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Published on: January 26, 2019
Indications and outcomes of home visits by geriatricians
Michelle Brennan1, Bushra Ali1, Stephanie M Robinson1
1Department of Geriatric Medicine, Galway University Hospitals, Galway, Ireland.
Insights
Home visits by geriatricians are valuable for selected older adults, especially when clinic attendance is difficult. These visits addressed complex needs, sometimes leading to accepted interventions or palliative care, demonstrating their continued importance.
Area of Science:
- Geriatrics
- Public Health
- Home Healthcare
Background:
- The utility of home visits by geriatricians, requested by general practitioners, has been debated.
- This study analyzes home visits conducted by geriatricians over a 14-year period in western Ireland.
Purpose of the Study:
- To evaluate the value and outcomes of home visits (HVs) performed by geriatricians.
- To understand the reasons for referrals and the impact of geriatrician assessments in the home setting.
Main Methods:
- A systematic record of all geriatrician-conducted home visits was maintained from 2002 to 2016.
- Data included reasons for referral, advice sought, and outcomes of the visits.
Main Results:
- Home visits were often necessitated by patient inability or refusal to attend clinics (41%) or severe immobility/illness (35%).
- Common outcomes included decisions against major intervention (39%), acceptance of previously declined interventions (20%), and initiation of palliative care (12%).
- Medication reviews and adjustments were frequent, and in some cases, legal applications for care determination were necessary.
Conclusions:
- Home visits by geriatricians remain a crucial service for specific elderly populations.
- These visits effectively address complex patient needs and circumstances that cannot be managed in a traditional clinic setting.
Purpose:
The value of the home (domiciliary) visit (HV) by geriatricians at the request of general practitioners has been questioned. We analysed HVs conducted by geriatricians in a west of Ireland hospital over a 14-year period.
Methods:
From 2002 to 2016, a systematic record was maintained of all HVs conducted by a geriatrician.
Results:
Consent to publication was obtained for 114 (81%) of 141 visits performed. A HV was requested in 47 (41%) cases because the person would not attend a clinic, most having a long history of refusing care, and in 40 (35%) cases because the person was severely immobile or too unwell to leave home. In 27 (24%) cases, assessment was best conducted in the home for other reasons including squalor. Of the referrals, only 40 (35%) sought specific medical advice and 15 (13%) sought advice regarding end-of-life planning. In many cases, general advice regarding management of self-neglect, unexplained decline, poor home circumstances and undue risk taking was sought. The commonest decision [45 (39%) participants] was that no major intervention would be appropriate or achievable in the person's circumstances and having regard to his or her own preferences. Twenty-three (20%) participants were persuaded to accept a major intervention they had previously declined. In 14 (12%) cases, a palliative care approach in the home was agreed. An application to court to determine what care the person should receive occurred in five (5%) cases. Many medications were stopped.
Conclusions:
Home visits by geriatricians remain a valuable option for selected older people.
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