Independent Community Living after Discharge from Hospital

127 Pages·2011·2.84 MB·English

Independent Community

Living after Discharge from

Hospital

Chapters 5, 6, 7, 8 & 9
Independent Community Living After Discharge From Hospital

Table of Contents

Chapter Five: Study sample descriptors ................................................................................................. 5
5.1 Enrolment details .......................................................................................................................... 5
5.1.1 Commencement dates ........................................................................................................... 5
5.1.2 Recruitment ........................................................................................................................... 5
5.2 Age and gender descriptors .......................................................................................................... 7
5.2.1 Patient participants ................................................................................................................ 7
5.2.2 Carer participants ................................................................................................................... 7
5.3 Health conditions of patients ........................................................................................................ 8
5.4 Summary ....................................................................................................................................... 9
Chapter Six: Key themes from interviews with patients and carers ..................................................... 11
6.1 The interview process ................................................................................................................. 11
6.2 Summary and commentary on themes ...................................................................................... 22
6.2.1 Negative aspects .................................................................................................................. 22
6.2.2 Positive aspects .................................................................................................................... 24
6.2.3 Carer aspects ........................................................................................................................ 24
Chapter Seven: Illustrative Case Studies ............................................................................................... 26
7.1 Introduction .......................................................................................................................... 26
7.3 Initial discharge from the acute hospital .............................................................................. 32
7.4 Patient-carer relationship ..................................................................................................... 43
7.5 Experiences with community services .................................................................................. 50
7.6 Strategies for independent living in the community ............................................................ 58
7.8 Spending time on a public hospital waiting list .................................................................... 64
7.9 Summary ..................................................................................................................................... 66
7.9.1 Health of the patient and carer over the time span of our study ........................................ 66
7.9.2 Initial discharge from acute hospital ................................................................................... 67
7.9.3 Experiences with community services ................................................................................. 67
7.9.4 Strategies for independent living in the community ........................................................... 68
7.9.5 Carer involvement ................................................................................................................ 68
7.9.6 Interaction with informal support networks ....................................................................... 68
7.9.7 Sources of information about community services that could meet their needs ............... 68
7.9.8 Rehospitalisation .................................................................................................................. 69
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Chapter Eight: Quantitative evaluation of discharge planning and quality of life ................................ 70
8.1. PREPARED instrument ............................................................................................................... 71
8.1.1 Patients’ scores .................................................................................................................... 71
8.1.2 Carers’ scores ....................................................................................................................... 71
8.2 SF-36 scores ................................................................................................................................ 74
8.2.1 Patients’ scores: women ...................................................................................................... 76
8.2.2 Patients’ scores: men ........................................................................................................... 76
8.2.3 Carers’ scores: women ......................................................................................................... 77
8.2.4 Carers’ scores: men .............................................................................................................. 77
8.3 Barthel Index ............................................................................................................................... 78
8.4 SF-12 scores for patients ............................................................................................................. 78
8.4.1 Female patients who live in the city .................................................................................... 79
8.4.3 City patient gender comparisons ......................................................................................... 81
8.4.4 Female patients who live in the country ............................................................................. 81
8.4.5 Comparing female patients in the city and country ............................................................ 83
8.4.6 Male patients who live in the country ................................................................................. 84
8.4.7 Gender comparisons for country patients ........................................................................... 85
8.4.8 Comparing male patients in the city and country ................................................................ 85
8.4.9 Summary .............................................................................................................................. 86
8.5 SF-12 scores for carers ................................................................................................................ 87
8.5.1 Female carers ....................................................................................................................... 87
8.5.2 Male carers .......................................................................................................................... 88
8.5.3 Gender comparisons for carers............................................................................................ 89
8.6 Comparisons between patients and carers ................................................................................ 90
8.6.1 Patients with carers, patients without carers and carers .................................................... 90
8.6.2 Gender effects in the carer / patient relationship ............................................................... 93
8.6.3 Predicting responses in health-related quality of life .......................................................... 95
8.7 Summary ..................................................................................................................................... 99
8.7.1 PREPARED responses ........................................................................................................... 99
8.7.2 Quality of life scores............................................................................................................. 99
Chapter Nine: Discussion .................................................................................................................... 103
9.1 Introduction .............................................................................................................................. 103
9.2 Patients and carers as reasonable informants .......................................................................... 104
9.3 The presence of a carer............................................................................................................. 105
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9.4 Rural and metropolitan differences .......................................................................................... 107
9.4.1 Systems differences ........................................................................................................... 107
9.4.2 Carers ................................................................................................................................. 108
9.4.3 Costs, transport and access ............................................................................................... 109
9.4.4 Obtaining services and information ................................................................................... 111
9.4.5 The role of the general practitioner....................................................................................... 112
9.5 Condition effect ........................................................................................................................ 115
9.6 System issues ............................................................................................................................ 116
9.6.1 The role of patients and their carers within the system .................................................... 117
9.6.2 The older person in the community .................................................................................. 120
9.7 Rehabilitation ............................................................................................................................ 121
9.8 A system perspective ................................................................................................................ 122
9.9 Proposed solutions.................................................................................................................... 123
9.9.1 Support groups ................................................................................................................... 123
9.10 Conclusions ............................................................................................................................. 127

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Chapter Five: Study sample descriptors

This chapter outlines the demographics and salient descriptors of the patient and carer
study sample.

June 2000 Mr Smith has not seen his GP for some time. He feels that his health is under

control now and that the secret to his re covery is social contact, many friends and being
busy. He finds he becomes tired easily and sometimes has a nap in the morning – “I think
it’s the cold weather”. He has had a death in the family in the last few weeks and is

feeling very sad – “It was a terrific funeral though”.

