Background
Methods
Study design
Study retrieval—search strategy
Selection criteria
Synthesis of findings
Results
Questions | Andreasen et al | Bagge et al. | Dilworth et al. | Dossa et al. | Jones | Karlsson et al. | Knight et al. | McKeown et al | Neiterman et al. | Perry et al. | Reay et al. | Rydeman et al. | Slatyer et al. |
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Is there congruity between the stated philosophical perspective and the research methodology? | U | U | NA | U | Y | Y | U | Y | U | Y | Y | NA | Y |
Is there congruity between the research methodology and the research question or objectives? | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y |
Is there congruity between the research methodology and the methods used to collect data? | Y | Y | Y | Y | Y | U | Y | Y | Y | Y | Y | Y | Y |
Is there congruity between the research methodology and the representation and analysis of data? | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y |
Is there congruity between the research methodology and the interpretation of results? | Y | Y | Y | Y | Y | Y | N | Y | Y | Y | Y | Y | Y |
Is there a statement that locates the researcher culturally or theoretically? | N | N | U | N | Y | N | N | Y | N | Y | N | N | N |
Is the influence of the researcher on the research, and vice versa, addressed? | Y | Y | Y | Y | Y | Y | N | Y | N | N | U | Y | Y |
Are participants, and their voices, adequately represented? | Y | Y | Y | Y | Y | Y | U | Y | Y | Y | Y | Y | Y |
Is the research ethical according to current criteria or, for recent studies, is there evidence of ethical approval by an appropriate body? | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y |
Do the conclusions drawn in the research report flow from the analysis, or interpretation, of the data? | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y |
Author, year, country | Country | Data collection/methodology | Sample | Setting | Cause of admission (n) |
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Andreasen, J, et al. (2015) [30] | Denmark | Semi-structured interviews/interpretive description | 7 Women 7 Men Age range: 69–93 Mean age: 80.6 years | At home approx. 1 week after discharge from hospital | 4 Pneumonia 1 Emboli 1 Amputee 1 Fall 1 Brain abscess 1 Weight loss 1 Hypoglycaemia 1 Renal failure 1 Pancreatitis 1 Type 2 diabetes 1 Dizziness |
Bagge et al. (2014) [41] | New Zealand | Semi-structured interviews/thematic analysis | 21 Women 19 Men Age range: 75–89 Mean age: not stated | At home 1–2 weeks after discharge from hospital | Not reported |
Dilworth et al. (2012) [40] | Australia | Semi-structured interview/thematic analysis | 1 Woman 2 MenAge range: not stated Mean age: not stated | In hospital after being readmitted to hospital following recent discharge (within 28 days) to their homes | 1 Renal failure/Fall 1 Cellulitis/Pulmonary emboli 1 Dizziness |
Dossa et al. (2012) [13] | United States | Semi-structured interviews/thematic coding technique informed by grounded theory methodology | 18 Men Age range:78–88 Mean age: not stated | At home 2 weeks, 1 month and 2 months after discharge from hospital | The discharge diagnoses included total hip or total knee replacements, laminectomy, diabetes, arthritis, coronary artery disease, hypertension and alcohol abuse |
Jones, GB (2012) [38] | United States | Semi-structured interviews/phenomenological hermeneutical interpretation method | 16 Women 4 Men Age range: 65–89 Mean age: 75 years | At follow-up visit in two cardiology/cardiovascular clinics within 4 weeks of discharge from hospital | The majority of participants had a cardiovascular medical diagnosis (n = 12, 60%) or experienced cardiovascular surgical procedures (n = 8, 40%) |
Karlsson et al. (2016) [43] | Sweden | Qualitative interview/content analysis | 7 Women 8 Men Age range: 65–86 Mean age: 71 years | At home within 2 months after discharge from hospital | 7 Surgery of aortic aneurysm 1 Epiglottitis 1 Pneumonia, sepsis 1 Pneumonia 1 Pulmonary edema 1 Pneumonia, sepsis, kidney failure 1 Myasthenia gravis, cardiac arrest 1 Unknown 1 Allergic shock |
Knight et al. (2011) [14] | United Kingdom | Semi-structured interviews/thematic analysis | 4 Women 3 Men Age range: 75–91 Mean age: 82.6 years | At home 6 weeks to 3 months after discharge from hospital | Not reported |
McKeown et al. (2007) [5] | Ireland | Qualitative interviews/ phenomenological approach | 5 Women 6 Men Age range: 71–92 Mean age: 81 years | At home 2 weeks after discharge from hospital | Not reported |
Neitherman et al. (2015) [15] | Canada | Semi-structured interviews/thematic analysis | 7 Women 10 Men Age range: 70–89 Mean age: 79 years | At home 2–5 weeks after discharge from hospital | The most common diagnoses for hospitalisation were cardiovascular conditions (congestive heart failure, stroke) and respiratory problems (chronic obstructive pulmonary disease, pneumonia). Other patients had a variety of health problems, including diabetes, kidney disease, gastro-intestinal and neurological problems and cancer |
