounter per participant during the recruitment period was included to avoid duplicate observations.
• Data Collection: Data were gathered via structured face-to-face interviews using a predesigned questionnaire developed by the investigators following a literature review and expert consultation. The instrument assessed sociodemographic characteristics, accompaniment status, reasons for attending alone, hospital-related challenges, understanding of prescribed treatment, adherence difficulties, follow-up issues, and perceived caregiver needs.
• Analysis: Data were analyzed using descriptive statistics (frequencies, percentages, means, medians) via SPSS. Exploratory comparisons between those attending alone and those accompanied were attempted, but inferential or multivariable analyses were not performed due to the extremely small size of the accompanied group (n=8).

Key Results

• Prevalence of Unaccompanied Visits: A striking 98.0% (392/400) of participants reported that they usually attended the geriatric outpatient department alone. The mean number of independent visits in the preceding six months was 2.8.
• Reasons for Attending Alone: The primary drivers for unaccompanied attendance were:
  • Preference for independence in managing one's own health (89.3%).
  • Reluctance to burden family members (87.8%).
  • Non-availability of family members (67.8%).
  • Confidence in using public transport (58.8%).
  • Financial constraints regarding bringing an accompanist (41.5%).
• Hospital-Related Challenges: Logistic difficulties within the hospital were relatively uncommon. Only 5.5% reported frequent difficulty understanding doctors' instructions, and 3.0% reported difficulty navigating the hospital for investigations or medications. Emotional stress and fear of being alone were reported by less than 3% of participants.
• Treatment-Related Challenges: Despite high rates of independent attendance, significant gaps in self-management were observed:
  • While 77.8% reported clear understanding of prescribed medications, 22.3% often or always required caregiver support for treatment adherence.
  • 5.5% frequently had difficulty remembering doctors' instructions.
  • 4.3% struggled to remember the treatment plan.
  • 3.0% experienced difficulty attending follow-up visits independently.
  • Conversely, 94.5% reported being able to follow diet or exercise advice.

Key Contributions
The study provides empirical evidence from a tertiary care setting in India demonstrating that unaccompanied attendance is the dominant pattern among older adults seeking geriatric care. Crucially, it establishes that physical independence in accessing the clinic does not equate to functional independence in managing treatment. The research highlights a specific "vulnerability gap" where patients can navigate the hospital environment but struggle with the cognitive and behavioral aspects of long-term treatment adherence and recall.

Significance and Claims
The paper claims that independent attendance should not be automatically interpreted as complete self-sufficiency in treatment-related decision-making or long-term self-management. The authors argue that a clinically relevant minority of older adults attending alone still require caregiver support for adherence and recall of medical advice.

Consequently, the study advocates for a shift in geriatric outpatient services to recognize this distinction. The authors suggest that healthcare providers should not assume that independent attendees can retain and implement all recommendations without support. Instead, services should be strengthened to include:

• Enhanced communication strategies.
• Provision of clear written instructions (e.g., large print, medication summaries).
• Active involvement of caregivers whenever needed, even if the patient attends the visit alone.

The authors conclude that these patient-centered interventions are necessary to bridge the gap between physical access to care and the effective continuity of care, thereby promoting safer and more responsive outcomes for older adults. The study acknowledges its limitations, including its single-center design, reliance on self-reported data, and cross-sectional nature, which precludes causal inferences.