Many Elderly Prefer Hospital to Home for Acute Care

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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."

The movement to develop home care came about in part because frail, elderly patients often don't do well in a hospital environment. And home care may prove to be less costly for some conditions. But the shift in thinking about such treatment will have to come from the medical community first, says Fried, before patients will accept it.

"Even more than doctors going to the home, the doctor's opinion [of best treatment place] was one of the most persuasive factors. So, I think the conclusion from that is if doctors believe in home care as a better alternative for their patient, then their patients may well be more accepting of that alternative," Fried says.

Fried adds "if you interviewed people who had really active home care in the community, with doctors making house calls, etc., then I think you might find different responses in terms of higher preference for home care."

James S. Goodwin, MD, tells WebMD, "There's a certain level of anxiety when you're sick. In our society, where we don't have a big history of home care, I think there would be a resistance -- [a thinking that] maybe if they stayed at home they wouldn't get optimal care." Goodwin is director of the Sealy Center on Aging at the University of Texas/Galveston.

But that is starting to change, slowly, and studies like this one are important, Goodwin tells WebMD. "What I think has been interesting over the past couple of years, is that there are now studies which suggest that home care is as good as hospital care. ... Particularly with the very old, for whom hospitalization can be such a threat and a burden, we're beginning to do these studies of these trials of treating at home compared to treating at a hospital."

This trial, and one's like it, "are the types of things that are going to change the attitudes of not only physicians, but as that information becomes better known among the public, then I think you're going to have more and more people say, 'sure, I believe you now when you say it's a better outcome,'" Goodwin says.


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