Why Elderly Patients Refuse Hospitalization

Barry, Patricia P.; Crescenzi, Caroline; Radovsky, Laurie; Kern, Donald C.; Steel, Knight

doi:10.1111/j.1532-5415.1988.tb02380.x

Cited by 8 publications

(4 citation statements)

References 10 publications

(10 reference statements)

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“…It might be that HF specialists tend to be more alert to signs of (potential) clinical deterioration of HF patients than generalists, resulting in higher admission and re-admission rates. In addition, patients with a low MIS-HF in primary care were significantly older and, in the case of deterioration, may have refused to be hospitalised [ 18 ]. This age difference might also explain why the trend towards higher mortality in the primary care group disappeared after multivariable adjustment for age, sex, COPD and diabetes mellitus.…”

Section: Discussionmentioning

confidence: 99%

Introduction of a new scoring tool to identify clinically stable heart failure patients

et al. 2022

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Introduction Heart failure (HF) poses a burden on specialist care, making referral of clinically stable HF patients to primary care a desirable goal. However, a structured approach to guide patient referral is lacking. Methods The Maastricht Instability Score—Heart Failure (MIS-HF) questionnaire was developed to objectively stratify the clinical status of HF patients: patients with a low MIS-HF (0–2 points, indicating a stable clinical condition) were considered for treatment in primary care, whereas high scores (> 2 points) indicated the need for specialised care. The MIS-HF was evaluated in 637 consecutive HF patients presenting between 2015 and 2018 at Maastricht University Medical Centre. Results Of the 637 patients, 329 (52%) had a low score and 205 of these 329 (62%) patients were referred to primary care. The remaining 124 (38%) patients remained in secondary care. Of the 308 (48%) patients with a high score (> 2 points), 265 (86%) remained in secondary care and 41 (14%) were referred to primary care. The primary composite endpoint (mortality, cardiac hospital admissions) occurred more frequently in patients with a high compared to those with a low MIS-HF after 1 year of follow-up (29.2% vs 10.9%; odds ratio (OR) 3.36, 95% confidence interval (CI) 2.20–5.14). No significant difference in the composite endpoint (9.8% vs 12.9%; OR 0.73, 95% CI 0.36–1.47) was found between patients with a low MIS-HF treated in primary versus secondary care. Conclusion The MIS-HF questionnaire may improve referral policies, as it helps to identify HF patients that can safely be referred to primary care.

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Section: Discussionmentioning

confidence: 99%

Introduction of a new scoring tool to identify clinically stable heart failure patients

et al. 2022

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“…But little is known about patient and family preferences for acute care, largely because the acute hospital is the accepted standard in developed countries for treatment and at present other acceptable options for care do not exist. Clinicians caring for older patients report that some of their patients refuse hospitalization for acute conditions, 12 but the extent of refusal, medical and support services the older person receives in lieu of hospitalization, and the consequences of not being hospitalized are not well known. Presumably, a home hospital would be welcomed by these individuals and their physicians.…”

Section: Discussionmentioning

confidence: 99%

Acceptability to Patients of a Home Hospital

Burton

Leff

Harper

et al. 1998

J American Geriatrics Society

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“…Negative perceptions of the health care system or passive acceptance of death have also been reported as reasons of refusal of hospitalisation. 35 In a small minority, health problems are being addressed through various means, including alternative therapies, 36,37 and even faith-based practices which are still very common in India. 38,39 Learning about the reasons why people refuse to seek medical care is essential as this information may help to modify the health care system more approachable.…”

Section: Factors For Inadequate Engagement With Health Servicesmentioning

confidence: 99%

Health Concerns of Older Adults: Observations from a Survey and Public Education Programme in Bhubaneswar, India

Kar¹,

Das²,

Mohapatra³

et al. 2019

Journal of the Indian Academy of Geriatrics

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Background: While it is apparent that old age is associated with multiple health concerns, the extent of its multiplicity and burden is often not clear. It was intended to find out self-reported health concerns for one month and cardiovascular risk factors in middle and older adults. Methods: In the cross-sectional survey, attendees of a Healthy Ageing Conference were approached with a semi-structured questionnaire about their health concerns and cardiovascular risks. Risk of a cardiovascular event in 10 years based on QRISK3 was calculated. Results: A considerable proportion of older adults had a range of physical symptoms, depressive mood state and memory problems. Mean number of health problems reported were 4.8±3.3 (male 4.4±3.1 and female 5.0±4.3). Cardiovascular risk was high, mean QRISK3 score for males were 22.2% (±14.4), and for females 10.3% (±6.6) (p<0.05). On average, the heart age was increased by 7.9±6.2 years (8.6±6.6 years for males and 5.0±3.3 for females). The relative risk of participants was 2.1 for males and 1.5 for females for heart attack or stroke within the ten years, compared to healthy persons. The symptoms and risk factors were elicited easily, and the process probably facilitated improving the awareness about the health concerns holistically. The survey also identified issues related to the engagement of older adults in the existing health care systems. Conclusions: The results suggested that questionnaire-based health screening in a community can identify a range of health concerns and identify multi-morbidity in general and cardiovascular risks in particular. This process may help to focus on the appropriate public health awareness and intervention programmes required in the community.

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Why Elderly Patients Refuse Hospitalization

Cited by 8 publications

References 10 publications

Introduction of a new scoring tool to identify clinically stable heart failure patients

Introduction of a new scoring tool to identify clinically stable heart failure patients

Acceptability to Patients of a Home Hospital

Health Concerns of Older Adults: Observations from a Survey and Public Education Programme in Bhubaneswar, India

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