Figure 1
Four groups of factors assumed to influence post-discharge outcome in the transition process from hospital to home for patients aged 80 years and over.
Figure 2
Flow chart of inclusion of respondents and discharge cases covered in the study.
Figure 3
Variables in our data material organized in four groups of factors assumed to influence post-discharge outcome in the transition process from hospital to home for patients aged 80 years and over.
Table 1.
Characteristics of the sample
| Discharged to own home, 43% (n=142/330) | |
|---|---|
| Length of hospital stay | |
| Mean | 10.4 days |
| Median | 7 days |
| Time since discharge | |
| Mean | 16.7 days |
| Median | 14 days |
| ADL-sum1 (S.D.) | |
| Mean | 10.5 (1.79) |
| Median | 11 |
| IADL-sum2 (S.D.) | |
| Mean | 4.9 (1.83) |
| Median | 5 |
| Age | |
| Mean | 85.9 years |
| Median | 85 years |
| % (n) | |
| Gender | |
| Women | 70.4 (100) |
| Men | 29.6 (42) |
| Marital status | |
| Married | 29.1 (41) |
| Widow/widower | 62.4 (88) |
| Divorced | 3.5 (5) |
| Cohabiting | 0.7 (1) |
| Unmarried | 4.3 (6) |
| Level of education | |
| Primary school | 46 (64) |
| Lower secondary/vocational school | 38.8 (54) |
| Upper secondary school | 5.8 (8) |
| University or college degree | 9.4 (13) |
| Living status | |
| Alone | 66.2 (92) |
| With someone | 33.8 (47) |
| Type of residence | |
| Private, not adapted | 42.8 (59) |
| Private, adapted | 26.8 (37) |
| Municipal housing, adapted | 29 (40) |
| Other | 1.4 (2) |
[i] 1ADL-sum ranges from 4—dependent in all activities to 12—independent in ail activities.
2IADL-sum ranges from 3—dependent in all activities to 9—independent in all activities.
Table 2.
Self-reported post-discharge outcome
| How have you managed since coming home from hospital? | % (n) |
|---|---|
| It has been okay all along | 54.1 (66) |
| It was difficult at first, but okay after a while | 18.9 (23) |
| It has been mixed (difficult and okay) all along | 16.4 (20) |
| It has been difficult all along, and I still find it difficult | 9.8 (12) |
| My experience does not fit in any of the categories | 0.8 (1) |
| Total1 | 100 (122) |
[i] 1Total number of patients discharged to own home were 142. For various reasons family caregivers were interviewed as proxy for 19 of the patients. Proxies were not asked to answer this question, thus, the total number of respondents who were asked this question was 123. One person did not answer the question, resulting in a total number of 122 answers.
Table 3.
Examples of patient statements
| Question | Typical statements—patient quotes | |
|---|---|---|
| How have you managed at home since your discharge? | Well | “I have received a lot of help, my son is visiting” “It has been okay all along thanks to the home nurses” “The home nurses and my wife are helping me” “It would not have gone this well without my daughter” |
| Not well | “I have not been well, very dizzy and powerless” “I feel tired and weak, and the home nurses are not here long enough” “I think I was discharged too early considering my health status” “I have had some pain, it has been difficult to walk” “I feel lonely after coming home” | |
| If you came home to an empty house, how was that experience for you? | Good | “It was okay, I didn't need someone there” “It was okay, I had my telephone and TV. I have always lived alone, so I'm used to it” “I knew I would be on my own at home, it was okay” |
| Bad | “No one was there. No one was there to say, “welcome home”. The mailbox was full. But the home care aide came and helped me to bed” “I was too tired to “feel anything”, I fell asleep in my chair. The taxi driver helped me to my living room” “I felt lonely and abandoned. I had a dream that the home care aide would be there ready with a cup of coffee” “It was very difficult. I had great pain in my hip, and I had to walk the stairs to my house. Luckily, a neighbor came to my assistance” “On account of a misunderstanding the hospital's discharge notice failed to reach my family. That's why I came to an empty house. I was able to reach my family, and they came shortly after.” | |
| If the formal help you receive is insufficient, what would you want differently? | “I would like to exercise more” “I could use some more physical therapy” “It is not enough and the job they do is often unsatisfactory” “I need more help with laundry and window cleaning. I am lonely” “I wish someone could do my grocery shopping” “I need help with house cleaning” “I only get help with one shower per week” “I wish I could get more than two hours per week now that I am ill” | |
| Did the timing of the discharge surprise you? | No | “I was prepared” “I was told the same day, but felt prepared” “No, I was prepared they wouldn't let me stay long, despite me feeling weak and weary” |
| Yes | “I felt I was too ill to go home” “I thought they would run more tests and that the stay would be longer. I was very ill” “I wanted to stay at the hospital longer” “I had not been told what was wrong with me, I was surprised. They took our beds in the morning, and I had to sit on a chair waiting for the taxi until 5 pm. It was horrible” “Yes, and because of that I asked to stay longer, but my request was declined” | |
Table 4.
Homecoming
| Was someone present when you came home from the hospital? | % (n) |
|---|---|
| Not necessary, I can manage on my own | 10.6 (13) |
| No, I came home to an empty house | 15.4 (19) |
| Yes, my next of kin was present | 57.7 (71) |
| Yes, someone from the formal home health services was present | 12.2 (15) |
| Someone else was present | 4.1 (5) |
| Total1 | 100 (123) |
[i] 1Total number of patients discharged to own home was 142. For various reasons family caregivers were interviewed as proxy for 19 of the patients. Proxies were not asked to answer this question, thus, the total number of respondents who were asked this question was 123.
Table 5.
Logistic regression model
| B (S.E.) | p-Value | Odds ratio (95% CI) | |
|---|---|---|---|
| Gender (0=female) | 0.396 (0.514) | 0.411 | 1.486 (0.543–4.070) |
| Age | –0.090 (0.056) | 0.110 | 0.914 (0.819–1.021) |
| Length of stay | –0.026 (0.025) | 0.298 | 0.974 (0.927–1.024) |
| ADL-sum1 | –0.246 (0.166) | 0.140 | 0.782 (0.565–1.084) |
| IADL-sum2 | 0.076 (0.149) | 0.608 | 1.079 (0.806–1.446) |
| Adequate help from municipality (0=no) | 1.430 (0.518) | 0.006 | 4.177 (1.514–11.526) |
| Someone present when I came home (0=no) | 1.558 (0.682) | 0.022 | 4.749 (1.248–18.078) |
| Live alone (0=yes) | 0.525 (0.520) | 0.313 | 1.690 (0.610–4.682) |
| Help from family now (0=no help) | –0.885 (0.600) | 0.140 | 0.413 (0.127–1.337) |
| Discharge planning conference (0=no) | 0.513 (0.995) | 0.606 | 1.671 (0.238–11.752) |
| Surprised by discharge (0=yes) | 0.903 (0.576) | 0.117 | 2.467 (0.797–7.634) |
| Constant | 7.736 (5.350) | 0.148 | 2288.178 |
[i] *The dependent variable: self-reported post-discharge outcome (0=the first 2–3 weeks after discharge from hospital were difficult in the beginning, but ok after a while/both difficult and ok all along/difficult all along and still difficult, 1=ok all along).
1ADL-sum ranges from 4—dependent in all activities to 12—independent in all activities.
2IADL-sum ranges from 3—dependent in all activities to 9—independent in all activities.
(Hosmer and Lemeshow model goodness of fit p=0.894) (n=122).