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Everyday activities in older adults readmitted to hospital
Örebro University, School of Health Sciences.ORCID iD: 0000-0001-5399-3104
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

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.

Place, publisher, year, edition, pages
Örebro: Örebro University , 2022. , p. 93
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 263
Keywords [en]
Activities of daily living, ageing, cognition, everyday activities, occupational therapy, patient discharge, patient readmission, performance
National Category
Other Health Sciences
Identifiers
URN: urn:nbn:se:oru:diva-97942ISBN: 9789175294391 (print)OAI: oai:DiVA.org:oru-97942DiVA, id: diva2:1643576
Public defence
2022-05-25, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2022-03-10 Created: 2022-03-10 Last updated: 2024-03-04Bibliographically approved
List of papers
1. Older people readmitted to hospital for acute medical care: Implications for occupational therapy
Open this publication in new window or tab >>Older people readmitted to hospital for acute medical care: Implications for occupational therapy
2017 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 24, no 2, p. 143-150Article in journal (Refereed) Published
Abstract [en]

Objective: To compare ADL, cognitive function, risk of pressure sores, malnutrition and falls in older people readmitted to hospital.

Methods: This was a comparative study. Persons ≥ 75 years, who were readmitted to hospital, were assessed using the ADL-taxonomy and the Mini Mental State Examination. Risks of pressure sores, malnutrition and falls were assessed using Risk Assessment Pressure Sores, Short-Form Mini Nutritional Assessment and Downton Fall Risk Index. Data for comparison for ADL were obtained from an earlier study and risk assessments from a national quality register.

Results: Sixty persons were included whose median age was 84 years. The patients had a median of four diagnoses. The mean hospital stay was five days. Most patients were independent in food intake. There was a high degree of dependency in other ADL activities. Nineteen out of 48 patients had 24 point or lower in MMSE. Compared to an age-matched sample, these patients showed a higher risk of pressure sores, risk of falls and dependency in ADL.

Conclusion: There is of importance to assess ADL, cognition, risk of falls and pressure sores to determine the needs of older people who are admitted to hospitals. Such assessments, and necessary interventions taken, may prevent unnecessary readmissions.

Place, publisher, year, edition, pages
Oxfordshire, United Kingdom: Taylor & Francis, 2017
Keywords
ADL-taxonomy, cognition, frail elderly, MMSE, occupational performance
National Category
Geriatrics
Research subject
Geriatrics
Identifiers
urn:nbn:se:oru:diva-52411 (URN)10.1080/11038128.2016.1227367 (DOI)000395105700008 ()27633187 (PubMedID)2-s2.0-84987859165 (Scopus ID)
Note

Funding Agency:

Department of Medicine, University Hospital, Region Örebro County

Available from: 2016-09-21 Created: 2016-09-20 Last updated: 2024-03-04Bibliographically approved
2. Everyday activities at home: Experiences of older repeatedly readmitted people
Open this publication in new window or tab >>Everyday activities at home: Experiences of older repeatedly readmitted people
2022 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 29, no 7, p. 555-562Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Informa Healthcare, 2022
Keywords
Activities of daily living, aging, everyday activities, occupational therapy, patient discharge, patient readmission, performance
National Category
Occupational Therapy Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-87556 (URN)10.1080/11038128.2020.1849393 (DOI)000591821900001 ()33222567 (PubMedID)2-s2.0-85096541841 (Scopus ID)
Note

Funding Agency:

Regions Örebro County 

Available from: 2020-11-24 Created: 2020-11-24 Last updated: 2024-03-04Bibliographically approved
3. Close relatives’ perspectives of everyday activities for older adults readmitted to hospital and discharged to home
Open this publication in new window or tab >>Close relatives’ perspectives of everyday activities for older adults readmitted to hospital and discharged to home
(English)Manuscript (preprint) (Other academic)
National Category
Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-98735 (URN)
Available from: 2022-04-27 Created: 2022-04-27 Last updated: 2024-03-04Bibliographically approved
4. Healthcare professionals’ perceptions on how to prevent readmission to hospital on an unplanned basis of older adults
Open this publication in new window or tab >>Healthcare professionals’ perceptions on how to prevent readmission to hospital on an unplanned basis of older adults
(English)Manuscript (preprint) (Other academic)
National Category
Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-98736 (URN)
Available from: 2022-04-27 Created: 2022-04-27 Last updated: 2024-03-04Bibliographically approved

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