Older persons' preferences for site of terminal care.
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.


METHODS
Cross-sectional quantitative and qualitative interviews.


METHODS
Participants' homes.


METHODS
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.


METHODS
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.
Geriatrics & Extended Care 240, Veterans Affairs Connecticut Healthcare System, West Haven 06516, USA. terri.fried@yale.edu
T R
TR
Fried
C
C
van Doorn
J R
JR
O'Leary
M E
ME
Tinetti
M A
MA
Drickamer
D000368:Aged / Q000523:psychology*; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000628:therapy; D006699:Home Care Services; D006761:Hospitals; D006801:Humans; D007407:Interviews as Topic; D008173:Lung Diseases, Obstructive / Q000628:therapy; D008297:Male; D009735:Nursing Homes; D017060:Patient Satisfaction; D011014:Pneumonia / Q000628:therapy; D013727:Terminal Care / Q000523:psychology*