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Many Elderly Prefer Hospital to Home for Acute Care


WebMD Health News

May 22, 2000 -- For certain conditions, home care may now be a suitable substitute to the hospital for place of treatment. But even though the technology is available for such advances, it might take a while for many people to warm up to the idea.

A new study from the Yale University School of Medicine asked 246 people over age 65 who had recently been hospitalized for congestive heart failure (CHF), pneumonia, or emphysema, whether they would have preferred to stay home for their treatment. The question was based on the assumption that the outcomes would have been the same in either the hospital or home. Still, just under half of the participants, or 46%, chose to stay home.

"Surprise" was the reaction of the study's lead researcher. "I had expected the large majority of people to tell me that they would have preferred to be cared for at home rather than in the hospital, so even finding a 50-50 split reminded me that you can't take people's preferences for granted," Terri R. Fried, MD, tells WebMD.

Fried says the study intentionally included specific health conditions that could be treated at home because of advances in home intravenous therapy, antibiotics, or oxygen delivery systems. A daily nursing visit and multihour home health aide also was included in the proposition. But many of the people just felt "safer" at the hospital, according to Fried. Cure took precedence over comfort.

Among those who preferred the hospital, a sense of greater safety was the main reason for their choice. "People who thought of their homes as being comforting places to be, by and large, wanted to be cared for at home," Fried says. "People who thought about the home as not being safe, or as putting a burden, for example, on their family and friends, those were the ones who preferred being cared for in the hospital."

People who had a higher socioeconomic status, were living with a spouse, or were deeply religious tended to prefer treatment at home, but these factors only had modest influence on the study's results. When an inability to get out of bed without help was added to the initial condition, then a large part of the participants chose the hospital. Fried also says the concept of home care may be too new for some people to trust.

"What reinforces that idea is that when we asked people if their doctors were to make house calls or see them at home, then a good proportion -- a quarter of the people who said they wanted to be taken care of in the hospital -- switched their preference to home care," Fried tells WebMD. "Clearly having the doctor see the patient at home, would have to be the key service. It didn't really matter if you gave them more nursing time or nursing assistant time."

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