Perry et al. (2011) [11] | New Zealand | Semi-structured interviews/interpretative phenomenological analysis | 8 Women 3 Men Age range: 66–88 Mean age 76.3 years | At home approx. 6 weeks after discharge from hospital | Orthopaedic lower limb surgery |
Reay et al. (2015) [39] | Australia | Semi-structured interviews /Giorgi’s phenomenological method | 6 Women 4 Men Age range: not stated Mean age: not stated | At home approx. 3 weeks after discharge | Total hip replacement surgery |
Rydeman et al. (2008) [42] | Sweden | Semi-structured interviews/grounded theory | 7 Women 10 Men Age range: 65–91 Mean age: 79 years | At home 4–8 weeks after discharge from hospital | 4 Infection 4 Heart problems 1 Rheumatic disease 3 Intestinal problems 1 Dehydration 1 Fracture 1 Pneumonia stroke 1 Intoxication |
Slatyer et al. (2013) [37] | Australia | Semi-structured interviews/thematic content analysis | 6 Women 6 Men Age range: 72–91 Mean age: 81.6 years | At home within 28 days of discharge (after readmission to hospital) | Breathing, gastric, renal or cardiovascular problems; falls; or chest pain7 |
Findings | Included studies | Frequency effect % |
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Theme 1: Experiencing an Insecure and Unsafe Transition | ||
Lack of information about health situation, treatment and/or care | 69% | |
Experience of rushed discharge | 62% | |
Confusion about medication | 62% | |
Lack of involvement in own treatment and care | 54% | |
Not being involved in decisions about own life | 54% | |
Not understanding information | 46% | |
Several providers coordinating care led to discontinuity of care | 46% | |
Errors in treatment | 46% | |
Discharge information not explained well | 38% | |
Lack of information about when to go home | 38% | |
Lack of communication between the different service providers | 38% | |
Conflicting opinions between healthcare providers | 31% | |
Lack of medical reconciliation | 23% | |
Experience of well-prepared and timely discharge | 23% | |
Theme 2: Settling into a New Situation at Home | ||
Dependent on additional help from others | 100% | |
Losing independence | 77% | |
Finding the transition back home a challenge | 62% | |
Home not being prepared | 54% | |
Problems performing daily activities | 54% | |
Not receiving care according to needs | 54% | |
Wanting to maintain and regain independence | 46% | |
Not feeling ready to go home | 38% | |
Feeling confident to go home | 38% | |
Not being able to participate in meaningful activities | 38% | |
Feeling lonely and isolated | 38% | |
Lack of specialised equipment | 38% | |
Changing healthcare personnel disturbed effort to get back to daily routines | 15% | |
Feeling depressed | 15% | |
Experiencing no meaning in life | 15% | |
Wanting to die | 15% | |
Theme 3: What Would I do Without My Informal Caregiver? | ||
Dependent on informal caregivers for medication and healthcare | 62% | |
Dependent on family and friends to manage daily activities at home | 62% | |
Being aware of the effort put in by informal caregivers | 38% | |
Importance of strong, positive relationships with family and friends | 38% | |
Dependent on informal caregivers to understand information | 31% | |
Illness putting a strain on relationship with family and friends | 23% | |
Feeling like a burden | 23% | |
Theme 4: Experience of a Paternalistic Model | ||
Healthcare personnel perceived as distant and stressed | 62% | |
Not being seen or heard | 46% | |
Reluctant to ask | 38% | |
Healthcare personnel perceived as authoritarian | 31% | |
Doctor knows best | 31% |
Theme 1: experiencing an insecure and unsafe transition
Theme 2: settling into a new situation at home
Theme 3: what would I do without my informal caregiver?
Theme 4: experience of a paternalistic medical model
Discussion
Implications for practice
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Older persons receiving (sufficient) information about their illness (es) and the course of the illness, medication, rehabilitation and psychosocial aspects of their recovery.
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Hospital discharge should include an assessment of the person’s post-discharge needs when it comes to food, specialised equipment, transportation to follow-up appointments and general care at home. These identified needs should be communicated to the next level of care.
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Adapting verbal and written communication in order to make the information clearer and easy to understand. Healthcare professionals should also assess whether the information is understood by the patient.
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Incorporating older persons’ involvement and perspectives into the decision-making process.
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Increasing the involvement of informal caregivers in the care planning.
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Strategies to reduce feelings of loneliness and social isolation after hospital discharge and resettling into the home situation.
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Better communication between service providers, professionals, older persons and their informal caregivers.