Background Care should be responsive to preferences but there is little evidence regarding the stability of care preferences, particularly in frail older people after acute illness.
Aim To describe the stability of preferred care outcomes in frail older people in the six months following acute illness.
Methods Prospective cohort study of frail older adults with recent acute illness requiring secondary care review or admission, surveyed at three time-points over six months. Participants rated the importance of six preferred care outcomes chosen from literature review (to extend life, be comfortable, improve quality of life, remain independent, support others, stay out of hospital) on a 0–4 Likert scale, and were then asked to prioritise the most important. We used descriptive statistics to analyse preferences at baseline and the stability of preferences during the study.
Results 67 participants; 63% female, mean age 84 (standard deviation 7.41). 10 participants (15%) died during the study. At baseline, all preferred outcomes were rated mean >3.3/4 in importance, except ‘to extend life’ (2.08/4). Most frequent baseline priorities were: stay out of hospital (20%), support others (16%), and improve quality of life (16%). During the study, the importance ascribed to each preferred outcome was largely stable, but what was most important changed at 66% of n=85 opportunities. Overall, being comfortable became most important for more patients during the study (increasing from 5% to 14%, (Chi2 4.41, p=0.036)), whilst there was a non-significant trend away from staying out of hospital being most important (27% to 22%).
Conclusions For frail older people, the importance of preferred care outcomes remains stable after acute illness, but the outcome ranked as most important frequently changes. Due to its stability, the level of importance ascribed to preferred outcomes may be more useful in clinical practice and advance care planning.
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