Given the choice, 54% of older Americans with acute illnesses would prefer to be cared for in a hospital, rather than in their homes, even if home and hospital provide the same outcome, according to a Yale doctor.

"This dispels the myth that older persons are more interested in comfort than in cure," says Dr. Terri Fried, assistant professor of medicine at the School of Medicine and the study's principal investigator.

Many assumptions have been made about older persons' wishes, Fried says, but they have never been directly asked which environment they prefer. This study is one of the first to do so.

Published in the May 22 issue of Archives of Internal Medicine, Fried's study found that people aged 65 or older with acute illnesses such as congestive heart failure, chronic obstructive pulmonary disease and pneumonia, are varied in their preferences for home vs. hospital care.

Home is a viable option only if it provides outcomes equally as good as the hospital, note the researchers. But the study showed that if the home and hospital provide the same outcomes, many older persons would still prefer to be cared for in the hospital. Those preferring hospital care were most likely to change their preference if physician housecalls were provided and if their doctors thought home would be a better option for them.

The advent of managed care has increasingly shifted the care of acute illness from the hospital to the home, which is rapidly expanding as a site of treatment for older persons and can even be used to substitute for the hospital. According to the study, there is a possibility that newly developing systems of care may not be meeting the needs and preferences of older patients.

Fried says treatment site preference is highly correlated with perceptions of the home and hospital. Those preferring home care view the home as a comfortable place to be cared for, while those preferring the hospital view the hospital as more comfortable and safer. The latter group also believes that treatment at home would place a burden on their families and friends.

"This study implies that home care will be a feasible alternative to hospital care only to the extent that it can be clearly proven to be as safe and efficacious as hospital care and that physicians are able and willing to provide housecalls to patients," Fried says. "But even if these conditions are met, there is a group of patients who will still prefer to be cared for in the hospital."

Fried adds, "If patient preferences are to inform medical decision-making, then physicians need to elicit the preferences of individual patients and there needs to be a choice in the system of care provided to older persons."

Fried's research team included Carol Van Doorn, associate research scientist in medicine at Yale; John R. O'Leary, research associate in Yale's Program on Aging; Dr. Mary E. Tinetti, professor of medicine at Yale; and Dr. Margaret A. Drickamer, associate professor of medicine at Yale and at the VA Connecticut Healthcare System.

-- By Karen Peart

T H I SW E E K ' SS T O R I E S

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Editor Claude-Anne Lopez describes her 'life with Benjamin Franklin'

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Reunions bring record numbers to campus

Yale SOM taking to the high seas to offer educational seminars for executives

School of Music awards first Simeone scholarship

Rubenfeld named to Law School's Slaughter chair

Events to celebrate the arrival of 'Amistad' ship

MEDICAL SCHOOL NEWS

• Cocaine treatment blends drugs for alcohol, opiate abuse
  
  
• Team studying the factors leading to cocaine addiction
  
  
• Many elderly prefer hospital stay to home care, study shows
  
  
• Herpesviruses will be focus of international conference
  
  
• Study: Grief for dead spouse impacts health
  
  
• Team finds sick teens are often suicidal
  
  
• Scientists say play prepares children for school
  
  
• Grants to fund Yale research on mental illness
  

OBITUARIES

• Long-time professor William N. Parker dies
  
  
• Physicist E. Robert Beringer, specialist in microwave spectroscopy, dies
  
  
• Arts advocate, gallery curator Janet Dickson dies
  
  

SOM Dean Jeffrey Garten assembles panel to explore 'new economy'

Study proposes tax on snack foods to fight obesity

Employees honored at awards dinner for their many years of service to Yale

Holmes is inducted into American Philosophical Society

Ian Shapiro selected as a Carnegie Scholar . . .

Comer lauded as leader in American education

DeVita honored for his research on lymphoma

Yale Athletics joins in venture to lure sports fans

Summer Cabaret season celebrates Yale playwrights

Yale Repertory Theatre marks milestones during its fall season

Diana D. Brooks resigns her post as Yale trustee

David Bromwich earns prestigious award for his literary works

Campus Notes

In the News

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