scholarly journals Experiences of an Emergency Department Visit Among Older Adults and Their Families: Qualitative Findings From a Mixed-Methods Study

2019 ◽  
Vol 7 (3) ◽  
pp. 346-356
Author(s):  
Deniz Cetin-Sahin ◽  
Francine Ducharme ◽  
Jane McCusker ◽  
Nathalie Veillette ◽  
Sylvie Cossette ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Mixed Methods ◽  
Family Members ◽  
Home Care Services ◽  
Mixed Methods Study ◽  
Telephone Interviews ◽  
Care Services ◽  
Ed Visits ◽  
Family Perceptions

Background: Emergency department (ED) visits are critical events for older adults, but little is known regarding their experiences, particularly about their physical needs, the involvement of accompanying family members, and the transition back to the community. Objective: To explore experiences of an ED visit among patients aged 75 and older. Methods: In a mixed-methods study, a cohort of patients aged 75 and older (or a family member) discharged from the ED back to the community was recruited from 4 urban EDs. A week following discharge, structured telephone interviews supplemented with open-ended questions were conducted. A subsample (76 patients, 32 family members) was purposefully selected. Verbatim transcripts of responses to the open-ended questions were thematically analyzed. Results: Experiences related to physical needs included comfort, equipment supporting mobility and autonomy, help when needed, and access to drink and food. Family members required opportunities to provide patient support and greater involvement in their care. At discharge, patients/families required adequate discharge education, resolution of their health problem, information on medications, and greater certainty about planned follow-up medical and home care services. Conclusions: Our findings suggest several areas that could be targeted to improve patient and family perceptions of the care at an ED visit.

scholarly journals P035: Impact of EMS direct referral to community care on emergency department utilization

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S75
Author(s):  
A. Dukelow ◽  
M. Lewell ◽  
J. Loosley ◽  
S. Pancino ◽  
K. Van Aarsen
Keyword(s):  
Emergency Department ◽  
Home Care ◽  
Community Care ◽  
Home Care Services ◽  
Emergency Department Visits ◽  
Emergency Department Utilization ◽  
Care Services ◽  
Significant Difference ◽  
Ed Visits ◽  
The Impact

Introduction: The Community Referral by Emergency Medical Services (CREMS) program was implemented in January 2015 in Southwestern Ontario. The program allows Paramedics interacting with a patient to directly refer those in need of home care support to their local Community Care Access Centre (CCAC) for needs assessment. If indicated, subsequent referrals are made to specific services (e.g. nursing, physiotherapy and geriatrics) by CCAC. Ideally, CREMS connects patients with appropriate, timely care, supporting individual needs. Previous literature has indicated CREMS results in an increase of home care services provided to patients. Methods: The primary objective of this project is to evaluate the impact of the CREMS program on Emergency Department utilization. Data for all CCAC referrals from London-Middlesex EMS was collected for a thirteen month period (February 2015-February 2016). For all patients receiving a new or increased service from CCAC the number of Emergency Department visits 2 years before referral and 2 years after referral were calculated. A related samples Wilcoxon Signed Rank Test was performed to examine the difference in ED visits pre and post referral to CCAC. Results: There were 213 individuals who received a new or increased service during the study timeframe. Median [IQR] patient age was 77 [70-85.5]. 113/213 (53%) of patients were female. The majority of patients 135/213 (63.4%) were a new referral to CCAC. The median [IQR] number of hospital visits before referral was 3 [1-5] and after referral was 2 [0-4]. There was no significant difference in the overall number of ED visits before versus after referral (955 vs 756 visits, p = 0.051). Conclusion: Community based care can improve patient experience and health outcomes. Paramedics are in a unique position to assess patients in their home to determine who might benefit from home care services. CREMS referrals for this patient group showed a trend towards decreased ED visits after referral but the trend was not statistically significant.

scholarly journals Understanding the Complexity of Diabetes and Urinary Incontinence in Older Adults Receiving Home Care Services: Protocol for a Mixed Methods Study

2019 ◽  
Vol 18 ◽  
pp. 160940691985200 ◽  
Author(s):  
Melissa Northwood ◽  
Jenny Ploeg ◽  
Maureen Markle-Reid ◽  
Diana Sherifali
Keyword(s):  
Older Adults ◽  
Urinary Incontinence ◽  
Mixed Methods ◽  
Home Care ◽  
Mixed Methods Research ◽  
Home Care Services ◽  
Research Attention ◽  
Care Services ◽  
Care Assessment ◽  
Home Care Nurses

