RURAL/URBAN DIFFERENCES IN HEALTH CARE NEEDS OF THE ELDERLY AFTER HOSPITAL DISCHARGE TO HOME (URBAN HEALTH CARE, HOME CARE).
Contributors: Oregon Health Sciences University.
Published: 1990
Number of pages: 245
Subjects: Health Sciences, Nursing.; Gerontology.
Description: The recent change in the Medicare reimbursement system has resulted in shorter hospital stays. In rural areas, where community resources may be limited, elderly may be particularly vulnerable to this change in the system. The purpose of this longitudinal study was to assess and evaluate the match of environmental resources with functional, behavioral, knowledge, and skilled care needs of rural and urban elderly during the transition period following hospital discharge to home.

Eighty-one elderly subjects, discharged from hospitals to one urban and two frontier rural counties, were selected. There were no significant differences in demographic variables between rural and urban subjects. The Comprehensive Health Care Needs Assessment (CHCNA) questionnaire, developed for this study, and the Behavioral and Mood Disturbance (BMD) Scale were used to assess needs at three days and three weeks after discharge. Using repeated measures analyses of variance, rural dwellers identified significantly more skilled care needs than did their urban counterparts. More behavioral needs were identified using the BMD than from using the CHCNA. In each domain, there were significantly fewer needs identified at three weeks than at three days after discharge.

The skilled care and knowledge needs of both groups were met primarily by the formal support system. Unexpectedly, at three weeks after discharge, considerably more functional needs were met by families in the urban area than in the rural area. While almost all the subjects reported unmet needs in at least one domain, behavioral needs were reported as unmet most of the time. Although only a small number of subjects reported unmet needs in multiple domains, the complexity of the unmet needs were clinically significant.

The findings suggest that the profile of needs experienced by elderly patients after hospital discharge in the 1990s may be different than reported in earlier studies and that continued contact during the transition period after discharge is necessary to monitor individual health care needs and the uneven response by the informal and formal systems to those needs. These findings are of clinical importance to nursing because continuity of care is a major emphasis in our practice.
Notes: Source: Dissertation Abstracts International, Volume: 52-11, Section: B, page: 5761.

Thesis (PH.D.)--OREGON HEALTH SCIENCES UNIVERSITY, 1990.

School code: 0368.