Daniel Liebzeit1,2, Lisa Bratzke1, Marie Boltz3, Suzanne Purvis4, Barbara King1. 1. University of Wisconsin - Madison School of Nursing, Madison, Wisconsin. 2. Geriatric Research, Education and Clinical Center (11G), William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin. 3. Pennsylvania State University College of Nursing, Michigan. 4. Beaumont Health, Royal Oak, Michigan.
Abstract
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.
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.
Authors: Erik H Hoyer; Dale M Needham; Levan Atanelov; Brenda Knox; Michael Friedman; Daniel J Brotman Journal: J Hosp Med Date: 2014-02-26 Impact factor: 2.960
Authors: Mary D Naylor; Linda H Aiken; Ellen T Kurtzman; Danielle M Olds; Karen B Hirschman Journal: Health Aff (Millwood) Date: 2011-04 Impact factor: 6.301
Authors: Daniel Liebzeit; Rachel Rutkowski; Alicia I Arbaje; Beth Fields; Nicole E Werner Journal: J Am Geriatr Soc Date: 2021-06-19 Impact factor: 7.538