The Health Status of Older Adults Discharged Home from an Acute Care Hospital: a Descriptive Study

Background. Hospitalized older adults are susceptible to adverse events reporting decreased activity, falls and dependence in activities of daily living after hospitalization. Falls incidence is higher among those in the hospital compared to community dwelling older adults. Research has demonstrated the rate of readmission to the hospital for older adults is essentially unchanged at approximately 20% over the last 20 years despite attempts to provide meaningful interventions while patients are in the hospital or once they return home. Objective. The study objectives were to describe the health status of older adults discharged home from a hospital, to explore the impact of health status of older adults discharged home from a hospital and to examine potential factors that influence readmission back to the hospital within 30 days of discharge. Design. This study was an exploratory, descriptive design. Methods. Demographic and medical characteristics were obtained from the electronic medical record for 73 participants. Participants completed the WHO QOL BREF and the 4 MWT. After discharge, each participant was contacted weekly by phone for a total of 4 weeks or until readmission to a hospital or death to answer structured questions. Results. The mean age for the total sample was 74.6 ± 7.2 years old. Sixty-seven percent of the sample was male and 88% of the sample was white. Fourteen participants (19.2%) were readmitted to the hospital within 30 days and of those, 21.4% were 85+ years old and had a medical diagnosis for admission 71.4% of the time. Readmitted participants walked 20% slower (0.49 m/s) compared to those not readmitted (0.59m/s). The WHO QOL BREF scores comparing time of discharge to 30 days after discharge for those not readmitted hospital differed significantly only for domain 4/environment (W= 416, z= 2.651, p= 0.009). Using multiple regression analysis, 93% of the readmission variance could be explained by combining domain 3/social, domain 4/environment and the 4 MWT score. Limitations. The participants were recruited from a single hospital. The sample size was underpowered and did not present diversity regarding ethnicity or sex. The participants all had a completed physical therapy evaluation prior to enrollment and this may have biased the results. None of the participants once discharged had measured outcomes other than by self-report with follow up phone calls. Conclusions. The study indicates traditional medical and demographic characteristics do not sufficiently describe the health status of older adults discharged home from a hospital and that inclusion of biopsychological factors is meaningful. Those readmitted to the hospital were more likely to have an admission diagnosis related to a medical condition and age did seem to be a factor

A Pro Bono Physical Therapy Clinic’s Pandemic Pivot to Telehealth and Its Impact on Student Readiness for a First Full-Time Clinic Experience

Purpose: The COVID-19 pandemic of 2020 led to a multitude of adjustments in physical therapist education. This article will describe the delivery model pivot that a student-run pro bono clinic made to sustain client care and student experience. The change in delivery model also led to a change in care model. The purpose of this study is to explore the impact that the change in delivery and care model within the student-run pro bono clinic had on student readiness for a first formal clinical education experience. Methods: This qualitative investigation utilized participant journals and a focus group to capture participants’ reflections and experiences in the first four weeks of their full-time clinical experience. Content analysis guided the research team in the data analysis. Triangulation, an audit trail, reflexivity, and member checking further enhanced confirmability of findings. Results: Seven participants kept journals and participated in the focus group. Six categories of impact emerged, three because of the change in delivery to telehealth and three due to the change in care model which led to increased continuity of care. The three categories related to telehealth included 1) impact on clinical skills, 2) facilitating communication, and 3) window into their home. The three categories specific to increased continuity of care included 1) clinical reasoning skills, 2) documentation, and 3) client rapport. Conclusions: Telehealth and the increased continuity of care presented advantages and disadvantages to student readiness. Post pandemic, student leaders should consider ways in which they might retain the positive outcomes of the switch in delivery and care model while resuming care in-person