ObjectivesSince the population continues ageing and the number of patients with multiple chronic diseases is rising in Western countries, a shift is recommended from disease oriented towards goal-oriented healthcare. As little is known about individual goals and preferences of older hospitalised patients, the aim of this study is to elucidate the goals of a diverse group of older hospitalised patients.DesignQualitative descriptive method with open interviews analysed with inductive content analysis.SettingA university teaching hospital and a regional teaching hospital.ParticipantsTwenty-eight hospitalised patients aged 70 years and older.ResultsSome older hospitalised patients initially had difficulties describing concrete goals, but after probing all were able to state more concrete goals. A great diversity of goals were categorised into wanting to know what the matter is, controlling disease, staying alive, improving condition, alleviating complaints, improving daily functioning, improving/maintaining social functioning, resuming work/hobbies and regaining/maintaining autonomy.ConclusionsOlder hospitalised patients have a diversity of goals in different domains. Discussing goals with older patients is not a common practice yet. Timely discussions about goals should be encouraged because individual goals are not self-evident and this discussion can guide decision making, especially in patients with multimorbidity and frailty. Aids can be helpful to facilitate the discussion about goals and evaluate the outcomes of hospitalisation.

An estimated 40% of patients in general health care settings suffer from a comorbid mental illness. A literature review was conducted to elucidate the factors underlying the different attitudes of nurses in general health care toward the nursing care of these patients. Although lack of knowledge, skills, and additional training with respect to dealing with patients with comorbid mental illness were frequently mentioned as a cause of negative attitudes, their exact relationships remained unclear. A holistic nursing vision, support, and older age were described as having a positive influence on a positive attitude, and workload was described as having a negative influence.

BackgroundThe hazards of hospitalisation, and the growing demand for goal-oriented care and shared decision making, increasingly question whether hospitalisation always aligns with the preferences and needs of older adults. Although decision models are described comprehensively in the literature, little is understood about how the decision for hospitalisation is made in real life situations, especially under acute conditions. The aim of this qualitative study was to gain insight into how the decision to hospitalise was made from the perspective of the older patient who was unplanned admitted to hospital.MethodsOpen interviews were conducted with 21 older hospitalised patients and/or their next of kin about the decision-making process leading to hospitalisation. Data were analysed according to the Constructivist Grounded Theory approach.ResultsAlthough a period of complaints preceded the decision to unplanned hospitalisation, ranging from hours to years, the decision to hospitalise was always taken acutely. In all cases, there was an acute moment in which the home as a care environment was no longer considered adequate. This conclusion was based on a combination of factors including factors related to complaints, general practitioner and home environment. Three parties were involved in this assessment: the patient, his next of kin and the general practitioner. At the same time, a very positive value was attributed towards the hospital. Depending on the assessment of the home as care environment by the various parties, there were four routes to hospitalisation: referral, shared, demanding and bypassing.ConclusionsFor all participants, the decision to hospitalisation was taken acutely, even if the problems evoking admission were not acute, but present for a longer period. Participants saw admission as inevitable, due to the negative perceptions of the care environment at home at that moment, combined with the positive expectations of hospital care. Advance care planning, nor shared decision making were rarely seen in these interviews. An ethical dilemma occurred when the next of kin consented to hospitalisation against the wishes of the patient. More attention for participation of older adults in decision making and their goals is recommended.