Perceptions of Hospital-Dependent Patients on Their Needs for Hospitalization

In the United States, older adults account for a significant proportion of hospitalizations, and a subset become hospital-dependent, for reasons that are unclear. We conducted a qualitative study to explore these individuals' perspectives on their need for hospitalizations. Twenty patients hospitalized at an academic medical center underwent semistructured qualitative interviews. Criteria for selection included age 65 and older, at least three hospitalizations over six months, admission to the medical service at the time of the study, did not meet criteria for chronic critical illness, was not comfort measures only, and did not have a conservator. Interviews were audiotaped, transcribed, and inductively analyzed. The major themes derived were the necessity and inevitability of hospitalizations ("You have to bring me in here"), feeling safe in the hospital ("It makes me feel more secure"), patients hospitalized despite having outside medical and social support ("I have everything"), and inadequate goals-of-care discussions ("It just doesn't occur to me"). Results suggested that candid discussions about health trajectories are needed to ensure hospitalization is consistent with the patient's realistic health priorities. (C) 2017 Society of Hospital Medicine