Outcomes as experienced by older patients after hospitalisation: Satisfaction, acceptance, frustration and hope - a grounded theory study

Background: outcomes of hospitalisation are often described in quantitative terms. It is unknown how older frail patients describe their own outcomes.

Objective: to discover how older frail persons describe their own hospitalisation outcomes and the meaning of these outcomes for their daily lives.

Design: Constructivist Grounded Theory approach.

Participants: frail older people discharged from hospital. Methods: Open interviews in the participant's home. Transcripts were coded inductively according to the Constructivist Grounded Theory approach.

Results: Twenty-four interviews were conducted involving 20 unique participants. Although for some participants hospitalisation was just a ripple, for others, it was a turning point. It could have positive or negative impacts on outcomes, including remaining alive, disease, fatigue/condition, complaints, daily functioning, social activities and intimate relationships, hobbies, living situation and mental well-being. Few participants were completely satisfied, but for many, a discrepancy between expectation and reality existed. Some participants could accept this, others remained hopeful and some were frustrated. Factors associated with these categories were research and treatment options, (un)clarity about the situation, setting the bar too high or pushing boundaries, confidence in physicians, character traits and social factors.

Conclusions: of the persons whose outcomes did not meet their expectations, some were frustrated, others hopeful and others accepted the situation. The following interventions can help patients to accept: clear communication about options and expectations before, during and after hospitalisation; giving room for emotions; help finding social support, encouragement to engage in pleasant activities and find meaning in small things. For some patients, psychological treatment may be needed.