Facilitators and inhibitors in hospital-to-home transitional care for elderly patients with chronic diseases: A meta-synthesis of qualitative studies

Abstract

BackgroundChronic diseases are long-term, recurring and prolonged, requiring frequent travel to and from the hospital, community, and home settings to access different levels of care. Hospital-to-home transition is challenging travel for elderly patients with chronic diseases. Unhealthy care transition practices may be associated with an increased risk of adverse outcomes and readmission rates. The safety and quality of care transitions have gained global attention, and healthcare providers have a responsibility to help older adults make a smooth, safe, and healthy transition.ObjectiveThis study aims to provide a more comprehensive understanding of what may shape health transitions in older adults from multiple perspectives, including older chronic patients, caregivers, and healthcare providers.MethodsSix databases were searched during January 2022, including Pubmed, web of science, Cochrane, Embase, CINAHL (EBSCO), and PsycINFO (Ovid). The qualitative meta-synthesis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. The quality of included studies was appraised using the Critical Appraisal Skills Programme (CASP) qualitative research appraisal tool. A narrative synthesis was conducted informed by Meleis's Theory of Transition.ResultsSeventeen studies identified individual and community-focused facilitators and inhibitors mapped to three themes, older adult resilience, relationships and connections, and uninterrupted care transfer supply chain.ConclusionThis study identified potential transition facilitators and inhibitors for incoming older adults transitioning from hospital to home, and these findings may inform the development of interventions to target resilience in adapting to a new home environment, and human relations and connections for building partnerships, as well as an uninterrupted supply chain of care transfer at hospital-home delivery.Systematic review registrationwww.crd.york.ac.uk/prospero/, identifier: CRD42022350478.

‘Hearing silences’: Exploring culturally safe transitional care: A qualitative study among Turkish‐speaking migrant frail older adults

“…Frail older people are often discharged from hospital with untreated health problems (Spencer, 2020), which creates a need for substantial follow‐up care – often within a fragmented healthcare system (Olsson et al, 2020). Therefore, frail older people often need assistance from their informal caregivers during the transition to different care settings (Kraun et al, 2022; Sun et al, 2023). Another problematic issue is that, as the use of internet‐based technologies in health care settings has increased, the lack of e‐health literacy among older adults means they may become even more isolated from care systems and services (Sun et al, 2023).…”

“…Therefore, frail older people often need assistance from their informal caregivers during the transition to different care settings (Kraun et al, 2022; Sun et al, 2023). Another problematic issue is that, as the use of internet‐based technologies in health care settings has increased, the lack of e‐health literacy among older adults means they may become even more isolated from care systems and services (Sun et al, 2023). We also found that many participants missed out on therapies such as speech therapy or web‐based physical therapy during the period following hospital discharge.…”

Volunteers of Third Sector Organizations in supporting older adults in the transition from hospital to home: A comparative case study

“…It is well documented that intersecting health and social issues often complicate the transition process and adversely affect physical recovery, mood, social participation, quality of life and ultimately, the self-management and self-care capacity of patients and caregivers (18,(30)(31)(32). The clients of the included programs benefited from a range of instrumental activity supports, such as transportation, grocery shopping, light housekeeping, and appreciated the psychosocial support provided by program volunteers.…”

“…Unresolved somatic symptoms, difficulties in daily management and processing of information, and an insufficient social support network contribute to challenging transitions home (5).…”

“…Self-governing: TSOs operate independently without interference from external authorities. 5. Voluntary: TSOs are driven by the commitment of individuals operating within it and typically involve a meaningful degree of volunteerism.…”