The decision-making process for unplanned admission to hospital unveiled in hospitalised older adults: a qualitative study

Abstract

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.

Comprehensive Geriatric Assessment and Clinical Outcomes in the Older People at the Emergency Department

“…A healthy patient may benefit from their ability to make their own decisions, while also offering relief to his/her caregiver and, thus, lessening their burden. These findings are consistent with a previous study that revealed unplanned admission was based upon a combination of factors including oneself, the family, and the physician [ 41 ]. Secondly, nearly half of the patients visiting EDs were experiencing cognitive impairment, with one third displaying symptoms of depression.…”

The dialogue as decision support; lived experiences of extended collaboration when an ambulance is called

“…Patients perceive optimal care as available, with continuity and adjusted to their needs (Bayliss et al, 2008 ). The decision to call for an ambulance is taken acutely by older patients or significant others (Van der Kluit et al, 2018 ). Factors leading to the decision are situations that cannot be self-handled and when no other choice exists (Booker et al, 2017 ; Van der Kluit et al, 2018 ).…”

Urgent assessment and ongoing care for infection in community-dwelling older people: a qualitative study of patient experience

“…Older people in this study also described a number of advantages of hospital not previously mentioned by GPs, 11 including the convenience of having assistance with everyday tasks, the security of regular monitoring and reduced burden and worry for family/caregivers compared with staying at home. These views are echoed in several existing qualitative studies exploring older patients views of a hospital stay in other European countries 23 24 and in the response of a survey of older patients in the USA. 25 …”