Publication

The decision-making process for unplanned admission to hospital unveiled in hospitalised older adults: a qualitative study

van der Kluit, M. J., Dijkstra, G. J. & de Rooij, S. E., 22-Dec-2018, In : BMC Geriatrics. 18, 12 p., 318.

Research output: Contribution to journalArticleAcademicpeer-review

APA

van der Kluit, M. J., Dijkstra, G. J., & de Rooij, S. E. (2018). The decision-making process for unplanned admission to hospital unveiled in hospitalised older adults: a qualitative study. BMC Geriatrics, 18, [318]. https://doi.org/10.1186/s12877-018-1013-y

Author

van der Kluit, Maria Johanna ; Dijkstra, Geke J. ; de Rooij, Sophia E. / The decision-making process for unplanned admission to hospital unveiled in hospitalised older adults : a qualitative study. In: BMC Geriatrics. 2018 ; Vol. 18.

Harvard

van der Kluit, MJ, Dijkstra, GJ & de Rooij, SE 2018, 'The decision-making process for unplanned admission to hospital unveiled in hospitalised older adults: a qualitative study', BMC Geriatrics, vol. 18, 318. https://doi.org/10.1186/s12877-018-1013-y

Standard

The decision-making process for unplanned admission to hospital unveiled in hospitalised older adults : a qualitative study. / van der Kluit, Maria Johanna; Dijkstra, Geke J.; de Rooij, Sophia E.

In: BMC Geriatrics, Vol. 18, 318, 22.12.2018.

Research output: Contribution to journalArticleAcademicpeer-review

Vancouver

van der Kluit MJ, Dijkstra GJ, de Rooij SE. The decision-making process for unplanned admission to hospital unveiled in hospitalised older adults: a qualitative study. BMC Geriatrics. 2018 Dec 22;18. 318. https://doi.org/10.1186/s12877-018-1013-y


BibTeX

@article{d660679dbd9646a398d71e13088e3ff2,
title = "The decision-making process for unplanned admission to hospital unveiled in hospitalised older adults: a qualitative study",
abstract = "BackgroundThe 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.MethodsOpen 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.ResultsAlthough 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.ConclusionsFor 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.",
keywords = "Decision making, Older adults, Hospitalisation, Primary care, Patient perspective, Qualitative research, Grounded theory, NURSING-HOME RESIDENTS, AGED CARE, EMERGENCY-DEPARTMENT, PATIENT PREFERENCES, PERSONS PREFERENCES, PARTICIPATION, OUTCOMES, DISABILITY, DEMENTIA, MATTER",
author = "{van der Kluit}, {Maria Johanna} and Dijkstra, {Geke J.} and {de Rooij}, {Sophia E.}",
year = "2018",
month = dec,
day = "22",
doi = "10.1186/s12877-018-1013-y",
language = "English",
volume = "18",
journal = "BMC Geriatrics",
issn = "1471-2318",
publisher = "BioMed Central Ltd.",

}

RIS

TY - JOUR

T1 - The decision-making process for unplanned admission to hospital unveiled in hospitalised older adults

T2 - a qualitative study

AU - van der Kluit, Maria Johanna

AU - Dijkstra, Geke J.

AU - de Rooij, Sophia E.

PY - 2018/12/22

Y1 - 2018/12/22

N2 - BackgroundThe 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.MethodsOpen 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.ResultsAlthough 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.ConclusionsFor 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.

AB - BackgroundThe 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.MethodsOpen 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.ResultsAlthough 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.ConclusionsFor 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.

KW - Decision making

KW - Older adults

KW - Hospitalisation

KW - Primary care

KW - Patient perspective

KW - Qualitative research

KW - Grounded theory

KW - NURSING-HOME RESIDENTS

KW - AGED CARE

KW - EMERGENCY-DEPARTMENT

KW - PATIENT PREFERENCES

KW - PERSONS PREFERENCES

KW - PARTICIPATION

KW - OUTCOMES

KW - DISABILITY

KW - DEMENTIA

KW - MATTER

U2 - 10.1186/s12877-018-1013-y

DO - 10.1186/s12877-018-1013-y

M3 - Article

VL - 18

JO - BMC Geriatrics

JF - BMC Geriatrics

SN - 1471-2318

M1 - 318

ER -

ID: 74802117