Outcomes of complex discharge planning in older adults with complex needs: a scoping review.
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ABSTRACT:
SUBMITTER: Rameli PM
PROVIDER: S-EPMC9340947 | biostudies-literature | 2022 Jul
REPOSITORIES: biostudies-literature
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Outcomes of complex discharge planning in older adults with complex needs: a scoping review.
Rameli Puteri Maisarah PM Rameli Puteri Maisarah PM Rajendran Nithya N
The Journal of international medical research 20220701 7
In this scoping review, we aimed to evaluate the effectiveness of integrated multidisciplinary team discharge planning and identify common outcomes among older adults with complex needs, focusing on a safe transition from the hospital to the community. We performed a literature search for relevant articles using seven electronic databases and agreed search terms. Only articles published in English were included. In total, 23,772 articles were identified, with 27 articles meeting the inclusion cr ...[more]
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Project description:BackgroundAging is often accompanied by a decrease in physical and sensory capacities and financial resources, which makes travel and the use of public transport a big challenge for older adults. These mobility limitations may prevent them from going out for groceries, medical appointments, or entertainment, which increases the risk of social isolation. A key element in helping older adults to maintain healthy aging and social engagement is to foster autonomy, freedom, and active mobility. A transportation planning e-tool can provide older adults with information about transport and trip options. There are many transportation planning e-tools, but little is known about whether and how their characteristics and functionalities address older adults' needs and preferences.ObjectiveThis study aims to map existing transportation e-tools and identify gaps to be filled in order to match their functionalities with older adults' needs and preferences.MethodsA scoping review of existing transportation planning e-tools was conducted based on the approach developed by Arksey and O'Malley. A search in the scientific literature (Academic Search Complete, MEDLINE, CINAHL, SocINDEX, and ERIC) as well as gray literature (TRID Database, Google Scholar, Proquest, Google Play, etc) was conducted in June 2020 and updated 3 times; in September 2021, December 2021, and May 2022. After the studies were selected, a comparative analysis was performed by 2 evaluators; an occupational therapy student and a computer science student. These e-tools were analyzed with respect to some characteristics (eg, tool's development status, target customers, and geographic coverage) as well as 10 functionalities (time autonomy, walkability, crowd avoidance, incline avoidance, weather consideration, dark avoidance, winter obstacles avoidance, amenities inclusion, taxi driver's information, and support affordance) that we defined based on older adults' needs and preferences (mainly Canadians). These needs were identified from a literature review and confirmed by workshops (focus groups).ResultsThe scientific and gray literature search yielded 463 sources, and 42 transportation e-tools were included. None of the e-tools reviewed addresses all 10 functionalities. More specifically, functionalities such as dark avoidance and support affordance were not addressed by any of the included e-tools.ConclusionsMost of the e-tools currently available to plan trips do not address older adults' needs and preferences. The results of this scoping review helped fill this gap by identifying functionalities to include in transportation planning e-tools designed to promote active aging. The findings of this study highlight the need to use a multicriteria optimization algorithm to address older adults' mobility needs and preferences.International registered report identifier (irrid)RR2-10.2196/33894.
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Project description:BackgroundPain is prevalent and poorly managed in older adults. Although pain self-management strategies are helpful, adoption and access are limited; thus, technology provides an opportunity for intervention delivery. Mobile health (mHealth) is feasible to use in older adults; however, we have yet to understand the effect of mHealth pain self-management interventions on pain outcomes in older adults.ObjectiveThe purpose of this scoping review is to examine the characteristics of mHealth interventions and their efficacy on pain outcomes in older adults with musculoskeletal pain.MethodsWith the assistance of a medical librarian, keywords and subject headings were generated, including but not limited to mobile health application, mHealth, digital, pain, pain management, and older. A search was conducted for papers in journal databases, including PubMed, Embase, CINAHL, Scopus, and IEEE Xplore, between 2000 and 2022. Papers were screened according to predetermined inclusion and exclusion criteria, and reference lists were reviewed for additional paper inclusion. Three authors appraised the methodology of papers independently, then collaboratively to synthesize the evidence.ResultsSix publications were included in the scoping review. The design and methodology ranged widely from pilot studies to a comparative effectiveness trial. Older participants in the studies reported a variety of musculoskeletal conditions. Delivery of the mHealth pain self-management interventions incorporated mobile devices, such as a smartphone or tablet. Most mHealth-delivered interventions were multicomponent and incorporated elements of in-person and telephone access to an interventionist. The findings suggested mHealth interventions may reduce pain intensity; however, pain interference and other pain-related conditions did not have a statistically significant reduction.ConclusionsResearch that has explored mHealth for pain self-management is beginning to move beyond feasibility. The few experimental studies conducted in older adults are heterogeneous, and the interventions are mostly multicomponent. It is premature to conclude the interventions' significant effect on pain or pain-related symptoms. As technology continues to integrate into health care, more experimental research is warranted to examine the efficacy of mHealth interventions on a variety of pain outcomes in older adults.
