Indications and outcomes of home visits by geriatricians

Abstract

Aim: What are the indications and outcomes of home visits and assessments by geriatricians? Findings: Home 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. Message: Home visits by geriatricians remain a valuable option for selected older people. 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.