Given the choice, 54 percent of older Americans with acute illnesses would prefer to be cared for in a hospital, rather than in their homes, even if home and hospital provide the same outcome, according to a Yale study.
"This dispels the myth that older persons are more interested in comfort than in cure," said Terri Fried, M.D., assistant professor of medicine at Yale School of Medicine and the study's principal investigator.
Many assumptions have been made about older persons' wishes, Fried said, but they have never been directly asked which environment they prefer. This study is one of the first to do that.
Published in the May 22 issue of Archives of Internal Medicine, Fried's study found that people aged 65 or older with acute illnesses such as congestive heart failure, chronic obstructive pulmonary disease and pneumonia, are varied in their preferences for home vs. hospital care. Home is a viable option only if it provides outcomes equally as good as the hospital. But if the home and hospital provide the same outcomes, many older persons would still prefer to be cared for in the hospital. Those preferring hospital care were most likely to change their preference if physician housecalls were provided and if their doctors thought home would be a better option for them.
The advent of managed care has increasingly shifted the care of acute illness from the hospital to the home, which is rapidly expanding as a site of treatment for older persons and can even be used to substitute for the hospital. According to the study, there is a possibility that newly developing systems of care may not be meeting the needs and preferences of older patients.
Fried said treatment site preference is highly correlated with perceptions of the home and hospital. Those preferring home care view the home as a comfortable place to be cared for, while those preferring the hospital view the hospital as more comfortable and safer. This group also believes that treatment at home would place a burden on their families and friends.
"This study implies that home care will be a feasible alternative to hospital care only to the extent that it can be clearly proven to be as safe and efficacious as hospital care and that physicians are able and willing to provide housecalls to patients," Fried said. "But even if these conditions are met, there is a group of patients who will still prefer to be cared for in the hospital."
Fried adds, "If patient preferences are to inform medical decision-making, then physicians need to elicit the preferences of individual patients and there needs to be a choice in the system of care provided to older persons."
Fried's research team included Carol Van Doorn, associate research scientist in medicine at Yale; John R. O'Leary, research associate in Yale's Program on Aging; Mary E. Tinetti, M.D., professor of medicine at Yale; and Margaret A. Drickamer, M.D., associate professor of medicine at Yale and at the VA Connecticut Healthcare System.
Journal
Archives of Internal Medicine