Transitions of care for older adults discharged home from the emergency department: an inductive thematic content analysis of patient comments

Couture, Vanessa; Germain, Nathalie; Côté, Émilie; Lavoie, Lise; Robitaille, Joanie; Morin, Michèle; Chouinard, Josée; Couturier, Yves; Légaré, France; Hardy, Marie-Soleil; Chartier, Lucas B.; Brousseau, Audrey-Anne; Sourial, Nadia; Mercier, Éric; Dallaire, Clémence; Fleet, Richard; Leblanc, Annie; Melady, Don; Roy, Denis; Sinha, Samir; Sirois, Marie-Josée; Witteman, Holly O.; Émond, Marcel; Rivard, Josée; Pelletier, Isabelle; Turcotte, Stéphane; Samb, Rawane; Giguère, Raphaëlle; Abrougui, Lyna; Smith, Pascal Y.; Archambault, Patrick M.; ,

doi:10.1186/s12877-023-04482-0

Cited by 4 publications

References 60 publications

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Caregivers’ burden of care during emergency department care transitions among older adults: a mixed methods cohort study

Germain,

Jémus-Gonzalez,

Couture

et al. 2024

Preprint

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ObjectiveImproving care transitions for older adults can reduce emergency department (ED) revisits, and the strain placed upon caregivers. We analyzed whether caregivers felt a change in burden following a care transition, and what may be improved to reduce it.MethodsThis mixed-methods observational study nested within LEARNING WISDOM included caregivers of older patients who experienced an ED care transition. Burden was collected with the brief Zarit Burden Interview (ZBI-12), and caregivers commented on the care transition. A qualitative coding scheme of patient care transitions was created to reflect themes important to caregivers. Comments were randomly analyzed until saturation and themes were extracted from the data. We followed both the SRQR and STROBE checklists.ResultsComments from 581 caregivers (mean age (SD) 64.5 (12.3), 68% women) caring for patients (mean age (SD) 77.2 (7.54), 48% women) were analyzed. Caregivers overwhelmingly reported dissatisfaction and unmet service expectations, particularly with home care and domestic help. Communication and follow-up from the ED emerged as an area for improvement. Caregivers who reported an increased level of burden following a care recipient’s care transition had significantly higher ZBI scores than caregivers who self-reported stable burden levels, but not improved burden levels.ConclusionCaregivers with increasing, stable, and improved levels of subjective burden all reported areas for improvement in the care transition process. Themes centering on the capacity to live at home most frequently and may represent serious challenges to caregivers. Addressing these challenges could improve both caregiver burden and care transitions.Key pointsWe analyzed caregivers’ thoughts about emergency department care transitions using both qualitative and quantitative tools.Caregivers reported dissatisfaction and unmet service expectations with home care, domestic help, and coordinating follow-ups.Variance in self-reported subjective caregiver burden corresponds to Zarit Burden Interview (ZBI) scores.

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Caregivers’ burden of care during emergency department care transitions among older adults: a mixed methods cohort study

Germain,

Jémus-Gonzalez,

Couture

et al. 2024

Preprint

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Emergency department revisits at thirty days are modestly explained by caregiver burden: a prospective cohort study

Germain,

Toulouse-Fournier,

Samb

et al. 2024

Preprint

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Importance: Caregivers play a protective role in emergency department (ED) care transitions. When the demands of caregiving result in caregiver burden, ED returns can ensue. Objective: We developed models describing how caregiver burden may predict ED revisits and admissions up to thirty days after discharge. Design: This prospective cohort study nested within the LEARNING WISDOM clinical trial included older adults and their caregivers who underwent a transition of care from one of four EDs in Quebec, Canada between January 1st, 2019, and December 21st, 2021. Setting: This study occurred within an integrated health multi-site organization consisting of four acute care hospitals. Participants: Patients aged 65 years or older who were discharged back to the community from the ED observation unit after being triaged to a stretcher on their index visit. Exposure: Caregiver burden, as collected using the brief twelve-item Quebec French version of the Zarit Brief Burden Interview (ZBI). Main Outcomes and Measure: Revisits to the ED were defined as a return to any ED in the 4-hospital network within 3, 7, or 30 days of the index visit. Admissions were return visits to the ED within 30 days resulting in hospitalization. Results: Among 1,409 caregiver-patient dyads, ZBI scores averaged 7.33 (SD = 7.11). Most caregivers were women (69%). Caregivers were most often spouses (48%) of patients or children of patients (38%). Among all patients, 5.3% returned to the ED within 3 days, 9.4% returned within 7 days, 20.7% returned within 30 days and 6.2% were admitted within 30 days. Each point increase on the ZBI scale was associated with a 2.8% increase in the odds of a 30-day revisit to the ED (p = 0.03), but not in models with shorter time windows, nor for admissions. ZBI scores on 30-day ED revisits were moderated by the COVID-19 pandemic waves: the first inter-wave period attenuated the association. Conclusions and Relevance: Caregiver burden may modestly predict ED revisits over 30 days. Future studies may enhance the management of ED revisits by predicting the longitudinal impact of caregiver burden on ED use in older adults. Trial Registration: https://clinicaltrials.gov/ct2/show/NCT04093245

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Discharge instruction comprehension by older adults in the emergency department: A systematic review and meta‐analysis

Haimovich,

Mulqueen,

Carreras‐Tartak

et al. 2024

Academic Emergency Medicine

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IntroductionOlder adults are at high risk of adverse health outcomes in the post–emergency department (ED) discharge period. Prior work has shown that discharged older adults have variable understanding of their discharge instructions which may contribute to these outcomes. To identify discharge comprehension gaps amenable to future interventions, we utilize meta‐analysis to determine patient comprehension across five domains of discharge instructions: diagnosis, medications, self‐care, routine follow‐up, and return precautions.MethodsUsing Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, two reviewers sourced evidence from databases including Medline (PubMed), EMBASE, Web of Science, CINAHL, and Google Scholar (for gray literature). Publications or preprints appearing before April 2024 were included if they focused on geriatric ED discharge instructions and reported a proportion of patients with comprehension of at least one of five predefined discharge components. Meta‐analysis of eligible studies for each component was executed using random‐effects modeling to describe the proportion of geriatric ED cases understanding the discharge instructions; where appropriate we calculated pooled estimates, reported as percentages with 95% confidence interval (CI).ResultsOf initial records returned (N = 2898), exclusions based on title or abstract assessment left 51 studies for full‐text review; of these, seven constituted the study set. Acceptable heterogeneity and absence of indication of publication bias supported pooled estimates for proportions comprehending instructions on medications (41%, 95% CI 31%–50%, I2 = 43%), self‐care (81%, 95% CI 76%–85%, I2 = 43%), and routine follow‐up (76%, 95% CI 72%–79%, I2 = 25%). Key findings included marked heterogeneity with respect to comprehending two discharge parameters: diagnosis (I2 = 73%) and return precautions (I2 = 95%).ConclusionsOlder patients discharged from the ED had greater comprehension of self‐care and follow‐up instructions than about their medications. These findings suggest that medication instructions may be a priority domain for future interventions.

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Transitions of care for older adults discharged home from the emergency department: an inductive thematic content analysis of patient comments

Cited by 4 publications

References 60 publications

Caregivers’ burden of care during emergency department care transitions among older adults: a mixed methods cohort study

Caregivers’ burden of care during emergency department care transitions among older adults: a mixed methods cohort study

Emergency department revisits at thirty days are modestly explained by caregiver burden: a prospective cohort study

Discharge instruction comprehension by older adults in the emergency department: A systematic review and meta‐analysis

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