期刊
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
卷 62, 期 8, 页码 1556-1561出版社
WILEY
DOI: 10.1111/jgs.12928
关键词
transitions of care; discharge care; vulnerable seniors; qualitative methods
资金
- Gordon and Betty Moore Foundation
- Hospital to Home for Elders Study and the qualitative study
- UCSF Clinical Translation Sciences Institute KL-2 Program
- Claude D. Pepper Older Americans Independence Center at UCSF Division of Geriatric Medicine [P30AG021342 NIH/NIA]
OBJECTIVES: To describe barriers to recovery at home for vulnerable older adults after leaving the hospital. DESIGN: Standard qualitative research techniques, including purposeful sampling of participants according to age, sex, race, and English proficiency, were used to ensure a wide breadth of experiences. All participants were interviewed in their native language (English, Spanish, or Chinese). Two investigators independently coded interviews using the constant comparative method. The entire research team, with diverse backgrounds in primary care, hospital medicine, geriatrics, and nursing, performed thematic analysis. SETTING: Urban public safety-net teaching hospital. PARTICIPANTS: Vulnerable older adults (low income and health literacy, limited English proficiency) enrolled in a larger discharge interventional study. MEASUREMENTS: Qualitative data (participant quotations) were organized into themes. RESULTS: Twenty-four individuals with a mean age of 63 (range 55-84), 66% male, 67% nonwhite, 16% Spanish speaking, 16% Chinese speaking were interviewed. An overarching theme of missing pieces was identified in the plan for postdischarge recovery at home, from which three specific subthemes emerged: functional limitations and difficulty with mobility and self-care tasks, social isolation and lack of support from family and friends, and challenges from poverty and the built environment at home. In contrast, participants described mostly supportive experiences with traditional focuses of transition, care such as following prescribed medication and diet regimens. CONCLUSION: Hospital-based discharge interventions that focus on traditional aspects of care may overlook social and functional gaps in postdischarge care at home for vulnerable older adults. Postdischarge interventions that address these challenges may be necessary to reduce readmissions in this population.
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