Abstract
BackgroundOlder adults hospitalized following a fall often encounter preventable adverse events when transitioning from hospital to home. Discharge planning interventions developed to prevent these events do not all produce the expected effects to the same extent. This realist synthesis aimed to better understand when, where, for whom, why and how the components of these interventions produce positive outcomes.MethodsNine indexed databases were searched to identify scientific papers and grey literature on discharge planning interventions for older adults (65+) hospitalized following a fall. Manual searches were also conducted. Documents were selected based on relevance and rigor. Two reviewers extracted and compiled data regarding intervention components, contextual factors, underlying mechanisms and positive outcomes. Preliminary theories were then formulated based on an iterative synthesis process.ResultsTwenty-one documents were included in the synthesis. Four Intervention-Context-Mechanism-Outcome configurations were developed as preliminary theories, based on the following intervention components: 1) Increase two-way communication between healthcare providers and patients/caregivers using a family-centered approach; 2) Foster interprofessional communication within and across healthcare settings through both standardized and unofficial information exchange; 3) Provide patients/caregivers with individually tailored fall prevention education; and 4) Designate a coordinator to manage discharge planning. These components should be implemented from patient admission to return home and be supported at the organizational level (contexts) to trigger knowledge, understanding and trust of patients/caregivers, adjusted expectations, reduced family stress, and sustained engagement of families and professionals (mechanisms). These optimal conditions improve patient satisfaction, recovery, functional status and continuity of care, and reduce hospital readmissions and fall risk (outcomes).ConclusionsSince transitions are critical points with potential communication gaps, coordinated interventions are vital to support a safe return home for older adults hospitalized following a fall. Considering the organizational challenges, simple tools such as pictograms and drawings, combined with computer-based communication channels, may optimize discharge interventions based on frail patients’ needs, habits and values.Empirically testing our preliminary theories will help to develop effective interventions throughout the continuum of transitional care to enhance patients’ health and reduce the economic burden of avoidable care.
Highlights
Older adults hospitalized following a fall often encounter preventable adverse events when transitioning from hospital to home
According to the U.S Centers for Disease Control and Prevention, falls are the leading cause of non-fatal injuries among older adults, and one in ten falls leads to a serious injury, such as a hip fracture or head injury, which requires hospitalization [2]
In the European Union, it is estimated that each year almost two thirds (62%) of older adults visiting emergency departments for fallrelated injuries were admitted to hospital [4]
Summary
Older adults hospitalized following a fall often encounter preventable adverse events when transitioning from hospital to home. Discharge planning interventions developed to prevent these events do not all produce the expected effects to the same extent. In Canada, accidental falls were the main cause (81%) of older adults being hospitalized for injury in 2019, which is a 9% increase over the previous year [3]. In the European Union, it is estimated that each year almost two thirds (62%) of older adults visiting emergency departments for fallrelated injuries were admitted to hospital [4]. Older adults hospitalized for serious injuries due to a fall are exposed to significant risks of adverse events after discharge, such as a new fall, functional decline, hospital readmission, and emergency visits [5, 6]. The way the discharge is planned and carried out can improve patients’ and families’ satisfaction with the process [8, 9, 14,15,16] and their quality of life [16, 17]
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