Transitional Care for Communication Impaired Older Adults: ICU to Home

Abstract

Post-intensive care unit (ICU) outcomes, are of increasing concern to critical care practitioners and researchers worldwide. Poor outcomes such as, patient cognitive impairment, or anxiety, depression and post-traumatic stress disorder among both patients and family caregivers, are of particular concern. Older adults are more likely to experience changes in physical and cognitive function and to have chronic care needs following critical illness than younger adult ICU patients. These changes can have profound effects on an individual’s psycho-emotional state and on the post-traumatic stress experienced by family caregivers. Communication impairment during critical illness is stressful for ICU patients and family visitors ; however, there has been little attention given to the effect that acute and/or prolonged communication impairment has on post-ICU recovery. In this column, we present an international perspective from Italy on a program of communication intervention that extends from critical illness hospitalization to chronic care follow-up. The two cases presented below illustrate the profound impact that transitional care nurse intervention to improve patient communication can have on an older adult’s psycho-behavioral symptoms, sense of self, treatment adherence, and family functioning in the post-ICU period. Cristina Cerantola, an Advanced Practice Nurse in the Veneto Region of Italy, presents narratives from her outpatient and home care practice with patients with pulmonary disorders. Dr. Happ provides format and commentary. Patient pseudonyms are used.