Short summary

The overall aim of this project is to provide nuanced knowledge on QoL and readmissions among elderly persons with homecare who are acutely admitted in an ED. In order to find specific characteristics, elderly persons with homecare will be compared to elderly persons not receiving homecare. Further, great emphasis will be on patient reported outcomes regarding wishes and needs related to care and treatment and thereby achieve deeper understanding of the patients' perspective. 

Rationale

Elderly are extraordinary challenged when they become acutely ill. Denmark has implemented ED's with one entrance for all emergency patients. The length of hospital stay in the ED's has been significantly reduced and patients are usually discharged within a few days - or even within few hours. Elderly who are dependent on homecare are more frequently hospitalized and are more likely to visit the emergency department. Two thirds of the elderly above 75 years were dependent on personal care at presentation to the ED, despite this we found no studies investigating to which extent homecare is associated with readmission. The ability to perform activities of daily living is associated with an improved quality of life (QoL). QoL is often measured by health-related standardized questionnaires. We found no studies investigating which aspects are important among acutely admitted elderly patients or how they rate their overall QoL through these aspects. Readmission is appointed as an official quality indicator in England, the USA, and Denmark. The rationale behind monitoring readmissions is that readmissions could be associated with a lack of quality.  However, only few studies have focused on the patient's perspective of readmission and we did not identify any studies that examined whether readmission can be experienced as a positive event for a frail elderly patient.

PROJECT DESCRIPTION: The project involves three sub-studies, which aim to answer the following research questions:

1) Is there an association between homecare and readmission rates among elderly persons who are acutely admitted for less than or equal to 2 days?

2) Does homecare affect how elderly persons, who are discharged directly from an ED, define and experience QoL?

3) How do readmissions affect the sense of QoL among elderly persons with homecare?

Description of the cohort

Elderly persons aged 65 and above, regardless of diagnosis, with homecare who are acutely admitted in an Emergency Department 

Data and biological material

1) A retrospective register-based cohort study. Data on elderly persons in Denmark will be extracted from Danish registers to construct a database on readmission rates and associated variables.

2) A cross sectional study conducted at two EDs within the Region of Southern Denmark. This study will use the questionnaire; Schedule for the Evaluation of Individual Quality of Life to rate and identify the most important aspects of QoL among elderly persons who are discharged from an ED.

3) A qualitative study using individual in-depth interviews to explore how a readmission affects the sense of QoL among elderly persons' receiving homecare.

Collaborating researchers and departments

Institute for Regional Health Research, University of Southern Denmark and Hospital of South West Jutland

• Associate professor Bibi Gram, PhD

Institute for Regional Health Research, University of Southern Denmark and Hospital of Southern Jutland, Gråsten 

• Associate professor Jette Primdahl, PhD, MHH

Institute for Regional Health Research, University of Southern Denmark and Hospital of Southern Jutland

• Associate professor in emergency medicin Christian Backer Mogensen, PhD, MHM

Institute for Regional Health Research, University of Southern Denmark and Odense University Hospital 

• Associate professor Mikkel Brabrand, MD, PhD