Background Researchers have shown that hospitalisation can decrease older persons’ ability to manage life at home after hospital discharge. Inadequate practices of discharge can be associated with adverse outcomes and an increased risk of readmission. This review systematically summarises qualitative findings portraying older persons’ experiences adapting to daily life at home after hospital discharge. Methods A metasummary of qualitative findings using Sandelowski and Barroso’s method. Data from 13 studies are included, following specific selection criteria, and categorised into four main themes. Results Four main themes emerged from the material: (1) Experiencing an insecure and unsafe transition, (2) settling into a new situation at home, (3) what would I do without my informal caregiver? and (4) experience of a paternalistic medical model. Conclusions The results emphasise the importance of assessment and planning, information and education, preparation of the home environment, the involvement of the older person and caregivers and supporting self-management in the discharge and follow-up care processes at home. Better communication between older persons, hospital providers and home care providers is needed to improve the coordination of care and facilitate recovery at home. The organisational structure may need to be redefined and reorganised to secure continuity of care and the wellbeing of older persons in transitional care situations. Electronic supplementary material The online version of this article (10.1186/s12913-019-4035-z) contains supplementary material, which is available to authorized users.

Background: Older people have varying degrees of unmet nutritional needs following discharge from hospital. Inadequate involvement of the older person and his or her family caregivers in care and care planning, and inadequate support of self-management in the discharge process and follow-up care at home, negatively affects the quality of care. Research on older patients' and their family caregivers' experiences with nutritional care in hospital and home care and in the transition between these settings is limited. Thus, the aim of this study was to explore older patients' and their family caregivers' perceptions regarding the food, meals and nutritional care provided in the transition between hospital and home care services, focusing on the first 30 days at home. The overall aim of this study is to produce knowledge that can inform policy and clinical practice about how to optimise the care provided to older persons that are malnourished or at risk of malnutrition. Methods: Using a qualitative interpretive descriptive design, we carried out face-to-face semi-structured interviews with 15 older patients, with documented risk of malnutrition or malnourishment (Mini Nutritional Assessment [MNA]), two and five weeks after hospital discharge. In addition, we interviewed nine family caregivers once during this five week period. The questions focused on perceptions of food, meals and nutritional care in hospital and home care and in the transition between these settings. We analysed the data thematically. Results: Four overarching themes emerged from the material: 1) the need for a comprehensive approach to nutritional care, 2) non-individualised nutritional care at home, 3) lack of mutual comprehension and shared decision making and 4) the role of family caregivers. Conclusion: The organisation of nutritional care and food provision to older people, depending on care, lack consideration for the individual's values, needs and preferences. Older patients' and their family caregivers' needs and preferences should guide how nutritional care is provided.

BackgroundRecent studies indicate inadequate nutritional care practices in healthcare institutions and identify several barriers to perform individualized nutritional care to older persons. Organisation of care can become rigid and standardised, thus failing to be respectful of and responsive to each person’s needs and preferences. There is limited research exploring health professionals’ views on how structure of care allows them to individualize nutritional care to older persons. In this study we aim to explore how healthcare professionals’ experience providing individualised nutritional care within the organisational frames of acute geriatric hospital care and home care.MethodsSemi-structured interviews with 23 healthcare professionals from hospital acute geriatric care and home care. Interviews were analyzed using thematic analysis.ResultsTwo main themes and six sub-themes emerged from the material. Theme 1: ‘Meeting patients with complex nutritional problems’ with the sub-themes: ‘It is much more complex than just not eating’ and ‘seeing nutrition as a part of the whole’. Theme 2: ‘The structure of the nutritional care’, with the sub-themes: ‘Nutritional routines: Much ado, but for what?’, ‘lack of time to individualize nutritional care’, ‘lack of interdisciplinary collaboration in nutritional care’ and ‘meeting challenging situations with limited resources in home care’.ConclusionsThe healthcare professionals described having a high focus on and priority of nutritional care when caring for older persons. They did however find it challenging to practice individualized nutritional care due to the complexity of the patients’ nutritional problems and constraints in the way nutritional care was organised. By describing the challenges the healthcare professionals face when trying to individualize the nutritional care, this study may provide important knowledge to health professionals and policy makers on how to decrease the gap between older patients’ preferences for care and nutritional care practice.

Background A person‐centred approach to nutritional care has the potential to increase an older person’s role in making informed decisions about their own care and possibly improving their quality of life. However, despite the considerable interest shown in person‐centred nutritional care in recent years, delivery of such care still appears to lack consideration for older persons’ needs and preferences. The present study aimed to explore healthcare professionals’ views on how older persons and their family caregivers participate in decisions about their own nutritional care and possible barriers for that participation. Methods Semi‐structured in‐depth interviews with 23 healthcare professionals in acute geriatric care and home care were conducted. Data were analysed thematically. Results The analysis of the interviews resulted in three main themes: (i) lack of shared decision‐making in nutritional care; (ii) conflict between patient’s preferences and standard nutritional care procedures; and (iii) the value of family caregivers who are seldom involved in nutritional care. Conclusions Healthcare professionals were aware of the importance of actively engaging older persons and their family members in the nutritional care to achieve positive outcomes. However, they encountered individual and structural barriers, including resistance from patients and family caregivers, conflicts between the patients’ nutritional wishes and standard nutritional procedures, a wish to shield the family caregivers from the stress of caring for a sick relative, and lack of time and caring structures that facilitate the older persons and their family’s active participation.

