"Missing Pieces"-Functional, Social, and Environmental Barriers to Recovery for Vulnerable Older Adults Transitioning from Hospital to Home
"Missing Pieces"-Functional, Social, and Environmental Barriers to Recovery for Vulnerable Older Adults Transitioning from Hospital to Home
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DOI：
10.1111/jgs.12928
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发表时间：
2014-08-01
影响因子：
6.3
通讯作者：
Kushel, Margot
中科院分区：
文献类型：
--
作者：
Greysen, S. Ryan;Hoi-Cheung, Doug;Kushel, Margot
目的：描述弱势老年人出院后在家中康复的障碍。设计：使用标准的定性研究技术，包括根据年龄、性别、种族和英语水平对参与者进行有目的的抽样，以确保广泛的经验。所有参与者都接受了母语(英语、西班牙语或中文)的采访。两名调查人员使用不断比较的方法独立编码采访。研究对象：城市公共安全网教学医院。研究对象：弱势老年人(低收入、低健康素养、英语水平有限)。测量：定性数据(参与者引文)。结果：24名受访对象平均年龄63岁(55-84岁)，66%男性，67%非白人，16%会说西班牙语，16%会说中文。在家庭出院后恢复计划中确定了“失踪物品”这一总体主题，由此产生了三个具体的次主题：行动和自我照顾任务的功能限制和困难、社会孤立和缺乏家人和朋友的支持，以及贫穷和家庭建筑环境带来的挑战。相比之下，参与者描述的大多是传统过渡重点的支持性经验，如遵循处方药物和饮食方案。结论：以医院为基础的出院干预侧重于传统护理方面，可能忽略了脆弱老年人出院后护理的社会和功能差距。应对这些挑战的出院后干预措施可能是必要的，以减少这一人群的重新入院。
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.