Urinary incontinence (UI) is a very prevalent problem for older adults with type 2 diabetes mellitus (T2DM) receiving home care services. However, the complexities of living with UI and T2DM and providing nursing care for older adults in the home care context have received very little research attention. This article describes a protocol for a convergent, mixed methods research design study to address this knowledge and practice gap. The objectives of the proposed study are to (a) determine the prevalence and correlates of UI in older adults living with T2DM receiving home care services, (b) explore the experiences of older adults living with T2DM and UI receiving home care services, (c) explore the experiences of home care nurses caring for this population, and (d) converge the multiple data sources to provide a deeper understanding of the problem and implications for provision of home care services to this population. The research methods are informed by a model of clinical complexity. The quantitative strand will involve descriptive and inferential analysis of standardized home care assessment data (interRAI) to determine the prevalence and correlates of UI in older adults with T2DM receiving home care services. Interpretive description methods will be used in the qualitative strand, and interviews will be conducted with older adults and home care nurses. The findings will be converged to inform a better understanding of the complexity of living with these chronic conditions for older adults receiving home care services and generate implications for complex intervention development. This protocol highlights methodological insights in utilizing mixed methods research to inform intervention design.

scholarly journals Emergencies in Long-Term Care Services for the Elderly in Korea: A Mixed-Methods Study

2019 ◽  
Vol 17 (1) ◽  
pp. 66
Author(s):  
Soon Ok Kim ◽  
Sun Hee Bae
Keyword(s):  
Mixed Methods ◽  
Emergency Response ◽  
Long Term Care ◽  
The Elderly ◽  
Home Care Services ◽  
Mixed Methods Study ◽  
Term Care ◽  
Emergency Situations ◽  
Care Services

This mixed-methods study explored ways to enhance the emergency response abilities of workers in long-term care services for the elderly. Based on different service types, we identify emergency situations and the response abilities of workers in long-term care services. Results indicated that there are more emergency situations in care facilities than in home care services. However, 71.3% of respondents in facilities said emergency response abilities were low compared to 44.2% of workers in home care services. Qualitative research identified six categories and 16 themes based on emotions experienced during emergencies and the challenges in determining solutions. The study confirms that there is a difference in emergency incidences and the coping abilities of workers in facilities and home services with high emergency incidence rates. Developing and applying guidelines for emergency response management by service type is recommended.

scholarly journals Optimising medication management for polymedicated home-dwelling older adults with multiple chronic conditions: a mixed-methods study protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e030030
Author(s):  
Filipa Pereira ◽  
Pauline Roux ◽  
Marie Santiago-Delefosse ◽  
Armin von Gunten ◽  
Boris Wernli ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Mixed Methods ◽  
Chronic Conditions ◽  
Management Practices ◽  
Medication Management ◽  
Emergency Department Visits ◽  
Mixed Methods Study ◽  
Multiple Chronic Conditions ◽  
At Home

IntroductionOptimal medication management is one of the basic conditions necessary for home-dwelling older adults living with multiple chronic conditions (OAMCC) to be able to remain at home and preserve their quality of life. Currently, the reasons for such high numbers of emergency department visits and the very significant rate of hospitalisations for OAMCC, due to medication-related problems (MRPs), is poorly explored. This study aims to reveal the current state of the medication management practices of polymedicated, home-dwelling OAMCC and to make proposals for improving clinical and medication pathways through an innovative and integrated model for supporting medication management and preventing adverse health outcomes.Methods and analysisA mixed-methods study will address the medication management of polymedicated, home-dwelling OAMCC. Its explanatory sequential design will involve two major phases conducted sequentially over time. The quantitative phase will consist of retrospectively exploiting the last 5 years of electronic patient records from a local hospital (N ≈ 50 000) in order to identify the different profiles—made up of patient-related, medication-related and environment-related factors—of the polymedicated, home-dwelling OAMCC at risk of hospitalisation, emergency department visits, hospital readmission (notably for MRPs), institutionalisation or early death. The qualitative study will involve: (a) obtaining and understanding the medication management practices and experiences of the identified profiles extracted from the hospital data of OAMCC who will be interviewed at home (N ≈ 30); (b) collecting and analysing the perspectives of the formal and informal caregivers involved in medication management at home in order to cross-reference perspectives about this important dimension of care at home. Finally, the mixed-methods findings will enable the development of an innovative, integrated model of medication management based on the Agency for Clinical Innovation framework and Bodenheimer and Sinsky’s quadruple aim.Ethics and disseminationEthical approval has been obtained from the Human Research Ethics Committee of the Canton Vaud (2018-02196). Findings will be disseminated in peer-reviewed journals, professional conferences and other knowledge transfer activities with primary healthcare providers, hospital care units, informal caregivers’ and patients’ associations.

