To Örebro University

Introduction: Relatives are important when older adults return home after a hospital stay. The aim of this study was to describe close relatives' perspectives of the everyday activities of older adults who are repeatedly readmitted to hospital and discharged to home.

Methods: A semi-structured interview was performed to collect data from twenty relatives (aged 45-82 years). Data were analysed using a deductive qualitative content analysis based on the results of a previous study within this field.

Results: The overall theme 'In need of support to manage an unpredictable everyday life' shows that the older adults often needed support in everyday activities. In the two categories 'Difficulties in dealing with an unstable day' and 'Managing an unstable day' and the 10 subcategories, close relatives described that the older adults needed support in various ways from relatives or other individuals. Close contact was important for how everyday activities worked at home and in maintaining social contacts and contact with healthcare.

Conclusion: It was found that social needs, such as social contacts/activities, are just as important to assess at discharge as medical and functional needs.

INTRODUCTION: Limitations in everyday activities are a risk factor for hospital readmission. Despite this, few studies have focussed on everyday activities of repeatedly readmitted older people. The experiences and specific needs of this group have been poorly described regarding their everyday activities at home. A deeper understanding may help occupational therapists and other health professions to facilitate readiness for this group at and after discharge. The aim of this study was, therefore, to describe the experiences of performing everyday activities of older people repeatedly readmitted to hospital and discharged to home.

METHODS: A qualitative interview study was used to collect data from sixteen participants (75 years and older). Data were analysed using qualitative content analysis.

RESULTS: One theme 'trying to manage an unpredictable everyday life' and two categories describe experiences of everyday activities at home. The participants expressed the importance of continuing everyday activities after discharge where support from relatives and healthcare seemed to be of importance.

CONCLUSION: It was found that performance of everyday activities and contact with family members were of importance in their everyday life. Therefore, assessments and support were of particular importance for the group of older people who do not have close social relations at home.

The coordination of health care and social care at discharge are particularly important for older adults with complex health and social needs, as approximately 30 % of these persons are readmitted to hospital on an unplanned basis within three months of discharge. In order to provide adequate care for this group of older adults, we need a deeper understanding of their experiences regarding their functional ability at hospital and at home.

The overall aim of this thesis was to describe older readmitted adults in terms of their abilities at hospital, everyday activities at home and of healthcare professionals’ conception of the care of older adults. Four studies were conducted using descriptive design. Data were gathered using four different methods of data collection. In this thesis, older readmitted adults are, defined as persons aged 75 years or older who have been readmitted to hospital on an unplanned basis three or more times within 12 months. In Study I, older adults readmitted to hospital (n=60), were assessed regarding personal activities of daily living, cognitive function, risk of falls, pressure sores and malnutrition. They were compared with samples from the general population. In order to describe everyday activities at home, semi-structured interviews were carried out with older readmitted adults (n=16) in Study II, and with close relatives (n=20) in Study III. In Study IV, focus group interviews were performed with healthcare professionals (n=29) about care at discharge and which measures that may be appropriate in order to prevent readmission.

The major findings were that the participants had a higher risk of pressure sores, falls and dependency on ADL at hospital compared to age-matched samples. 40% of the participants had a cognitive limitation. At home, older adults strived to perform everyday activities but the ability was limited. Close relatives described that social relations were fundamental to perform everyday activities and social activities at home. Healthcare professionals stated that older readmitted adults were vulnerable. Multidisciplinary teamwork and geriatric expertise were fundamental but were perceived as lacking. Medical resources and rehabilitation resources should be developed and include rapid follow-up appointments at home in order to prevent readmission.

Overall, health care and social care must identify this group and offer preventive assessments and interventions.

Introduction: Older people admitted to hospital are at risk of decreased ability to perform ADL, lower quality of life and dependency after discharge. There is also a higher risk for readmission to hospital shortly after discharge. To be old and repeatedly seeking acute care is also more than a medical problem. Their repeated contacts with the healthcare system may be due to a dependency on others that may affect daily occupations at home. The specific needs of this group of older people have been poorly described from these older persons perspective.

Objectives: The objective of this study was to describe barriers and opportunities in daily occupations for older people repeatedly readmitted to hospital and now discharged to home.

Methods: Sixteen participants (≥75 years) readmitted to hospital for the third time within a 12 -month period were interviewed in their homes after discharge from an acute medical ward about two weeks after their latest hospital stay. A qualitative content analysis was used for analysis.

Results: An overarching theme was found, trying to manage an unpredictable everyday life. Three categories and seven subcategories were identified, which represented barriers and opportunities for their daily occupations. The categories were Dealing with an unstable day, Dealing with social relations and Dealing with the health care system. These categories were important for maintaining daily occupations for most of the participants.

