Participation in daily activities after acute illness hospitalization among high‐functioning older adults: a qualitative study

Abstract

Aims and objectives To describe high‐functioning older adults' experiences of participation in daily activities and perceived barriers and facilitators to participation one‐ and 3‐months post‐acute hospitalization. Background Older adults discharged after acute illness hospitalization are at risk for functional decline and adverse health outcomes. Yet, little is known about the subjective experience of resuming participation in meaningful activities beyond the immediate post‐discharge period among high‐functioning older adults, a mostly overlooked sub‐sample. Design Qualitative descriptive longitudinal study adhering to the COREQ guidelines. Methods Forty two participants ages ≥65 years (mean age 75, SD ± 7.9) were recruited from internal medicine wards. Semi‐structured interviews were conducted at participants' homes one‐month post‐discharge, followed by a telephone interview 3‐months after. Data were analyzed using thematic analysis. Results Participants perceived the hospitalization as a disruption of healthy and meaningful routines. This first key theme had unique expressions over time and included two sub‐themes. At one month: (1) reduced life spaces and sedentary routines. At 3 months: (2) a matter of quality not quantity – giving up even one meaningful activity can make a difference. The second key theme was described as a combination of physical and psychological barriers to participation over time. These themes demonstrated the profound impact of the hospitalization on behavior (participation) and feelings (e.g., symptoms). The third key theme was described as a dyad of intrinsic and extrinsic facilitators to participation. Conclusions Acute illness hospitalization may lead to subtle decreases in participation in meaningful health‐promoting activities, even among high‐functioning older adults. These changes may impact overall well‐being and possibly mark the beginning of functional decline. Relevance to clinical practice This study highlights the need for a more comprehensive assessment of participation, relevant for high‐functioning older adults, to enable person‐centered care. Intervention programs should address the modifiable barriers and facilitators identified in this study.

Gender, Pain, and Function Associated With Physical Activity After Hospitalization in Persons Living With Dementia

“…Recovering from acute hospitalization can pose significant challenges for older adults as they strive to readjust to their regular activities and restore their previous level of functioning 1–3 . About 30% to 60% of adults 65 years of age and older experience functional decline (a decrease in the ability to engage in activities of daily living) during their hospital stay, associated with prolonged periods of inactivity during hospitalization 4–6 .…”

“…Physical activity has several benefits for older adults as it can improve physical and cognitive function, boost mental health, reduce falls, prevent delirium, and lower the risk of disease in older adults 12,13 . Despite the established benefits of physical activity, low physical activity is common in older adults after hospitalization from an acute illness 1,3,14 . Prior work has shown that low levels of physical activity in older adults can persist for 6 months following hospitalization 15 .…”

“…Prior work has shown that low levels of physical activity in older adults can persist for 6 months following hospitalization 15 . Some barriers to lack of physical activity among older adults after hospitalization can include poor cognitive function, physical limitations, social isolation, poor nutritional status, and psychological symptoms 1,16,17 . Persons living with dementia are even more susceptible to lower levels of physical activity after hospitalization due to increased risk of significant functional decline and delirium acquired during hospitalization 18 …”

“…Physical activity is associated with a variety of factors including physical, cognitive, and psychological health, as well as demographic characteristics in older adults 1,12,15,17,19–22 . Demographic factors including male gender, younger age, and white race have been associated with increased physical activity 17,19,20 .…”

“…Demographic factors including male gender, younger age, and white race have been associated with increased physical activity 17,19,20 . In addition, clinical factors associated with higher levels of physical activity include increased physical function, less comorbidity, lower depression, less behavioral symptoms, reduced pain, and decreased delirium severity 1,12,15,20,21 . However, these studies were focused on older adults without cognitive impairment 1,12,15,17,19–21 .…”