Risk of readmission and the elderly patient's perspective of return to everyday life after discharge from a short-stay unit at the Emergency Department

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Abstract

Background: Increasing numbers of older people are admitted to emergency departments’ (EDs) short-stay units in Denmark. Elderly patients often present atypical symptoms, comorbidity and limitations in performing activities, compli-cating care and treatment, and increases their risk of readmission after discharge. Due to the their health conditions’ complexity, elderly patients typically need to receive care and rehabilitation from different healthcare sectors. Therefore, it is important to find a way to meet the rehabilitation needs of elderly patients discharged from a short-stay unit at an ED and provide a well-coordinated and safe transition from the secondary to the primary healthcare sector.
Aim: The present PhD project aims to improve and inform current practices regarding the discharge of elderly patients from a short-stay unit at an ED in order to reduce their risk of readmission. This was done through two studies, reported in three papers.
Methods: Study I comprised two parts. In the first part (Study Ia, Paper I), development of the Elderly Activity Performance-intervention was conducted and described systematically through the Intervention Mapping approach. In the second part (Study Ib, Paper II), an outcome evaluation of the effectiveness of the developed intervention was conducted in a quasi-experimental trial comparing an intervention group (n=144) and a usual practice group (n=231). In Study II (Paper III), qualitative interviews were conducted with 11 elderly patients who received the intervention in study Ib to examine their experiences of being
discharge and returning to everyday life after discharge from a short stay unit at an ED.
Results: In Study I, the Elderly Activity Performance intervention was developed to address two risk factors: 1) limitations in performing activities and 2) an incoherent discharge for elderly patients discharged from a short-stay unit at the ED. In total, 375 elderly patients were included in the study to evaluate the effectiveness of the developed intervention. The outcome evaluation revealed that the Elderly Activity Performance intervention was not effective in reducing the risk of readmission compared to usual practice. However, the results revealed that 60% of patients in the intervention group had limitations in performing activities, thus, the need for further rehabilitation was identified. It also revealed that the elderly patients identified as having activity limitations were at higher risk of readmission than patients with no identified limitation. This was supported by results from Study II, where eleven elderly patients expressed that their everyday lives after discharge were influenced by pain, fatigue and lack of energy, which limited their performance of activities.
Speculations concerning their health condition and the future were also present in their everyday lives. The qualitative interviews further revealed that factors such as receiving information, feeling secure and being involved and prepared were considered important by the elderly patients during discharged from a short-stay unit at an ED.
Conclusion: Evaluating the effectiveness of the Elderly Activity Performance intervention revealed no effectiveness in reducing risk of readmission in elderly patients discharged from a short stay unit at the ED. The results, however revealed that elderly patients identified with limitations in performing activities were at higher risk of readmission than patients with no identified limitations. In addition, the PhD project contributed with knowledge concerning how elderly patients experienced being discharged and returning to everyday life after
discharge from a short-stay unit at an ED. Receiving information, being prepared and involved and feeling secure about returning home were identified as factors of importance for the elderly patients during discharge. Factors such as limitations in performing activities and speculations concerning health condition and the future were present in the elderly patients’ everyday lives after discharge.
Original languageDanish
Place of PublicationAarhus
PublisherAarhus Universitet
Number of pages158
Publication statusPublished - 14 Jan 2019

Keywords

  • occupational therapy

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