Unplanned readmission for older persons: A concept analysis

Area of Science:

• Gerontology
• Healthcare Management
• Nursing Theory

Background:

• Unplanned readmissions are a significant concern in healthcare systems globally.
• Older persons, particularly those with multiple chronic conditions, are at higher risk for readmission.
• Existing literature lacks a clear, unified definition of unplanned readmission for this demographic.

Purpose of the Study:

• To perform a concept analysis to define and analyze unplanned readmission to hospital for older persons.
• To establish a clear conceptual understanding of unplanned readmission in the context of elderly care.

Main Methods:

• A comprehensive literature review was conducted using Walker and Avant's eight-stage concept analysis method.
• Searches were performed across four major databases (Ovid MEDLINE, Scopus, CINAHL, Embase) for studies published between 1946 and 2020.
• Included studies focused on older persons, chronic conditions, experiences, and unplanned readmissions, encompassing quantitative, qualitative, mixed-methods, and historical articles.

Main Results:

• Unplanned readmission is conceptualized as an experience, process, and event.
• A proposed definition: an older person's need for acute care treatment for an urgent or emergent health crisis following previous hospitalization(s).
• Key attributes include prior hospitalizations, the emergent nature of the health crisis, and the necessity of acute hospital services.

Conclusions:

• Unplanned readmission is distinct from planned admissions and emergency visits, and is linked to discharge readiness.
• This analysis supports viewing unplanned readmissions as a consequence of discharge readiness, reducing patient blame.
• Findings underscore the importance of incorporating older persons' experiences into nursing theory and interventions for unplanned readmissions.