van der Kluit Maria Johanna, Dijkstra Geke J, de Rooij Sophia E
University of Groningen, University Medical Center Groningen, University Center for Geriatric Medicine, Groningen, The Netherlands
University of Groningen, University Medical Center Groningen, Department of Health Sciences, Applied Health Research, Groningen, The Netherlands.
BMJ Open. 2019 Aug 5;9(8):e029993. doi: 10.1136/bmjopen-2019-029993.
Since 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.
Qualitative descriptive method with open interviews analysed with inductive content analysis.
A university teaching hospital and a regional teaching hospital.
Twenty-eight hospitalised patients aged 70 years and older.
Some 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.
Older 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.
鉴于西方国家人口持续老龄化且患有多种慢性病的患者数量不断增加，建议从以疾病为导向的医疗保健转向以目标为导向的医疗保健。由于对老年住院患者的个人目标和偏好了解甚少，本研究旨在阐明不同老年住院患者群体的目标。
采用定性描述方法，通过开放式访谈进行归纳性内容分析。
一所大学教学医院和一所地区教学医院。
28名70岁及以上的住院患者。
一些老年住院患者最初难以描述具体目标，但经过深入询问后，所有人都能够说出更具体的目标。各种各样的目标被归类为想知道是怎么回事、控制疾病、维持生命、改善状况、减轻不适、改善日常功能、改善/维持社交功能、恢复工作/爱好以及恢复/维持自主性。
老年住院患者在不同领域有各种各样的目标。与老年患者讨论目标尚未成为一种常见做法。应鼓励及时讨论目标，因为个人目标并非不言而喻，这种讨论可以指导决策，尤其是在患有多种疾病和身体虚弱的患者中。辅助工具可能有助于促进关于目标的讨论并评估住院治疗的结果。
