Patient-based outcomes : older adults' perceptions of hospital and recovery experiences

Fitzpatrick, Janet M. (1999) Patient-based outcomes : older adults' perceptions of hospital and recovery experiences. Doctoral (PhD) thesis, Memorial University of Newfoundland.

[English] PDF - Accepted Version Available under License - The author retains copyright ownership and moral rights in this thesis. Neither the thesis nor substantial extracts from it may be printed or otherwise reproduced without the author's permission. Download (5MB)

Abstract

This descriptive-correlational prospective study was designed to investigate the hospital and recovery experiences of a sample of 430 patients¹ aged 55 years and older, admitted to medicine, surgery, cardiac care or women's health programs, in a recently restructured health system. The study investigated physical/mental health status during hospitalization and at two weeks post-discharge, and functional status at three days and two weeks post-discharge. Relationships between patient characteristics, illness-related variables, discharge planning and health/functional status were also explored. The conceptual framework for the study was based on the Medical Outcomes Study (MOS) framework (Tarlov et al., 1989). -- Most patients were married (68.2%), retired (70.8%), had someone they could turn to for help (94.4%), were 65 years of age or older (63.8%), and had highschool or post-secondary education (56.4%). There were fairly equal numbers of males (49%) and females (51%). Data were collected between January and June, 1998. -- The SF-12 Health Survey, Functional Autonomy Measurement System, Post-Hospital Questionnaire, Symptom Questionnaire, and Patient Information Questionnaire were administered during face-to-face and telephone interviews. Study findings indicated that physical health ratings were lower than mental health status prior to and post-hospitalization. With regard to functional status, limitations were noted in mobility and instrumental activities of daily living (IADL) at both time periods. A significant improvement was observed in patients' mental health status, mobility, and IADL, whereas, physical health status evidenced a significant decline. -- With regard to discharge planning indicators, most patients reported relatively high levels of understanding, confidence and satisfaction, but minimal or no participation in decision-making about care. Over 50% of patients did not receive recovery-related information, and over 75% did not receive information on community resources. Health-care providers overestimated patients' understanding of health problems, participation in decision-making about care, confidence in resuming normal activities at discharge, and satisfaction with discharge arrangements. -- Patient characteristics and illness-related variables influenced physical/mental health status at two weeks post-discharge. There was little association between discharge planning variables and health/functional status at two weeks post-discharge. -- Regression analysis identified mental health status at two weeks as the most significant predictor of physical health, and physical health status at two weeks surfaced as the most significant predictor of mental health. Functional status indicators (ADL, IADL, communication and mobility) at three days post-discharge surfaced as the most significant predictors of their counterparts at two weeks post-discharge. -- The factors affecting health and functional status are varied and complex, and require further investigation. Study findings suggest that medical/surgical patients admitted to acute-care settings are experiencing poorer physical health and improved mental health and functional status two weeks following discharge. Findings point to a need to improve provider-patient communication and to increase the opportunity for patient involvement in decision-making about care. -- ¹ The term 'patient' refers to client or consumer of health services.

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