Early identification of relocation risk in older adults with critical illness

Relocation experiences with unplanned admission to a nursing home: a qualitative study

BACKGROUND

In many countries, people over 85 years of age are relocated involuntarily or unplanned to a nursing home. In Switzerland, 43% of elderly over 85 years are admitted to nursing homes after hospital discharge. This percentage is higher than in the USA with 32.5% or in Germany with only 19%. Despite those more frequent Swiss admissions, no research has been conducted exploring how unplanned admissions to nursing homes affect the adaptation. Therefore, the aim of this study was to gain an in-depth understanding into unplanned admissions to nursing homes and to explore its impact on adaptation.

METHODS

The study used a qualitative interview design based on Meleis' transition model. Secondary data analysis was guided by Mayring's qualitative content analysis. Face-to-face interviews with elderly over 77 years (n = 31) were conducted from a convenience sample in Switzerland between January and March 2013.

RESULTS

The following four patterns of adaptation emerged from the analysis: "being cut-off," "being restricted," "being cared for," and "moving on." The patterns evaluate the relocation into nursing homes and provide an opportunity to appraise the stages of adaption.

CONCLUSIONS

This study presents a model of analysis to evaluate patterns of adaptation following an unplanned admission to a nursing home after hospital discharge.

Making the Move: A Mixed Research Integrative Review

The purpose of this mixed research integrative review is to determine factors that influence relocation transitions for older adults who are considering a move from independent living to supervised housing, such as assisted living, using the Theory of Planned Behavior as a conceptual guide. PubMED, CINAHL, and PsychInfo databases were queried using key words: relocation, transition, older adults, and, elderly and time limited from 1992 to 2014. Sixteen articles were retained for review. The majority of articles, qualitative in design, reveal that older adults who comprehend the need to move and participate in the decision-making process of a relocation adjust to new living environments with fewer negative outcomes than older adults who experience a forced relocation. The few quantitative articles examined the elements of impending relocation using a variety of instruments but support the necessity for older adults to recognize the possibility of a future move and contribute to the relocation process. Additionally, the influence of family, friends, and health care providers provides the older adult with support and guidance throughout the process.

Individual characteristics and relocation factors affecting adjustment among relocated American and Egyptian older adults

Worldwide, the population of elders is increasing significantly. Relocation can be a positive or a negative experience, depending on many factors, including culture. The purpose of this study is to compare individual characteristics (age, gender, marital status, education, perceived health status, activities of daily living), relocation factors (movement preparation, time passed since relocation, closeness of prior home to the present, and whether relocation was from home or another facility), and adjustment in relocated American and Egyptian elders. This secondary analysis study merged data from two cross-sectional descriptive studies of a 104 elders relocated to retirement communities in Northeast Ohio and 94 elders relocated to retirement communities in Alexandria, Egypt. Our findings indicated that American elders have greater independence in daily activities (t (161.23) = -3.03, p = .003); better perceived health (χ(2)[3, N = 198] = 53.21, p < .001), better education (χ(2)[1, N = 198] = 47.28, p < .001), better preparation before the move (χ(2)[1, N = 198] = 40.58, p < .001), and better relocation adjustment (t (196) = 9.42, p < .001) than relocated Egyptian elders. Our results indicate that culture should be taken into account when caring for older adults who relocate to retirement communities. Additionally, interventions, such as counseling, and preparation before relocation are needed to help elders adjust to relocation.

Resourcefulness, positive cognitions, relocation controllability and relocation adjustment among older people: a cross-sectional study of cultural differences

BACKGROUND

The population of older people in both the United States and Egypt is expected to double by the year 2030. With ageing, chronic illnesses increase and many older people need to relocate to retirement communities. Research has shown that positive cognitions and resourcefulness are positively correlated with adaptive functioning and better adjustment.

AIMS AND OBJECTIVES

The purpose of this study was to examine and compare relocation controllability, positive cognitions, resourcefulness and relocation adjustment between American and Egyptian older people living in retirement communities. The purpose of this cultural comparison is to gain insight into influencing factors in each culture that might lead to interventions to help relocated older adults in both cultures adjust to their new surroundings.

DESIGN AND METHOD

A cross-sectional, descriptive design was used to compare relocation controllability, positive cognitions, resourcefulness and relocation adjustment of a convenience sample of American older people (n = 104) and a convenience sample of Egyptian older people (n = 94). The study was a secondary analysis of two studies of older people residing in six retirement communities in Northeast Ohio and in five retirement communities in Alexandria, Egypt.

RESULTS

Examination of mean scores and standard deviations on the measure of positive cognitions using independent sample t-tests indicated that on average, the American older people reported more positive cognitions (t (131.16) = 11.29, P < 0.001), more relocation controllability (t (196) = -6.78, P < 0.001) and more relocation adjustment (t (196) = 9.42, P < 0.001) than the Egyptian older people. However, there was no significant difference between Egyptians and Americans in resourcefulness (t (174.16) = -0.97, P > 0.05).

CONCLUSION

The results provide direction for the development of positive cognition interventions and engaging older people in the decision-making process to help them to adjust to relocation. Implications for practice.  Positive thinking and resourcefulness training interventions can be used by nurses to help relocated older people to adjust to the stress of relocation to retirement communities. These interventions can be used on primary, secondary, and tertiary levels. Primary interventions can help to prevent the stress of relocation before happening by helping older people to use their positive thinking and their resources and work with them before relocating to retirement communities. Secondary prevention can be used by nurses to help older people who have already relocated to retirement communities and have already experienced stress of relocation to help them out by decreasing the stress that they are suffering. Tertiary prevention can be used to prevent further stress and deterioration for those who have suffered physical and psychological symptoms as a result of relocation.