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Project description:IntroductionMany hospitalised older adults experience delayed discharges due to increased postacute health and social support needs. Transitional care programmes (TCPs) provide short-term care to these patients to prepare them for transfer to nursing homes or back to the community with supports. There are knowledge gaps related to the development, implementation and evaluation of TCPs. The aims of this scoping review (ScR) are to identify the characteristics of older patients served by TCPs; criteria for transfer, components and services provided by TCPs; and outcomes used to evaluate TCPs.Methods and analysisThe study involves six-step ScR and is informed by a collaborative/participatory approach whereby stakeholders engage in the development of the research questions, identification of literature, data abstraction and synthesis; and participation in consultation workshop. The search for scientific literature will be done in the Medline, PsychINFO, Emcare and CINAHL databases; as well, policies and reports that examined models of transitional care and the outcomes used to evaluate them will be reviewed. Records will be selected if they involve community dwelling older adults aged 65 years or older, or indigenous persons 45 years or older; and presented in English, French, Dutch and German languages. Records will be screened, reviewed and abstracted by two independent reviewers. Extracted data will be analysed using descriptive statistics and a narrative analysis, and organised according to Donabedian's model of structure (characteristics of older adults experiencing delayed discharge and served by TCPs), process (TCP components and services) and outcome.Ethics and disseminationThis ScR does not require ethics approval. Dissemination activities include integrated knowledge translation (KT) (consultation with stakeholders throughout the study) and end-of-grant KT strategies (presentations at national and international conferences; and publication in peer-reviewed interdisciplinary journal).
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Project description:BackgroundHospital pre-discharge interventions are becoming one of the leading strategies to promote early discharge. For older adult patients, it remains unclear what these interventions are and how they affect discharge outcomes.ObjectiveThis scoping review categorizes pre-discharge interventions promoting early acute care hospital discharging or total hospital length of stay reductions among older adults, synthesizes contextual factors (e.g., cost, staffing) driving implementation, and assesses the perceived intervention's impact.DesignThe review followed the five states of the Arksey and O'Malley framework and the PRISMA-ScR extension. The PubMed, Embase, and Scopus databases were searched from 1983 to 2020 for pre-discharge interventions designed or adapted to discharge older adults earlier in their stay from acute care hospitals. Potentially relevant articles were screened against eligibility criteria. Findings were extracted and collated in data charting forms followed by brief thematic analyses.ResultsThe search yielded 5,455 articles of which 91 articles were included. Eight pre-discharge intervention categories were identified: clinical management, diagnostic/risk assessment tools, staffing enhancements, drug administration, length of stay protocols, nutrition planning, and communication improvements. Leading motivations for intervention implementation included the nationwide drive to reduce care costs and hospitals' need to increase hospital profitability, improve quality of care, or optimize resource utilization. Discharge outcomes reported included hospitalization costs, readmission rates, mortality rates, resource utilization rates and costs, and length of stay. Mixed results were found regarding the effectiveness of early discharge interventions on discharge outcomes based on expressed author sentiment.ConclusionsThe drive for pre-discharge interventions that reduce older adult hospital stays and associated costs continues to stem primarily from economic and governmental policies. Follow-up studies may be required to emphasize patient perspectives and care trajectories to avoid unintentional costly and health-deteriorating consequences.
