Risks Perceived by Frail Male Patients, Family Caregivers and Clinicians in Hospital: Do they Change after Discharge? A Multiple Case Study.

Véronique Provencher,Dominique Giroux,Véronique Dubé,Mary Egan,Hélène Corriveau,Monia D’Amours,Chantal Viscogliosi,Manon Guay,Nathalie Delli-Colli

doi:10.5334/ijic.4166

Véronique Provencher, Dominique Giroux + Show 7 more

Open Access

https://doi.org/10.5334/ijic.4166

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Abstract

Introduction:Up to 40% of hospitalised seniors are frail and most want to return home after discharge. Inaccurate estimation of risks in the hospital may lead to inadequate support at home. This study aimed to document convergences and divergences between risks and support needs identified before hospital discharge and perceived at home post-discharge.Methods:This research used a multiple case study design. Three cases were recruited, each involving a hospitalised frail patient aged 70+, the main family caregiver and most of the clinicians who assessed the patient before and after hospital discharge. Thirty-two semi-structured interviews were conducted and their transcripts analysed using a qualitative thematic analysis approach.Results:Among risks raised by participants, falls were the only one with total inter-participant/inter-time/inter-case convergence. In all cases, all participants mentioned, before and after discharge, home adaptations and use of technical aids to mitigate this risk. However, clinicians recommended professional services while patients and family caregivers preferred to rely on family members and their own coping strategies.Conclusion:The divergences identified for most risks and support needs between users and clinicians, before and after discharge, provide new insights into a comprehensive and patient-centred risk assessment process to plan hospital discharge for frail elderly.

Highlights

The Iso-SMAF profile is a valid and reliable classification [36] based on the functional autonomy measurement system (SMAF) [37,38,39]
To see different resources that could ... for example, for transportation, instead of it always being the spouse who has to provide them, maybe we could ... we will look for resources to ... find other alternatives”. This multiple case study identified convergences and divergences between risks and support needs targeted before hospital discharge and perceived after discharge by
Loss of autonomy was mostly perceived by patients and family caregivers, while medical deconditioning was mainly reported by clinicians

Summary

Introduction

Up to 40% of hospitalised seniors are frail and most want to return home after discharge. During hospitalisation, functional decline [4, 5] and deconditioning [6] often result in precarious discharge situations for frail patients [7], with increased risks of potentially preventable harm upon return home (e.g. falls, injuries, inadequate nutrition/medication intake) [8,9,10,11]. Recent data suggest these potential harms are largely preventable through optimal discharge planning [7, 12, 13]. The risk analysis process may be compromised by: 1) the patient’s unfamiliarity with the hospital context in which the assessment is done [15]; 2) the clinician’s lack of information about home hazards [16]; 3) fluctuations in the patient’s functional abilities due to medication, fatigue or pain [17]; and 4) the clinician’s difficulty predicting clinical progress after discharge, such as a sudden deterioration [5] or gradual improvement [18]

Methods

Discussion

Conclusion