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20 July 1999 | Volume 131 Issue 2 | Pages 109-112
Background: Little is known about patients' preferences for site of terminal care.
Objective: To describe older persons' preferences for home or hospital as the site of terminal care and to explore potential reasons for their preferences.
Design: Cross-sectional quantitative and qualitative interviews.
Setting: Participants' homes.
Patients: Community-dwelling persons 65 years of age or older who were recently hospitalized with congestive heart failure, chronic obstructive pulmonary disease, or pneumonia and were not selected according to life expectancy; 246 patients participated in quantitative interviews and 29 participated in qualitative interviews.
Measurements: Preference for site of terminal care and the reasons for that preference.
Results: In quantitative interviews, 118 patients (48%) preferred terminal care in the hospital, 106 (43%) preferred home, and 22 (9%) did not know. One third changed their preference when asked about their preference in the event of a nonterminal illness. Reasons for preference identified during qualitative interviews included the desire to be with family members and concerns about burden to family members and their ability to provide necessary care. Concern about long-term care needs resulted in preference for a nursing home when choice was not constrained to home and hospital.
Conclusions: Preference for home as the site of care for terminal illness exceeds existing practice. However, the current debate about home versus hospital as the ideal site for end-of-life care may ignore an important issue to older persons—namely, the care of disabilities that precede death.
Author and Article Information
From Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut; and Yale University School of Medicine, New Haven, Connecticut.
Grant Support: By The Picker/Commonwealth Scholars Program, the Oxford Foundation, and the Claude D. Pepper Older Americans Independence Center of Yale University.
Requests for Reprints: Terri R. Fried, MD, Geriatrics & Extended Care 240, Veterans Affairs Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516; e-mail, terri.fried{at}yale.edu.
Current Author Addresses: Drs. Fried and Drickamer: Geriatrics & Extended Care 240, Veterans Affairs Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516.
Dr. van Doorn and Mr. O'Leary: Yale University Program on Aging, 129 York Street, New Haven, CT 06511.
Dr. Tinetti: Yale University School of Medicine, 333 Cedar Street, PO Box 202025, New Haven, CT 06520. BRIEF COMMUNICATION
Older Persons' Preferences for Site of Terminal Care
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