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Brennan, M;Ali, B;Robinson, SM;Mulkerrin, EC;O'Keeffe, ST
European Geriatric Medicine
Indications and outcomes of home visits by geriatricians
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Key Summary PointsAimWhat are the indications and outcomes of home visits and assessments by geriatricians?FindingsHome visits were mainly conducted when older people would not or could not attend a clinic. Many visits occurred to socially isolated people living in poor circumstances in deprived rural areas.MessageHome visits by geriatricians remain a valuable option for selected older people. AbstractPurposeThe 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.MethodsFrom 2002 to 2016, a systematic record was maintained of all HVs conducted by a geriatrician.ResultsConsent 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.ConclusionsHome visits by geriatricians remain a valuable option for selected older people.
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