Exploring Older Adults' Perception of their Functional Status: A Grounded Theory Study

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Project Summary/Abstract The purpose of this training application is to provide the applicant with the skills and research experience to become an independent investigator studying functional status in older adults and related health outcomes, including life satisfaction and mortality. Almost half of older adults experience a decline in functional status as they age. For hospitalized older adults, the transition from hospital to home is a crucial time in terms of function, with half of older adults experiencing continued decline in the first year post discharge. Decline in functional status has many consequences, including decreased ability to live independently at home, poorer quality of life, increased caregiver burden, increased need for additional home care services, and eventually long-term care placement. Over one third of the population of older adults have been hospitalized a year and the number of older adults in the US is increasing. Given the high-risk transition from hospital to home, it is crucial that we better understand how older adults experience functional status during this crucial time. The current tools used to measure functional status include activities of daily living (ADLs) and instrumental activities of daily living (IADLs). However, ADL and IADL tools were developed by clinicians to track progress in rehabilitation and assess primarily one domain of function—physical. Other non-physical domains, such as leisure, productive, and social activities, are critical components of older adults’ functional status. These non- physical domains of functional status have been related to important outcomes (including life satisfaction and mortality), but have not been developed for use as markers in older adults transitioning from the hospital to home. Given that we do not know which domains of functional status may be best suited for social markers in the transition from hospital to home, grounded theory is the best approach to understand how older adults experience functional status during the transition from hospital to home. The aims of the proposed study are the following: (1) determine how older adults perceive non-physical functional domains during the transition from hospital to home, (2) understand what actions older adults take to maintain or improve non-physical functional domains during the transition from hospital to home and the consequences of these actions, and (3) construct a conceptual model that illustrates the process older adults engage in to maintain non-physical functional domains during the transition from hospital to home. This training grant will support the applicant’s short-term goals of building a foundation of knowledge related to non-physical domains of functional status and becoming an independent nurse researcher. The applicant’s long-term goal is to design community-based interventions to improve older adults’ life satisfaction and health outcomes, e.g., mortality, during the transition from the hospital to home. This study directly aligns with the NINR mission of promoting and improving the health of individuals.