May 8, 2014 - Someone present at homecoming. (OR = 4.75, p = 0.022). ⢠Receiving adequate help from the municipality (OR = 4.18, p = 0.006). Struggle to ...
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The indispensable informal caregivers! !
The role of informal caregivers in the discharge process of older relatives! ! Line Kildal Bragstad, OT, MHSc, PhD Candidate ! Institute of Health and Society, Department of Nursing Science, University of Oslo, Norway! !
Results
• Older individuals with mul1ple and o4en complex care requirements are being discharged from hospital to home “quicker and sicker” than ever before. • Spouses and adult children are o4en the first to assume caregiving responsibili1es for older rela1ves when care needs arise. • Care recipients and informal caregivers are expected to take an ac1ve consumer role and par1cipate in decision-‐making. • The care policy and organiza1on of the care sector is shi4ing to ensure a sustainable model of health care provision in the future. • Responsibili1es are more explicitly placed on the family and informal caregivers than previously.
Par8cipa8on in discharge planning at the hospital
Shorter hospital stays, an aging popula1on, retrenchment of ins1tu1onal care, and increased emphasis on aging in place challenges the contemporary care policy and calls for a closer look at the role of informal caregivers as par1cipants in the discharge process of older rela1ves.
Materials and methods This PhD study has a mixed methods approach and consists of three sub-‐studies with two different designs: • Cross-‐sec1onal design with consecu1ve sampling procedure (Paper I and II) • Exploratory qualita1ve design (Paper III)
Recruitment and data collec1on was carried out in two phases:
Quan1ta1ve data from structured ques1onnaire interviews were analyzed using chi-‐square tests for trend and associa1on and mul1variate logis1c regression (Paper I and II)
Qualita1ve data from telephone interviews were analyzed using an induc1ve thema1c content analysis (Paper III)
• Informal caregivers consistently report that they want to par1cipate in the discharge planning. • Only half of the informal caregivers reported par1cipa1on in planning the pa1ent discharge. • The younger genera1on caregivers were beXer informed and reported par1cipa1ng in dialogue and coopera1on with hospital personnel to a greater degree than the older genera1on caregivers. Par1cipa1on is predicted by two factors: Generation of caregiver Patients’ hearing ability (OR=2.121, P=0.045)" (OR=1.722, P=0.049)"
Conclusions The role of the informal caregiver is o4en that of an intermediary between the older individual and the health care services.
Illustration pictures: colourbox.com"
Background
Factors predic8ng a successful post-‐discharge outcome
• 54% of the pa1ents experienced a (self-‐ reported) successful post-‐discharge outcome. Successful post-‐discharge outcome is predicted by two factors: • Someone present at homecoming (OR = 4.75, p = 0.022) • Receiving adequate help from the municipality (OR = 4.18, p = 0.006)
Struggle to achieve influence at and a@er discharge
Informal caregivers describe taking on all-‐ consuming roles as intermediaries between the care recipient and the health care services. • They strive to ac1vely par1cipate on behalf of their older rela1ve. • They struggle to establish a dialogue with the “gatekeepers” of the services • Achieving the best possible care for their older rela1ve seem to depend on the informal caregivers having the resources to choose appropriate strategies for gaining influence over decisions.
Informal caregivers’ par1cipa1on in the discharge process is lacking. • The younger genera1on informal caregivers have beXer chances of par1cipa1on than older genera1on caregivers. It is impera1ve for a successful post-‐discharge outcome that: • the pa1ent does not come home to an empty house • the pa1ent receives adequate formal home-‐care services The pa1ents’ extensive frailty and increasing dependence on their families contribute to the percep1on of the informal caregivers’ indispensable role as intermediaries between their older rela1ve and the health care services.
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Acknowledgments
I would like to acknowledge Chris1na Foss and Marit Kirkevold who have supervised my work in this PhD study and who have co-‐authored the papers of this study. Dag Hofoss has also contributed as a co-‐author for this study. Thank you!
This PhD study was funded by: The Norwegian Research Council and The Department of Nursing Science, University of Oslo
Papers
I. Bragstad, LK., Kirkevold, M., Hofoss, D. & Foss, C. (2014) Informal caregivers’ par1cipa1on when older adults in Norway are discharged from the hospital. Health & Social Care in the community, Vol. 22(2): 155–168. II. Bragstad, LK., Kirkevold, M., Hofoss, D. & Foss, C. (2012) Factors Predic1ng a successful post-‐discharge outcome for individuals aged 80 years and over. Interna1onal Journal of Integrated Care, Vol. 12, 10. Feb. 2012. III. Bragstad, LK., Kirkevold, M. & Foss, C. The indispensable intermediaries: A qualita1ve study of informal caregivers’ struggle to achieve influence at and a4er hospital discharge. SubmiXed 15.11.2013, Re-‐submiXed 08.05.2014.
