How Do Older People Experience Hospital to Home Discharge? An Overview of Qualitative Reviews

Prolonged hospital stays can increase the risk of hospital-acquired adverse events among older people, and this can give rise to increasingly complex care needs following discharge from hospital. The unique experiences of older people are important to inform effective healthcare service design. This review aims to better understand our current knowledge regarding the experiences of older people during hospital to home discharge through examining (i) the characteristics of older people included in research regarding hospital to home discharge and (ii) older people's experiences of hospital to home discharge.

An overview of qualitative reviews methodology was applied. CINAHL, MEDLINE, PsycINFO and the Cochrane Library databases were systematically searched from inception to October 2024, using a combination of keywords and database specific terms and reporting followed PRISMA 2020 guidance. To estimate the extent of overlap among primary studies included in the reviews, the formula for calculated covered area (CCA) was applied. Data were extracted and analysed according to the aims of this review, and results were thematically synthesised.

Six qualitative reviews reporting on 98 international primary research studies were included. Analysis revealed mixed and somewhat limited reporting of older person characteristics including age, gender, ethnicity, health conditions and reasons for hospital admission. All studies offered some insight into older persons' experiences of hospital discharge; half included the views of lay carers and healthcare practitioners. Five core themes were derived from inductive analysis: (i) wanting to be at home, (ii) working together and communication, (iii) the system versus the person, (iv) failing to meet needs and (v) role of family carers. The overarching finding was older people want to be at home but feel uninvolved in planning and therefore poorly prepared for discharge.

This review exposes limited research addressing the older persons' gender, ethnicity, existing health conditions and reason for admission suggesting gaps in our understandings of the older person and their unique home context in existing research. More detailed reporting of older persons' individual characteristics and greater attention to direct reports from older persons would enrich our understanding of older persons' unique hospital to home discharge experience in different contexts. This more detailed understanding might serve to advance more bespoke strategies to enhance person-centred discharge processes and inform future research.

In communicating, healthcare practitioners need to be actively 'present' to enable older people to effectively engage in discharge planning, enhance autonomy and promote shared decision making.