Understanding the positive outcomes of discharge planning interventions for older adults hospitalized following a fall: a realist synthesis

Abstract

Background 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. This realist synthesis aimed to better understand when, where, for whom, why and how the components of these interventions produce positive outcomes. Methods Nine 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. Results Twenty-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). Conclusions Since 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.

Healthcare professionals’ perception of barriers and facilitators for care coordination of older adults with complex care needs being discharged from hospital: A qualitative comparative study of two Nordic capitals

“…In Stockholm, there were coordinators designated to manage the hospital discharge planning, which in previous research has shown to facilitate a good discharge process [18,19]. This was not brought up as a facilitator, but this might be because all our participants from the hospital had this role and did not reflect upon them self as a facilitator for the discharge process.…”

“…Carefully planned and performed discharges have also the potential to improve both patients' quality of life [16] and satisfaction with the process [17]. Providing a coordinator designated to manage the hospital discharge planning has shown to facilitate the process, however, this is often not standard [18,19].…”

Desafios para realização da alta na atenção domiciliar

“…Contudo, apesar de evidenciados os benefícios obtidos a partir do envolvimento do paciente, cuidadores e familiares no processo de planejamento da alta, os relatos dos participantes demonstram dificuldades de inseri-los na elaboração das ações, consonante a uma revisão narrativa que destaca falas de cuidadores não envolvidos nas tomadas de decisão (9) . Diversos estudos destacam a insatisfação dos utentes de saúde e cuidadores responsáveis sobre a falha de comunicação com os profissionais prestadores da assistência durante o planejamento da alta e transição dos cuidados (9,(17)(18) .…”

“…As orientações devem abranger todas as questões e dificuldades, adequadas aos aspectos socioculturais e retomadas. Além disso, é importante instruir quanto às possibilidades de complicações e direcionamento do cuidado em quadros de urgência (18) . Aspectos influentes na efetivação da alta pelos Aspectos influentes na efetivação da alta pelos serviços de AD serviços de AD Nessa categoria, foi possível reconhecer alguns aspectos que interferem no processo de elaboração e planejamento da alta.…”

Health Emergencies, Falls, and Use of Communication Technologies by Older People with Functional and Social Frailty: Ageing in Place in Deprived Areas of Italy

“…Furthermore, falls in older age significantly impact healthcare and related costs all over the world [ 13 ]. After a fall, seniors experience indeed long hospitalizations, complex treatments, thus needing resource-intensive care, including rehabilitation and home care [ 24 , 25 ], in addition to effective discharge planning interventions [ 26 ].…”