Background: Nursing home patients at nutritional risk are often not identified, nor given entitled nutritional treatment. One approach proven suitable to facilitate change in clinical practise is participatory action research (PAR). This is a process which involves research participants in reflection, planning, action, observation, assessing and re-planning, targeted to bring about change. The aim of the present study was to evaluate whether a PAR project resulted in improved documentation of nutritional care in a nursing home ward. Method and sample: A quantitative evaluation. Documentation of the nutritional information was collected from medical records of residents in a nursing home ward at baseline and five months into the project period. Results: Increased documentation of individual nutritional treatment measures was found from baseline to the follow-up. The number of residents with a nutritional care plan (NCP) also increased significantly. On the other hand, the study identified a significant decrease in the proportion of residents with documented weight and nutritional status. Conclusion: The evaluation found several improvements in the documentation of nutritional care practice in the nursing home ward as a result of the PAR project, indicating that a PAR approach is suitable to bring about change in practice.

Background Unplanned readmission may result in consequences for both the individual and society. The transition of patients from hospital to postdischarge settings often represents a discontinuity of care and is considered crucial in the prevention of avoidable readmissions. In older patients, physical decline and malnutrition are considered risk factors for readmission. The purpose of the study was to determine the effects of nutritional and physical exercise interventions alone or in combination after hospital admission on the risk of hospital readmission among older people. Methods A systematic review and meta-analysis of randomized controlled studies was conducted. The search involved seven databases (Medline, AMED, the Cochrane Library, CINAHL, Embase (Ovid), Food Science Source and Web of Science) and was conducted in November 2018. An update of this search was performed in March 2020. Studies involving older adults (65 years and above) investigating the effect of nutritional and/or physical exercise interventions on hospital readmission were included. Results A total of 11 randomized controlled studies (five nutritional, five physical exercise and one combined intervention) were included and assessed for quality using the updated Cochrane Risk of Bias Tool. Nutritional interventions resulted in a significant reduction in readmissions (RR 0.84; 95% CI 0.70–1.00, p = 0.049), while physical exercise interventions did not reduce readmissions (RR 1.05; 95% CI 0.84–1.31, p-value = 0.662). Conclusions This meta-analysis suggests that nutrition support aiming to optimize energy intake according to patients’ needs may reduce the risk of being readmitted to the hospital for people aged 65 years or older.

Background: The evidence base is steadily increasing regarding the time savings of using machine learning (ML) within evidence synthesis, particularly supervised methods such as classification. Unsupervised methods such as clustering have been less explored. Yet clustering – a method to uncover groups of similar data, from a large and heterogenous dataset – may be a particularly relevant tool within the study identification and data extraction processes of reviews, during which researchers must often read thousands of studies to identify the handful relevant to their review. This protocol is for a mixed methods evaluation of clustering implemented within systematic reviews.Research questions: We will answer the following questions: 1) Can clustering while screening at title/abstract level provide useful automatic categorizations of studies that help reviewers extra data to categorize studies? 2) What are reviewers’ perceptions of and experiences with clustering in relation to acceptability and feasibility in future reviews? Methods: We will identify one or two systematic reviews as models to answer these research questions. Reviewers will use the clustering algorithm Lingo3G built into EPPI Reviewer during the screening process. The main outcome to answer research question 1 is content validity, as an indicator of usefulness, defined by similarities between automatic clusters and reviewer-generated categories. We will display multi-class confusion matrices and use these to estimate precision, recall, and F1-score for each useful cluster. Research question 2 will be answered qualitatively, through semi-structured interviews with participating reviewers before and after having been trained on clustering and implementing it in the model review(s), followed by a focus group presenting results and exploring reviewer trust. Conclusion: The planned evaluation will provide important information as to the feasibility of an unsupervised ML method, clustering, in bridging and aligning two currently linear steps in evidence synthesis. We invite interested evidence synthesis organizations to follow this protocol and subsequently share data with us, or to tailor it to produce a more relevant evaluation.

Background Opioid Maintenance Treatment (OMT) is the gold standard for people with opioid dependence but drop-out can be high. Understanding both patients and health personnel’s experiences with the treatment can provide valuable information to improve the quality of OMT and to increase acceptability and accessibility of services. The aim of this systematic review is to explore the knowledge base of experiences of patients and health care providers, in order to inform the Norwegian Directorate of Health’s national guideline process. Methods We conducted a qualitative evidence synthesis. We first conducted a systematic literature search in electronic databases. Among the 56 studies that met inclusion criteria, we extracted data about study contexts and populations to assess relevance to our research question and on data richness, then purposively sampled to arrive at a manageable sample. Two researchers independently extracted and coded data in Nvivo, and we used the Andersen’s healthcare utilization model to organize and develop codes into four main domains. We assessed the methodological quality of the included studies, and our confidence in findings using CERQual. Results After a literature search retrieved 56 references, we included and analyzed 24 qualitative studies of patients’ and health providers’ experiences with OMT services. We found that stigma was a cross-cutting theme that linked the four domains of Andersen’s healthcare utilization model. Stigma from people outside OMT was a barrier to seeking out and remaining in treatment. Both patients and health personnel perceived that the OMT system contributed to further stigma. OMT services itself was a source of stigma and communication and staff-patient relations were either facilitators or barriers to treatment compliance. Inadequate knowledge and competence among health care providers was a barrier as reported by both patients and providers, which affected the availability and quality of OMT. Patients also had expectations related to non-medical treatment outcomes of OMT such as employment, housing and social relationships. Patients continuously balanced positive expectations of OMT, and negative outcomes related to stigma. Conclusion These results show the need for increased competence in relational work, among OMT personnel, to improve the quality and to avoid stigma and negative attitudes among health providers. OMT should also have a holistic approach to meet patients' non-health-related needs, as these seem to be crucial for treatment compliance and outcomes.