Objective: To identify the needs of hospitalized cognitively impaired older adults and their caregivers throughout an episode of illness.
Design: Qualitative content analysis of case studies
Population, Sample, Setting, Years: Data were obtained during a larger study that examined the incidence of cognitive impairment among adults age 70 and older admitted from home to one of three Philadelphia-area hospital sites during a 6 month period with a common medical or surgical condition (congestive heart failure, angina, myocardial infarction, respiratory tract infection, coronary artery bypass graft, cardiac valve replacement, major small and large bowel procedures and orthopedic procedures of the lower extremities). A purposive sub-sample (n=5) of patients and their caregivers consisted of 3 women and 2 men, all African American except for one Caucasian, ranging in age from 78 to 84. Mini-Mental Status Exam scores ranged from 5 to 20 and all had been admitted directly from home. Caregivers were a spouse (1), other family member (2), friend (1), or paid companion (1).
Concept studied: Transitional care needs of hospitalized cognitively impaired older adults and their caregivers
Methods: Specially trained registered nurses conducted in-depth, face-to-face, audio-taped interviews with the cognitively impaired patients and their caregivers during hospitalization, then 48 hours, 2 weeks and 6 weeks after discharge. An additional telephone interview was conducted with the caregiver one week after discharge to provide an opportunity to freely discuss any additional issues. The semi-structured interview questions were designed to elicit information about what both patients and caregivers perceived to be their priority needs and concerns. The interviews were transcribed and content analyzed for themes identifying the needs of cognitive impaired patients and their caregivers.
Findings: Content analysis of audio-taped interviews revealed that patients and caregivers had unmet needs in the following categories: managing and negotiating care with multiple providers and family; managing illness (e.g., physical and psychological symptoms, therapies, problem behaviors, long-term effects of cognitive changes, and lack of awareness of community resources); and psychosocial/coping (e.g., patients’ coping with multiple losses; and caregiver burden, depression, isolation and fear). Dementia, delirium and depression were poorly recognized and addressed in this sub-sample as well as in the overall larger study population.
Conclusions: Caregivers face profoundly challenging issues as they attempt to help older adults suffering from multiple health problems complicated by cognitive impairment. Consistent with this team’s previous studies, the two-week period after discharge remains a very tenuous time for patient physical, emotional and/or cognitive decompensation and increased risk of rehospitalization.
Implications: Data reinforce the critical importance of comprehensive interventions that span hospitalization and the immediate post-discharge period to address the needs of this under-recognized and underserved vulnerable population. Hospital staff and families need further education and training in the early identification of cognitive impairment and the appropriate interventions that promote safety & well-being and prevent functional decline. These study findings helped inform the design of a comprehensive advanced practice nurse intervention for cognitively impaired hospitalized older adults and their caregivers.
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