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Project description:Limited evidence exists that serves to guide the field of practice and research pertaining to the long-term issues and needs of adults with spina bifida. Understanding the lived experience of adults with spina bifida has lagged behind considerably resulting in limited evidence-based guidance for individuals with spina bifida and their families and the health care professionals who provide services to this population. Given the paucity of knowledge of the lived experience as it pertains to adulthood, this scoping review was undertaken. More than 10,000 records from 1974 through 2023 were screened based upon the search criteria whose purpose was to examine the research conducted the psychosocial outcomes and needs of adults with spina bifida. A total of 81 articles were included in this review. The findings of this review revealed significant gaps were apparent. There was limited data on adulthood benchmarks of employment, education, community living and social relationships. Limitations associated with the investigations of this review included underpowered samples, lack of longitudinal designs, use of instruments with insufficient psychometrics, and the use of clinical and administrative data sets not designed for research purposes. As the survival rates of individuals with spina bifida continue to improve with medical advances more robust psychosocial research pertaining to this population is needed.
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Project description:BackgroundTransitions of care between providers are vulnerable periods in healthcare delivery that expose patients to preventable errors and adverse events. Patient discharge from the intensive care unit (ICU) to a medical or surgical hospital ward is one of the most challenging and high risk transitions of care. Approximately 1 in 12 patients discharged will be readmitted to ICU or die before leaving the hospital. Many more patients are exposed to unnecessary healthcare, adverse events and/or are disappointed with the quality of their care. Our objective is to conduct a scoping review by systematically searching the literature to identify ICU discharge planning tools and their supporting evidence-base including barriers and facilitators to their use.Methods and analysisSystematic searching of the published health literature will be conducted to identify the existing ICU discharge planning tools and supporting evidence. Literature (research and non-research) reporting on the tools used to facilitate decision making and/or communication at ICU discharge with patients of any age will be included. Outcomes will include adverse events and provider and patient/family-reported outcomes. Two investigators will independently review the abstracts (screen 1) to identify those meeting the inclusion criteria and then independently assess the full text articles (screen 2) to determine if they meet the inclusion criteria. Data collection will include information on citations and identified tools. A quality assessment will be performed on original research studies. A descriptive summary will be developed for each tool.Ethics and disseminationOur scoping review will synthesise the literature for ICU discharge planning tools and identify the opportunities for knowledge to action and gaps in evidence where primary evidence is necessary. This will serve as the foundational element in a multistep research programme to standardise and improve the quality of care provided to patients during ICU discharge. Ethics approval is not required for this study.
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Project description:BackgroundAdvance care planning (ACP) is pivotal in mitigating end-of-life suffering and ensuring healthcare congruence with the values of older adults and dignity in death. Despite its paramount importance, the current readiness for ACP among community-dwelling older adults and the intricate influencing factors have yet to be explored.ObjectiveTo review the literature focusing on ACP readiness among community-dwelling older adults and the influencing factors.MethodsA scoping review conducted using the Arksey and O'Malley (2005) framework. Electronic databases (PubMed, CINAHL, Cochrane, Web of Science, PsycINFO), as well as grey literature databases (OpenGrey and GreyLit.org) were searched to identify studies published in English between January 2012 and March 2023.Results19 studies were selected, comprising 3 qualitative, 13 quantitative, 2 mixed-methods, and 1 review article. The study evaluated the readiness of older adults for ACP by examining their knowledge and attitudes. It categorizes influencing factors into intrinsic and extrinsic levels. This review revealed that the knowledge about ACP among older adults across all settings was limited. However, they had positive attitudes toward it. In addition, intrinsic factors including sociodemographic characteristics, psychological factors, and family relationships, along with extrinsic factors including health care professionals' attitudes and experience, as well as policies and laws, influenced the ACP readiness among older adults.ConclusionsThis study established the groundwork for future ACP intervention trials, providing a theoretical framework to guide their design and implementation. operationalization.
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