Psychometric properties of the pressure to move scale in relocated american older adults: further evaluation

The number of elders who relocate to retirement communities is increasing exponentially, and their ability to exercise free choice, personal control, and autonomy has been associated with relocation adjustment and positive outcomes in regard to physical, emotional, and social well-being. Although a measure of relocation controllability (the degree of personal control associated with the move) exists, there is limited evidence of its psychometric adequacy. This study tested the reliability and validity of the Pressure to Move Scale (PTMS). A convenience sample of 104 American elders who relocated to six Northeast Ohio retirement communities was recruited. Study participants completed the nine-item PTMS and two validation measures during structured interviews. Cronbach's alpha was .71. Homogeneity was supported by item-to-total correlations between .30 and .70, except for two items. Deletion of the item asking about the elder's first impression of relocation improved the alpha to .74. The PTMS was correlated in the expected direction with positive cognitions (r = -.37, p < .01) and relocation adjustment (r = -.62, p < .01), indicating convergent validity. Factor extraction generated three factors, the first reflecting "internal" control factors and the second reflecting "external" control factors; a third factor, containing two items with low item-to-total correlations, reflected another level of "external" control. With preliminary evidence of its reliability and validity, this scale can be a useful tool for screening for pressure to move or involuntary relocation among older adults so that negative outcomes associated with relocation can be prevented through tailored interventions.

Institutional variations in frequency of discharge of elderly intensive care survivors to postacute care facilities

OBJECTIVE

To examine variations in the frequency of discharge of elderly patients to postacute care facilities across multiple intensive care units and identify the influence of institutional and patient factors on the frequency of postacute care discharge.

DESIGN

Observational cohort study.

SETTING

Consecutive admissions from 65 intensive and coronary care units in 24 US hospitals during 2002-2008. Each hospital had a clinical information system in place.

PATIENTS

A total of 13,370 admissions in patients aged≥65 yrs who were alive at hospital discharge and met inclusion criteria.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Demographic, clinical, diagnostic, and physiological variables were obtained on all patients. In addition, information for each hospital and intensive care unit was recorded. Among hospital survivors, 46.2% were discharged to postacute care facilities with a range of 8.8-77.8%. A multivariable logistic regression model was developed that predicted discharge to a postacute care facility. The major variables affecting postacute care discharge were diagnosis, day 5 physiology, and day 5 therapy; these variables accounted for 61% of the model's explanatory power. Patient age, hospital bed size, teaching status, and intensive care unit type also affected postacute care discharge. Physiology and therapy on day 1 had little impact on postacute care discharge. The model accounted for only 31% of the variation in rates across intensive care units, indicating that unmeasured factors play a part in dictating discharge location.

CONCLUSION

Discharge of elderly intensive care unit patients to postacute care facilities varies widely by institution. These variations are only partially explained by differences in patient and institutional characteristics and are affected more by diagnosis and physiology on day 5, respectively. Unmeasured factors such as admission from a postacute care facility, postacute care availability, patient preferences, and socioeconomic factors may account for unexplained variations in postacute care discharge.

The Role of Positive Cognitions in Egyptian Elders’ Relocation Adjustment

Relocation is a major life event for elders and it has been found to adversely affect their adjustment. Resilience theory suggests that adverse effects can be minimized if elders have positive cognitions. In addition, research has shown that positive cognitions are related to independence and healthy, productive lifestyles in older adults. Yet no studies have determined whether the relationship between relocation and adjustment is mediated or moderated by positive cognitions. This study examined these relationships in a sample of 94 cognitively intact elders (aged 60+ years) who had relocated to retirement communities in Alexandria, Egypt. Results showed that relocation controllability had direct effects on positive cognitions and on relocation adjustment. Positive cognitions had a moderating and a partial mediating effect on the relationship between relocation controllability and relocation adjustment. These findings suggest that it is imperative to develop interventions to enhance positive thinking for elders facing the need to relocate.

The user experience of critical care discharge: a meta-synthesis of qualitative research

OBJECTIVES

This review identifies the most significant factors, which impact upon the user experience of progress and recovery from critical illness during the first month after discharge from critical care, and discusses these in relation to the development of effective critical care discharge support strategies.

DESIGN

Meta-synthesis of qualitative primary research.

DATA SOURCES

Qualitative research published in English between 1990 and 2009 was identified using online databases: CINAHL, MEDLINE, EMBASE, British Nursing Index, CDSR, ACP Journal Club, Cochrane library, Social Policy and Practice and PsycInfo. Studies of adult patients, relatives/carers/significant others, which focused on experiences after discharge from an intensive care or high dependency unit to a general ward were retrieved.

REVIEW METHODS

Following screening against inclusion/exclusion criteria, methodological appraisal of studies was conducted using a published framework. Ten studies met the criteria for inclusion.

RESULTS

Five key themes emerged from the meta-synthesis: physical and psychological symptoms; making progress; the need to know; and safety and security.

CONCLUSIONS

Findings from this meta-synthesis and other related literature supports the existence of physical and psychological problems in the immediate period following discharge from critical care to the ward, and suggests that patients and their families have a desire for more control over their recovery. However, this desire is countered by a need to feel safe and protected, culminating in an expression of dependence on healthcare staff. Any effective support strategy needs to take account of these findings.