Review
Older people's and relatives’ experiences in acute care settings: Systematic review and synthesis of qualitative studies

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Abstract

Objective

To explore older people's and their relatives’ views on and experiences of acute health care.

Design

Systematic procedures were used for study selection and data extraction and analysis. A comparative thematic approach to synthesis was taken with a number of features adopted from the literature on meta-ethnography.

Data sources

Worldwide grey and published literature written in English between January 1999 and June 2008 identified from databases: CINAHL, Medline, British Nursing Index, EMBASE Psychiatry, International Bibliography of the Social Sciences, PsychINFO, and AgeInfo.

Review methods

We conducted a systematic review and synthesis of qualitative studies describing older patients’ and/or their relatives’ experiences of care in acute hospital settings. 42 primary studies and 1 systematic review met the inclusion criteria.

Results

A number of themes emerged. The quality of technical care is often taken for granted by older patients, and good or bad experiences are described more in terms of relational aspects of care. Older patients in hospital may feel worthless, fearful or not in control of what happens, especially if they have impaired cognition, or communication difficulties. Three key features of care consistently mediated these negative feelings and were linked to more positive experiences: “creating communities: connect with me”, “maintaining identity: see who I am” and “sharing decision-making: include me”.

Conclusion

These findings highlight the perspectives of older people and their relatives on the delivery of personalized and dignified care in acute settings. They lend support to previous calls for relationship-centred approaches to care and provide a useful experience-based framework for practice for those involved in care for older people.

Introduction

The number of frail older people in receipt of acute care services is increasing as the population ages. For instance, in the UK, two thirds of acute hospital beds are occupied by people aged 65 years and over (Department of Health, 2000). In many developed countries, including the UK, Australia and USA, health and social care service developments and reconfigurations have led to a shorter length of hospital stay, resulting in a frailer in-patient population with more complex needs. Recognition is growing that current models of acute hospital care may not adequately meet older people's needs (Cheek and Gibson, 2003, Flatley and Bridges, 2008), but what we know about patient experiences has largely relied on survey results and anecdotal evidence. Satisfaction surveys highlight that older people tend to evaluate care differently to younger people, often more positively (Ahmad and Alasad, 2004, Cohen, 1996, Commission for Healthcare Audit and Inspection, 2006). These relatively positive evaluations may be because older people's expectations of care are lower than those of younger adults (Owens and Batchelor, 1996, Spilsbury et al., 1999), so it is appropriate to use qualitative methodologies to better understand older people's experiences of acute care. While there are now an increasing number of qualitative studies providing such insight, a systematic overview of this work has not been previously conducted.

This paper presents the findings from a systematic review of qualitative research focused on older people's and their relatives’ views on and experiences of acute care. The review was undertaken to underpin the revision of a national set of guidelines on the nursing care for older people in acute settings (Bridges et al. 2009), previously published in 2001 alongside the National Service Framework for Older People (Standing Nursing and Midwifery Advisory Committee, 2001b, Standing Nursing and Midwifery Advisory Committee, 2001a).

Section snippets

Methods

The synthesis of qualitative studies is in relatively early development and no consensus is in place on its correct execution (Britten et al., 2002, Thomas and Harden, 2008). Systematic procedures were used for study selection and data extraction and analysis (Moher et al., 2009). A comparative thematic approach to synthesis was taken with a number of features adopted from the literature on meta-ethnography (Britten et al., 2002, Marston and King, 2006, Thomas and Harden, 2008). This approach

Results

Most of the primary studies included were single-site (n = 29 studies) interview studies (n = 37) conducted on older patients’ (n = 38 studies) and relatives’ (n = 17) experiences of in-patient hospital care. The countries where studies were carried out are shown in Table 1. Other study characteristics are shown in Table 2, Table 3.

The findings provide an in-depth understanding of older patients’ and their relatives experiences of care in acute hospital settings. The remainder of this paper presents

Discussion

This review's findings indicate that relational approaches to care may underpin more positive experiences of acute health care. They echo the findings of other work that acute hospital admission can threaten older people's sense of identity and involvement (Coyle, 1999, Dill, 1995, Social Care Institute for Excellence, 2006). The three key messages link with themes identified elsewhere that support quality of life in care home settings, suggesting that the findings are more widely transferable

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