scholarly journals A mixed-methods study evaluating the impact of an excursion-based social group on quality of life of older adults

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Joyce Siette ◽  
Mikaela Jorgensen ◽  
Amy Nguyen ◽  
Gilbert Knaggs ◽  
Stuart Miller ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Mixed Methods ◽  
Social Isolation ◽  
Aged Care ◽  
Mixed Methods Study ◽  
Care Staff ◽  
Care Services ◽  
The Impact

Abstract Background Social isolation is an increasing concern for older adults who live in the community. Despite some availability of social support programs to address social isolation, their effectiveness is not routinely measured. This study aimed to evaluate an innovative excursion-based program offering unique social experiences to older adults receiving aged care services. Methods This six-month before and after mixed-methods study evaluated the outcomes of an Australian excursion-based program which offered social and physical outings to bring older adults receiving aged care services into the wider community. The study combined two parts: Part 1 was a pre-post survey assessing the quality of life of older adults who received the excursion-based program for 6 months (n = 56; two time-points, analysed using signed rank test) and Part 2 involved qualitative in-depth, semi-structured interviews (n = 24 aged care staff, older adults and carers; analysed using thematic analysis). Results Older adults experienced a significant increase in quality of life scores (p < 0.001) between baseline and 6 months. Interviews confirmed these observations and suggested that benefits of participation included increased opportunities for social participation, psychological wellbeing, physical function, and carer respite. Interviews also revealed being in a group setting, having tailored, convenient and accessible activities, alongside supportive staff were key drivers in improving the wellbeing of participants. Conclusions Participating in an excursion-based community program may improve wellbeing in older adults. Aging policy should focus on prioritizing initiatives that promote social connectivity with the wider community and assist in improving outcomes for older adults.

scholarly journals Insights from an early stage development mixed methods study on arts-based interventions for older adults following hospitalisation

2021 ◽  
pp. 102745
Author(s):  
Amanda M. Clifford ◽  
Joanne Shanahan ◽  
Hilary Moss ◽  
Triona Cleary ◽  
Morgan Senter ◽  
...  
Keyword(s):  
Older Adults ◽  
Mixed Methods ◽  
Early Stage ◽  
Mixed Methods Study ◽  
Stage Development

scholarly journals Impact of the Outbreak of the COVID-19 Pandemic on Formal and Informal Care of Community-Dwelling Older Adults: Cross-National Clustering of Empirical Evidence from 23 Countries

2021 ◽  
Vol 13 (13) ◽  
pp. 7277
Author(s):  
Aviad Tur-Sinai ◽  
Netta Bentur ◽  
Paolo Fabbietti ◽  
Giovanni Lamura
Keyword(s):  
Older Adults ◽  
Home Care ◽  
Informal Care ◽  
Home Care Services ◽  
Community Dwelling ◽  
European Countries ◽  
Care Services ◽  
The Impact ◽  
Community Dwelling Older Adults ◽  
Informal Help

The COVID-19 pandemic has been dramatically affecting the life of older adults with care needs and their family caregivers. This study illustrates how the initial outbreak of the pandemic changed the supply of formal and informal care to older adults in European countries and Israel and assesses the resilience of these countries in providing support to their older populations by means of a mix of both types of care. We subjected data from the Survey of Health, Ageing and Retirement in Europe COVID-19 period (SHARE-COVID-19) across 23 European countries (including Israel) to descriptive and cluster analyses. In the first wave of the outbreak, a significant proportion of older adults in European countries received informal help, with an increase in the frequency of informal help received from children, neighbors, friends, or colleagues and a decrease in that received from other relatives. In most countries, difficulties in receiving home care services from professional providers were reported. Seven clusters were identified, reflecting different combinations of changes in the formal/informal care provision. In most countries, informal care is more resilient than home care services that formal providers deliver. Since they are an essential source for sustainable care, their challenges related to care should be addressed. The impact of the pandemic does not follow the traditional characterization of welfare regimes. A clustering effort may yield more understanding of the priorities that future care policies should exhibit at the national level and may identify potential systems for policymakers to enhance sustainability of care for community-dwelling older adults.

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