Safeguarding Survival: Older Persons with Multiple Chronic Conditions' Unplanned Readmission Experiences: A Mixed Methods Systematic Review
Creators: Coatsworth-Puspoky, Robin D.
Publisher: name: University of Alberta Library
Year: 2022

<p>Background: As older persons (&gt;60 years of age) live longer with more than one chronic condition they will experience more unplanned readmissions to hospital and will require more support from community and hospital health care services to reduce or prevent unplanned readmissions. Little is known about the experience of unplanned readmission from the perspectives of older persons with multiple chronic conditions. Purpose: The purpose of this dissertation project was to construct knowledge about older persons with multiple chronic conditions’ experiences with unplanned readmission to hospital within 30 days of discharge. Older persons’ perspectives about unplanned readmission and what hospital and community services and resources they need is essential for the development of strategies to reduce unplanned readmission. Method: Several strategies were used to investigate unplanned readmission. First an integrative review method was used to explore older persons with multiple chronic conditions’ unplanned readmission experiences. Next, Walker and Avant’s method was used to analyze the concept of unplanned readmission. Combined, these studies provided the foundation for conducting a mixed methods systematic review. A paper outlining in detail the adapted Harden and Thomas’s approach and procedure is part of this dissertation. The mixed methods systematic review was conducted to understand the psychosocial processes of and factors that influence unplanned readmission for older persons with multiple chronic conditions.Data Analysis: In the mixed method systematic review qualitative data (n=5 studies) were analyzed using a meta-synthesis approach and an applied thematic analysis to construct themes and factors about the psychosocial processes of unplanned readmission. Quantitative data (n=5 studies) were analyzed using vote counting. Qualitative and quantitative data were integrated using a cross-study matrix to identify factors that matched, did not match, and gaps. Quantitative data informed the qualitative data. Findings: Unplanned readmission was a process, experience, and sequel of complex interconnected events that included previous hospital experiences, intrinsic and extrinsic challenges at home, and unpleasant emotions. Older persons needed acute care unplanned readmission health services to resolve their urgent or emergent health crisis that occurred after a previous hospital stay. “Safeguarding survival” described how older persons experienced unplanned readmission by identifying missing pieces of care, reaching for lifelines, and feeling unsafe. The factors that older persons identified as influencing these processes included older persons’ chronic conditions and discharge diagnosis, increased need for help with functional needs, lack of discharge planning, lack of support, increased intensity of symptoms and previous hospital readmission experiences.Conclusion: A holistic model of unplanned readmission using the voices and experiences of older persons with multiple chronic conditions was constructed. These findings are foundational for future testing, research, and the development of a middle range theory about unplanned readmission. Improving or maintaining older persons’ functioning is a safety priority that may reduce unplanned readmission. Future research should focus on developing and evaluating strategies to understand older persons’ previous hospital readmission experiences, unpleasant emotions, and how to support and include family caregivers in care planning.</p>