How older people cope with frailty within the context of transition care in Australia: implications for improving service delivery

Abstract

Transition care is increasingly common for older people, yet little is known about the subjective experience of the transition care 'journey' from the perspective of clients themselves. This study examines how older people cope with frailty within the context of a dedicated transition care programme and discusses implications for improving service delivery. Qualitative in-depth interviews were carried out during 2011 in the homes of 20 older people who had recently been discharged from a transition care programme operating in Adelaide, South Australia (average age 80 years, 65% female). Thematic analysis identified three key themes: 'a new definition of recovery', 'complexities of control' and 'the disempowering system'. Despite describing many positive aspects of the programme, including meeting personal milestones and a renewed sense of independence, participants recognised that they were unlikely to regain their previous level of functioning. For some, this was exacerbated by lacking control over the transition care process while adapting to their new level of frailty. Overall, this research highlighted that benefits associated with transition care can be undermined by fragmentation in service delivery, loss of control and uncertainties around future support.

Stakeholders’ views and experiences of care and interventions for addressing frailty and pre-frailty: A meta-synthesis of qualitative evidence

“…Twentysix papers contributed to this theme [31–36,38–40,43,46,47,52–58,60,62,65,70–72,74]. This theme presents findings related to care providers’ capacity to care, taking a patient-centred and family-centred approach to care.…”

“…However, studies illustrate examples of older people and their carers refusing services offered [15], or expressing reluctance to seek care even whilst acknowledging that such support is needed [16]. There are also indications that dependency on services, but limited participation in decision making, can produce feelings of devaluation and disempowerment in older persons [17]. It is essential to take into account older adults’ views, attitudes and understandings related to their own coping and care planning strategies, and to care and interventions in the context of frailty.…”

User experience and care for older people transitioning from hospital to home: Patients’ and carers’ perspectives

“…In a meta‐synthesis review, user experience of transitional care was a social process of negotiation and navigation of independence for older people and carers . Other research has also found that independence is important to older people living in the community both with and without support . The current finding contributes to our understanding that ideal transitional care interventions should focus on patients’ desire and need to regain independence as well as on communication between practitioners about the discharge assessment and plan of care; preparation of the person and carer for the care transition; reconciliation of medications at transition; a plan for follow‐up care; and patient education about self‐management …”

Addressing the Needs of an Aging Population in the Health System: The Australian Case

“…Fragmentation of service delivery, lack of control of the client over the services delivered, and uncertainty about future support were identified as the issues whose resolution would increase benefits from the program. 43 In part, the difficulties of transition relate to the availability of residential aged care. Podger, writing in 2006, pointed to about 2,000 elderly people in hospital awaiting residential aged care.…”