Abstract
Patient participation is highlighted in healthcare policy documents as an important area to address in order to improve and secure healthcare quality. The literature on healthcare quality and safety furthermore reveals that transitional care carries a risk of adverse events. Elderly persons with co-morbidities are in need of treatment and healthcare from several care professionals and are transferred between different care levels. Patient-centered care, shared decision-making and user involvement are concepts of care that incorporate patient participation and the patients’ experiences with care. Even though these care concepts are highlighted in healthcare policy documents, limited knowledge exists about their use in transitions, and therefore points to a need for a review of the existing literature. The purpose of the paper is to give an overview of studies including patient participation as applied in transitional care of the elderly. The methodology used is a literature review searching electronic databases. Results show that participation from elderly in discharge planning and decision-making was low, although patients wanted to participate. Some tools were successfully implemented, but several did not stimulate patient participation. The paper has documented that improvements in quality of transitional care of elderly is called for, but has not been well explored in the research literature and a need for future research is revealed. Clinical practice should take into consideration implementing tools to support patient participation to improve the quality of transitional care of the elderly.
Highlights
There is a fast-growing elderly population worldwide (WHO 2011a, b) often with several medical diagnoses and with an increasing need for clinical care across primary and secondary healthcare. This complex need for care and treatment is often caused by chronic diseases, physical disability, cognitive impairments and polypharmacy (Foss and Askautrud 2010; McCall et al 2008) and require the elderly patients to transfer between different levels of healthcare, with an increasing risk of fragmented care and adverse events (Coleman et al 2005; Danielsen and Fjær 2010)
It was sometimes just to inform about decisions already taken by professionals (Efraimsson et al 2004). ‘‘Real participation’’ belongs to the third and highest step of the ladder and was sparsely found (Thompson 2007). This concept has been explained in one of the studies as a high degree of shared decision (Foss and Hofoss 2011), and some participants experienced to be heard, involved and supported in their needs (Ellis-Hill et al 2009; Rydeman and Tornkvist 2009). These results show that real participation may be difficult to achieve and that information is necessary for active participation in transitional care of the elderly
Results show that elderly patients often were excluded and not participating in discussions about discharge
Summary
There is a fast-growing elderly population worldwide (WHO 2011a, b) often with several medical diagnoses and with an increasing need for clinical care across primary and secondary healthcare This complex need for care and treatment is often caused by chronic diseases, physical disability, cognitive impairments and polypharmacy (Foss and Askautrud 2010; McCall et al 2008) and require the elderly patients to transfer between different levels of healthcare, with an increasing risk of fragmented care and adverse events (Coleman et al 2005; Danielsen and Fjær 2010). Inadequate discharge planning often leads to readmission (Huber and McClelland 2003) The patients and their caregivers are most often the only common and stable factor moving across different levels and sites of care (Coleman et al 2004). Involvement and participation of elderly in transitional care has been suggested as one way of preventing adverse events and improving the quality of transitional care (Foss and Hofoss 2011; Huber and McClelland 2003)
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