Experiences of elderly patients regarding participation in their hospital discharge: a qualitative metasummary

Abstract

BackgroundAgeing patients are discharged from the hospital ‘quicker and sicker’ than before, and hospital discharge is a critical step in patient care. Older patients form a particularly vulnerable group due to multimorbidity and frailty. Patient participation in healthcare is influenced by government policy and an important part of quality improvement of care. There is need for greater insights into the complexity of patient participation for older patients in discharge processes based on aggregated knowledge.ObjectiveThe aim of this study was to review reported evidence concerning the experiences of older patients aged 65 years and above regarding their participation in the hospital discharge process.MethodsWe conducted a qualitative metasummary. Systematic searches of Medline, Embase, Cinahl, PsycINFO and SocINDEX were conducted. Data from 18 studies were included, based on specific selection criteria. All studies explored older patients’ experience of participation during the discharge process in hospital, but varied when it came to type of discharge and diagnosis. The data were categorised into themes by using thematic analysis.ResultsOur analysis indicated that participation in the discharge process varied among elderly patients. Five themes were identified: (1) complexity of the patients state of health, (2) management and hospital routines, (3) the norm and preference of returning home, (4) challenges of mutual communication and asymmetric relationships and (5) the significance of networks.ConclusionsCollaboration between different levels in the health systems and user-friendly information between staff, patient and families are crucial. The complexity of patient participation for this patient group should be recognised to enhance user involvement during discharge from hospital. Interventions or follow-up studies of how healthcare professionals can improve their communication skills and address the tension between client-centred goals and organisational priorities are requested. Organisational structure may need to be restructured to ensure the participation of elderly patients.

What matters when asking, “what matters to you?” — perceptions and experiences of health care providers on involving older people in transitional care

“…One important aspect of improving the transitional care experience is to make transitional care more patient-centered. Previous research on patient involvement in transitional care has revealed that older patients experience a lack of participation during transitions [8][9][10][11]. Transitional care is also characterized by the challenges of coordinating care across organizational and disciplinary boundaries, managing conflicting goals of care, which may be stressful for health care providers (HCPs) [12][13][14].…”

The tension between carrying a burden and feeling like a burden: a qualitative study of informal caregivers’ and care recipients’ experiences after patient discharge from hospital

“…As the average length of stay declines, older people are being discharged from the hospital "quicker and sicker" than before (Deniger et al, 2015;Galvin et al, 2017;Spehar et al, 2005). Although there has been increasing studies in the area care transitions for older patients and how this situation affects the patient and their informal caregiver (Gupta et al, 2019;Hvalvik & Reierson, 2015;Jeffs et al, 2017;Lilleheie et al, 2020Lilleheie et al, , 2019, there are few studies addressing how this influences feelings of reciprocity, equity and family dynamics. Furthermore, few studies have focused on the experience of caregiver burden and on recipients' feelings of being a burden (Sales, 2003).…”

‘They Just Came with the Medication Dispenser’ – A Qualitative Study of Service User Involvement and Welfare Technology in Public Home Care Services

“…Studies and reports have highlighted that service users who are actively engaged in their health and care can experience better health outcomes and care experiences (7,34,42). However, research shows that, in many situations, user involvement is too little integrated into health care for elderly (35,43). There are several studies from hospitals and discharge processes to home care or mental health, but few empirical studies on user involvement are from public home care services (35,(43)(44)(45).…”

“…The study by Bjørkquist et al (6) indicates that involving elderly service users in the process of implementing welfare technology is challenging due to a lack of competence and information about what technology is available and what service users might bene t from. Another study found that elderly service users reported that they often struggled to understand and remember the information they were given about welfare technology, which is a challenge for user involvement (43). Bennett (20) argues that consideration must be given to patients' decision-making capability and human rights in connection with user involvement.…”