University of Groningen, University Medical Center Groningen, University Center for Geriatric Medicine, Hanzeplein 1, 9700, RB, Groningen, The Netherlands.
University of Groningen, University Medical Center Groningen, Department of Health Sciences, Applied Health Research, Hanzeplein 1, 9700, RB, Groningen, The Netherlands.
BMC Geriatr. 2018 Dec 22;18(1):318. doi: 10.1186/s12877-018-1013-y.
The 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.
Open 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.
Although 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.
For 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.
住院的风险，以及对以目标为导向的护理和共同决策日益增长的需求，越来越多地质疑住院是否始终符合老年人的偏好和需求。尽管决策模型在文献中得到了全面描述，但对于在现实生活中，尤其是在急性情况下，如何做出住院决策，人们知之甚少。本 qualitative 研究的目的是深入了解未计划住院的老年患者从自身角度看待住院决策的过程。
对 21 名住院的老年患者及其家属或近亲进行了开放式访谈，了解导致住院的决策过程。根据建构主义扎根理论方法对数据进行分析。
尽管在决定非计划性住院之前，患者会经历一段时间的抱怨，从几小时到几年不等，但住院的决定总是急性做出的。在所有情况下，都有一个急性时刻，家庭作为护理环境不再被认为是足够的。这一结论基于一系列因素的综合，包括与抱怨有关的因素、全科医生和家庭环境。这一评估涉及三方：患者、其近亲以及全科医生。同时，医院被赋予了非常积极的价值。根据各方对家庭作为护理环境的评估，有四种住院途径：转诊、共同、要求和绕过。
对于所有参与者而言，住院的决定是急性做出的，即使引发入院的问题不是急性的，而是存在较长时间。参与者认为入院是不可避免的，因为当时对家庭护理环境的负面看法，加上对医院护理的积极期望。在这些访谈中很少看到预先护理计划或共同决策。当近亲违背患者的意愿同意住院时，就出现了伦理困境。建议更多关注老年人参与决策和他们的目标。
