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Gerontologist. 2019 Jun 1. pii: gnz075. doi: 10.1093/geront/gnz075. [Epub ahead of print]

A Preference-Based Model of Care: An Integrative Theoretical Model of the Role of Preferences in Person-Centered Care.

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College of Nursing, The Pennsylvania State University, University Park.
Department of Sociology and Gerontology, Miami University, Oxford, Ohio.
Mayo Clinic College of Medicine, Mayo Clinic Robert D. and Patricia E. Kern Center for Healthcare Delivery, Rochester, Minnesota.
Independent Research Consultant, Ardmore, Pennsylvania.


Knowledge of individuals' everyday preferences is a cornerstone of person-centered care (PCC). Initial evidence demonstrates the positive impact of honoring preferences in care for older adults receiving long-term services and supports (LTSS). Yet, the mechanisms through which preference-based care affects individual well-being remain poorly understood. This article proposes a theoretical model of PCC entitled the Preference-Based Model of Care that integrates the Theory of Human Motivation, Self-determination Theory, the Competence-Press Model of person and environment fit, the Living Systems Framework, and the Broaden-and-Build theory of positive emotions to deepen our understanding of the processes through which preference-based care affects well-being among older adults receiving LTSS. The Preference-Based Model of Care illustrates how goal-directed behaviors facilitate need fulfillment through the expression of individual preferences and how these behaviors mediate the relationship between person-environment fit and affect balance within a particular social, cultural, and political context. The Preference-Based Model of Care can advance research on PCC in LTSS and can inform LTSS clinical practice guidelines for older adults, regardless of functional or cognitive capacity.


Long-term care; Person–environment fit; Preference-based care; Theory


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