An observational study of older patients’ participation in hospital admission and discharge - exploring patient and next of kin perspectives

Abstract

Aims and objectives: To explore older patients’ participation during hospitaladmission and discharge. Background: Patient participation is suggested as a means to improve the quality of tran-sitional healthcare. Older people with chronic diseases, physical disabilities and cognitiveimpairments often need to transfer from primary to hospital healthcare and vice versa. Design: This study adopts a participant observational research design.Methods. Participant observations of 41 older patients (over 75 years of age) dur-ing hospital admission and discharge were conducted in two hospitals in Norway(in 2012). The observations included short conversations with the patient andtheir next of kin to capture their participation experiences. Systematic text con-densation was used to analyse the data material from the field notes. Results: Varying degrees of information exchange between healthcare profession-als and patients, and a lack of involvement of the patient in decision-making (inadmission and discharge) were observed and experienced by patients and theirnext of kin. The next of kin appeared to be important advocates for the patientsin admission and provided practical support both during admission and discharge. Data suggest that patient participation in admission and discharge is influencedby time constraints and the heavy workloads of healthcare professionals. Patients’health conditions and preferences also influence participation. Conclusions: Several issues influence the participation of the older patients duringhospital admission and discharge. Participation of the older patients needs contin-uous support from healthcare professionals that acknowledges both the individualpatient’s preferences and their capacity to participate.Relevance to clinical practice. Study findings report discrepancies in the involve-ment of older people and their next of kin. There is a need to increase and sup-port older patients’ participation in hospital admission and discharge.