5.1 Enrolment details
5.1.1 Commencement dates
th
Whyalla Hospital 7 February 2000
th
Lyell McEwin Hospital 6 March 2000
th
Port Pirie Hospital 27 March 2000
th
Port Augusta Hospital 17 July 2000

5.1.2 Recruitment
Overall, 163 patients were approached to enter the study. Fifty -six of these patients were
found to be ineligible when considering one or more of the eligibility criteria. There were
seven refusals from eligible patients, thus producing a sample of 100 eligible patients who
also agreed to participate. 24 carers of these patients were also recruited . With respect to
carers, of the 100 eligible patients who agreed to enter the study, 66 patients did not
nominate a ‘carer’ (either lived alone or would not identify one individual) and of those
consenting patients who did nominate a ‘carer’, ten carers refused to participate. The
enrolment details per site are provided below.
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5.1.2.1 Lyell McEwin Health Service

5.1.2.2 Whyalla Hospital and Health Services

5.1.2.3 Port Pirie Hospital
Total number recruited
Month-Ebyli-gmibonleth c poantiseennt tsitnatgi sptiacst ients 935 32
Month-by-month patient statistics
Consenting carers 171 6
March April May June July August
Patients w ho wMitahrdcrhe w 03 A p r i l (includMed ainy the abovJeu nnuem bers) July August
Recruited 7 2 2 14 7 1
Patients who died 014 (included in the above numbers)
Recruited 6 10 15 11 8 2
Deaths 1
Patients who refused to 321
Deaths 1 2 1
WWithitdhr darwawn n partic i pate 1 2 12 P a g e | 6
(incCluodnese 1n tcionmg palatinent)t s who were 1147
Unable to contact 1 2
Unable itnoe lcigoinbtlaec fto r the s tudy 1
Independent Community Living After Discharge From Hospital

5.1.2.4 Port Augusta Hospital

5.2 Age and gender descriptors
5.2.1 Patient participants
The average age of patient participants was 73.5 years (SD 8.3 years) in the metropolitan
area (range 61 years to 89 years) and 76.6 years (SD 6.5 years) in the country areas (range
63 years to 90.6 years). There were more female than male patients in the sample, 61.5%
women and 38.5% men in the city and 55.6% women and 44.4% men in the country. Mean
age for the female patients was 74.1 years (SD 8.2 years), and male patients was 77.4 years
(SD 6.2 years). There was no significant difference in age by gender or metropolitan /
country location.
5.2.2 Carer participants
The average age of carer participants was 67.5 years (SD 15.0 years) in the metropolitan
area (range 37.2 years to 80.5 years) and 74.7 years (SD 4.9 years) in the country areas
(range 69 years to 83 years). This represented a statistically significant difference between
locations (p<0.05). The proportion of male and female carers in the sample was dissimilar
between metropolitan and rural locations, being 50% women and men in the city and 16.7%
women and 83.3% men in the country. The mean age for female carers was 62.5 years (SD
Total number recruited
Eligible consenting patients 6
Consenting carers 0
Patients who withdrew 0
Patients who died 0
Month-by-mPoanttihe npatsti ewnht sot arteisftuicsse d to 1
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AJupnreil MJualy June July
Consenting patients who were 14
Rineeclriugitbelde for the 31st udy 3 3 2
Independent Community Living After Discharge From Hospital

17.7 years), which was significantly different (younger) from that of male carers, which was
75.1 years (SD 3.6 years).
5.3 Health conditions of patients
We report the main condition for which patients were hospitalised, by gender and location,
in Tables 5.1 – 5.4. The tables report these conditions in descending frequency. Subjects
were selected for this study by convenience (seeking people who may have a story to tell)
and thus we report diagnosis only to describe our sample more completely.
Table 5.1 Conditions for which female metropolitan patients were hospitalised
Heart problems
Tests for generally being unwell
Bowel problems
Collapsed at home
Renal failure, dehydration, low blood
sugar
Hip replacement
Car accident
Infection
Breathing difficulties

Table 5.2 Conditions for which male metropolitan patients were hospitalised
Heart attack
Chest and abdominal pains (not heart)
Bladder, bowel and prostate infections
Chronic congestive heart failure
Breathing difficulties
Motor vehicle accident (MVA)
Cerebrovascular accident (CVA)
Generally unwell
Pneumonia

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Table 5.3 Conditions for which female country patients were hospitalised
Result of falling
Heart attack
High blood pressure
Uncontrolled diabetes
Chronic obstructive airways disease
(COAD)
Back pain
Severe arthritis
Gout
Osteoporosis
Bronchitis
Varicose ulcers in leg
Duodenitis / chest pain
Table 5.4 Conditions for which male country patients were hospitalised
Cardiovascular investigations
CVA
Heart attack
Breathing difficulties
Shingles

5.4 Summary
This study sample reflected a group of patients who were perceived to be on the ‘cusp of
chronicity’ by hospital nursing staff. There were only a small number of refusals from
patients who were eligible to participate in the study (6.5% of the eligible study cohort of
107 patients), and 5% deaths and 6% withdrawals from the recruited / consenting sample.
There were no significant differences between country and city patients in gender
proportions or age. There was considerable gender variability between city and country
carers, with a significantly greater proportion of carers being male in the country. Country
carers were older than city carers, and the male carers were significantly older than the
female carers.
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The main medical reason for hospitalisation was heart problems, followed by having
investigations for being unwell.
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