Evaluations of postoperative transitions in care for older adults: a scoping review

Abstract

Background Most people having major surgery are over the age of 65. The transition out of hospital is a vulnerable time for older adults, particularly after major surgery. Research on postoperative transitions in care is growing, but it is not clear how postoperative transitions are being evaluated. The objective of this scoping review was to synthesize processes and outcomes used to evaluate postoperative transitions in care for older adults. Methods We conducted a scoping review that included articles evaluating a postoperative transition in care among adults aged > 65 having major elective surgery. We searched Medline (Ovid), EMBASE (Ovid), CINHAL, and Cochrane Central Register of Controlled Trials (CENTRAL) from their respective inception dates to April 6, 2021. We also searched The World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov from their respective inception dates to April 6, 2021. Screening and data extraction was completed by reviewers in duplicate. Data relevant to study design and objective, intervention description, and process or outcome evaluations were extracted. Process evaluations were categorized using the Ideal Transitions in Care Framework, and outcome evaluations were categorized using the Institute for Healthcare Improvement Triple Aim Framework. Results After screening titles and abstracts and full-text article review, we included 20 articles in our final synthesis. There was variability in the processes and outcomes used to evaluate postoperative transitions in care. The most common outcomes evaluated were health service utilization (n = 9), including readmission and Emergency Department visits, experiential outcomes (n = 9) and quality of life (n = 7). Process evaluations included evaluating the education provided to patients to promote self-management (n = 6), coordination of care among team members (n = 3) and outpatient follow-up (n = 3). Only two articles measured frailty, one article used theory to guide their evaluations and no articles engaged knowledge users. Conclusions There is inconsistency in how postoperative transitions in care were evaluated. There is a need to use theories and to engage key stakeholders involved in postoperative transitions in care, including older adults and their caregivers, to identify the most appropriate approaches for developing and evaluating interventions to meaningfully improve care.

“It’s Incapacitated me in so Many Ways”

“…The participants in our study emphasized the need for more information on symptom management before and after surgery, highlighting the inadequacy of perioperative education on symptom management at home. This finding aligns with a recent review on postoperative hospital-to-home care transitions in older adults, revealing a gap in the provision of patient symptom management education 33 . Study participants also expressed receptiveness to a variety of technology-based options for the delivery of education and support for symptom management.…”

“…Previous research on CABG surgery indicates that patients rarely encounter isolated symptoms but rather often experience multiple simultaneous postoperative symptoms, leading to reduced psychosocial functioning. 24,[29][30][31][32]33 Our study echoes these findings, with ~75% of participants reporting 2 or more symptoms affecting their psychosocial well-being 1 month postsurgery, and nearly 40% reporting 2 or more symptoms during the 3-month interview. Previous research also suggests that psychological symptoms such as anxiety and depression are among the most frequently occurring postoperative symptoms affecting psychosocial functioning after major surgery.…”

“…This finding aligns with a recent review on postoperative hospital-to-home care transitions in older adults, revealing a gap in the provision of patient symptom management education. 33 Study participants also expressed receptiveness to a variety of technology-based options for the delivery of education and support for symptom management. This finding is consistent with current research demonstrating that older adults are open to using a variety of technologies, including immersive virtual reality, for the delivery of education on symptom management so as long as training and support are available.…”

Lost in transition? Community residential facility staff and stakeholder perspectives on previously incarcerated older adults’ transitions into long-term care

“…This finding substantiates prior transitional care literature that affirms that patient advocacy is critical to reduce access barriers of complex older adults during transitions in care [ 43 ]. This support has been conducive to minimizing the admittance of complex older adults to hospital, avoiding the poor health outcomes that have been routinely connected with long-term hospital stays [ 11 ]. The need for advocacy and support is not limited to access to care for this population, as previously incarcerated adults face similar barriers in access to permanent housing, employment, volunteer opportunities, and community based programs [ 44 ].…”

“…In particular, education and training [ 9 ], patient advocacy [ 10 ] and a shared responsibility of care between health professionals [ 9 ] can enhance the care provided to older adults across the care continuum. Although numerous transitional care interventions have been designed to address the complex needs of older adults [ 11 ], contemporary scholars continue to find that transitional care is not individualized and therefore does not reflect the populations being treated or account for the distinct settings in which care is provided [ 12 ]. Marginalized older populations are most at risk, often experiencing health and care inequities during care transitions that are not clearly understood [ 13 ].…”