Getting Back to Normal: A Grounded Theory Study of Function in Post-hospitalized Older Adults.
Functional status
Home
Qualitative
Transitions
Journal
The Gerontologist
ISSN: 1758-5341
Titre abrégé: Gerontologist
Pays: United States
ID NLM: 0375327
Informations de publication
Date de publication:
15 05 2020
15 05 2020
Historique:
received:
25
01
2019
pubmed:
16
5
2019
medline:
11
11
2020
entrez:
16
5
2019
Statut:
ppublish
Résumé
The literature on transitions after hospitalization is based on a medicalized model focusing primarily on medication management and readmission, but little is known about the process older adults engage in to maintain their normal life posthealth event or how older adults define what the transition is. This grounded theory study aimed to describe how older adults understand and define a transition process, what actions they take based on their understanding, and what consequences they experience as they transition. Adults aged 65 and older discharged from a large Midwestern teaching hospital (N = 14) were interviewed using in-depth one-on-one interviews. Data were analyzed using open, axial, and selective coding. All participants described the process of transition as moving from a state of normal function to loss, and then working back to a normal state. A conceptual model was developed to illustrate the complexity of movement related to how older adults understand and manage the transition. All participants described starting out being normal until they experienced a major health event (acute or chronic illness). Losing normal involved experiencing a lower level of function both inside and outside the home. Working back to normal was accomplished by two different pathways: those "working to regain" focused on getting back to the level they were at prior to the major health event, whereas those "working to maintain" often involved redefining a new normal. The consequences of the two pathways were quite different, with those working to maintain describing several negative consequences. This study provides a detailed understanding of how older adults transition and the complexity of that transition. Findings provide a foundation for broadening our understanding of function beyond typical activities of daily living and reveal a more complex transition process that can span months to years.
Sections du résumé
BACKGROUND AND OBJECTIVES
The literature on transitions after hospitalization is based on a medicalized model focusing primarily on medication management and readmission, but little is known about the process older adults engage in to maintain their normal life posthealth event or how older adults define what the transition is. This grounded theory study aimed to describe how older adults understand and define a transition process, what actions they take based on their understanding, and what consequences they experience as they transition.
RESEARCH DESIGN AND METHODS
Adults aged 65 and older discharged from a large Midwestern teaching hospital (N = 14) were interviewed using in-depth one-on-one interviews. Data were analyzed using open, axial, and selective coding.
RESULTS
All participants described the process of transition as moving from a state of normal function to loss, and then working back to a normal state. A conceptual model was developed to illustrate the complexity of movement related to how older adults understand and manage the transition. All participants described starting out being normal until they experienced a major health event (acute or chronic illness). Losing normal involved experiencing a lower level of function both inside and outside the home. Working back to normal was accomplished by two different pathways: those "working to regain" focused on getting back to the level they were at prior to the major health event, whereas those "working to maintain" often involved redefining a new normal. The consequences of the two pathways were quite different, with those working to maintain describing several negative consequences.
DISCUSSION AND IMPLICATIONS
This study provides a detailed understanding of how older adults transition and the complexity of that transition. Findings provide a foundation for broadening our understanding of function beyond typical activities of daily living and reveal a more complex transition process that can span months to years.
Identifiants
pubmed: 31087040
pii: 5489156
doi: 10.1093/geront/gnz057
pmc: PMC7228418
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
704-714Subventions
Organisme : NINR NIH HHS
ID : F31 NR017104
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002373
Pays : United States
Informations de copyright
© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Références
J Gerontol. 1991 Mar;46(2):M52-6
pubmed: 1997573
J Am Geriatr Soc. 2003 Apr;51(4):556-7
pubmed: 12657079
Health Aff (Millwood). 2012 Dec;31(12):2659-68
pubmed: 23213150
Ann Acad Med Singapore. 2006 Jan;35(1):17-23
pubmed: 16470269
Prof Case Manag. 2018 Nov/Dec;23(6):318-326
pubmed: 30289859
J Am Geriatr Soc. 2009 Feb;57(2):195-201
pubmed: 19170778
J Am Geriatr Soc. 2003 Apr;51(4):549-55
pubmed: 12657078
Health Aff (Millwood). 2011 Apr;30(4):746-54
pubmed: 21471497
Arch Intern Med. 2006 Sep 25;166(17):1822-8
pubmed: 17000937
J Hosp Med. 2014 May;9(5):277-82
pubmed: 24616216
J Am Geriatr Soc. 2013 Jul;61(7):1095-102
pubmed: 23731003
J Am Geriatr Soc. 2017 Jun;65(6):1119-1125
pubmed: 28369722
Md State Med J. 1965 Feb;14:61-5
pubmed: 14258950
J Comp Eff Res. 2014 May;3(3):245-57
pubmed: 24969152
Geriatr Nurs. 2018 May - Jun;39(3):336-343
pubmed: 29249631
J Am Geriatr Soc. 2017 Sep;65(9):1996-2002
pubmed: 28636200
JAMA. 1963 Sep 21;185:914-9
pubmed: 14044222
Vital Health Stat 3. 2013 Dec;(37):1-107
pubmed: 26158640
West J Nurs Res. 2007 Feb;29(1):65-79
pubmed: 17228061
J Am Geriatr Soc. 2014 Aug;62(8):1556-61
pubmed: 24934494
J Am Geriatr Soc. 2015 Jan;63(1):55-62
pubmed: 25597557
Res Nurs Health. 1995 Apr;18(2):179-83
pubmed: 7899572
Int J Nurs Pract. 2010 Aug;16(4):381-8
pubmed: 20649670
Int J Qual Health Care. 2004 Dec;16(6):465-72
pubmed: 15557356
Arch Gerontol Geriatr. 2013 Nov-Dec;57(3):305-10
pubmed: 23806790
Arch Gerontol Geriatr. 2010 May-Jun;50(3):306-10
pubmed: 19520442
Gerontologist. 2016 Apr;56(2):326-34
pubmed: 24682396
J Clin Nurs. 2013 May;22(9-10):1322-31
pubmed: 23279450
Health Soc Care Community. 2015 Mar;23(2):216-24
pubmed: 25427647
Gerontologist. 2017 Oct 1;57(5):867-879
pubmed: 27174895
J Am Geriatr Soc. 2009 Jan;57(1):55-61
pubmed: 19170790
Annu Rev Med. 2014;65:471-85
pubmed: 24160939
Res Nurs Health. 1999 Feb;22(1):67-77
pubmed: 9928965
PLoS One. 2011;6(11):e26951
pubmed: 22110598