Conclusion: To the extent the older person had the opportunity to perform daily occupations, this was seen as important and contributed to maintain abilities. Close contact with relatives was essential to the performance of daily occupations at home, and for the old person without contact with relatives this was a barrier to occupation and increased their vulnerability. Therefore, occupational interventions and appropriate support are required in acute care and these must be communicated at discharge. Interventions and timed support are of particular importance for those who do not have close social relations at home.

Introduction: Older people admitted to hospital are at risk of decreased ability to perform ADL, lower quality of life and dependency after discharge. There is also a higher risk for readmission to hospital shortly after discharge. The specific needs of this group of older people have been poorly described from these older peoples’ perspective. A deeper understanding may help the occupational therapist and other health professions to choose interventions in order to maintain daily occupations for this group. The aim of this study was to describe barriers and opportunities in daily occupations for older people repeatedly readmitted to hospital and now discharged to home.

Methods: Sixteen participants 75 years and older were interviewed in their homes after discharge from an acute medical ward. A qualitative content analysis was used to analyze barriers and opportunities in daily occupations.

Results: An overarching theme was found trying to manage an unpredictable everyday life. Three categories and seven subcategories were identified representing barriers and opportunities. The categories were Dealing with an unstable day, Dealing with social relations and Dealing with the health care system. These were important for maintaining daily occupations for most of the participants.

Conclusion: The result indicates that daily occupations and contact from relatives were of importance. Therefore, appropriate support and occupational interventions are required in acute care and these must be communicated at discharge. Occupational therapy interventions and timed support are of particular importance for the group of older people who do not have close social relations at home.

Introduction: Being old and visiting acute care several times has been shown to be more than a medical problem. Aging individuals often have a vulnerable life situation, with physical frailty combined with mental disorders. In occupational therapy it is important to assess and describe the elderly patients’ ability to perform activities of daily living (ADL) and cognitive function. The aim is to describe ADL, cognitive function but also the risk for pressure sores, malnutrition and falls in this group.

Methods: This was a comparative study, where data were collected during four months. Persons 75 years, were assessed on one occasion by an occupational therapist using the ADL-taxonomy and the MMSE. Risks for pressure sores, malnutrition and falls were assessed using Risk Assessment Pressure Sores, Mini Nutritional Assessment, and Downton Fall Risk Index. External data was used for comparison.Results:60 persons were included, mean age was 84 years. The patients had a median of 4 diagnoses. Mean hospital stay was 5 days. Most patients were independent in food intake. There was a high degree of dependency in other ADL activities. Nineteen of 48 patients had 24 point or lower in MMSE. Compared to an age-matched sample, these patients showed a higher risk for pressure sores, risk for falls and dependency in ADL.

Conclusion: There is a need for assessments of ADL, cognition, risk for falls, and pressure sores in older people who are readmitted to hospitals. Such assessments, and necessary interventions taken, may prevent unnecessary admissions.

Introduction: Being old and visiting acute care several times has been shown to be more than a medical problem. Aging individuals often have a vulnerable life situation, with physical frailty combined with mental disorders. It is important to assess and describe the elderly patients´ ability to perform activities of daily living (ADL) and cognitive function in medical acute care.

Objectives: To describe ADL, cognitive function and risk for pressure sores, malnutrition and falls in elderly inpatients readmitted to acute care medical ward.

Design: A prospective cross-sectional study from acute medical ward (n= 60) in Örebro, Sweden. Data were collected during a period of four months.

Methods: The patients were assessed on one occasion by occupational therapist. ADL were assessed using the ADL-taxonomy. Cognitive function was assessed using the MMSE (n=48). Risk assessments for pressure sores, malnutrition and falls were assessed using the Senior alert register.

Results:Mean age was 84 years, mean hospital stay 5 days and the most common head-diagnosis heart failure. Most patients were independent in “Eating and Drinking”. When comparing ADL between patients (n=60) and another study (n=684) where the ADL taxonomy were used, showed that there was a significant difference in five of six activities. The assessments of cognitive function showed a higher incidence of cognitive impairment compared to other research. The patients also showed a higher risk for pressure sores and risk for falls compared with persons aged 75 to the Senior alert register.

Conclusion: There is of importance of earlier assessments of ADL, risk for falls, pressure scores and early detection of cognitive impairment for the elderly who are at risk for readmission to medical acute care. An early assessment is vital to allow interventions aimed to reducing inacitivity and avoid hospital stay.