Intervenir en partenariat avec les personnes âgées fragiles et leurs proches lors de la planification du congé hospitalier pour faciliter le retour à domicile

 

Véronique Provencher

Centre de recherche sur le vieillissement de l'IUGS

 

Domaine : vieillissement

Programme chercheurs-boursiers - Junior 1

Concours 2017-2018

Approximately one out of three frail older patients will be re-hospitalized within 30 days after hospital discharge. Many of these readmissions could however be avoided through better discharge planning. Providing appropriate care and support upon discharge is important to improve seniors' health and reduce costs due to re-hospitalization. However, discharge planning is often very complicated, especially in vulnerable patients: Do the risks assessed in the hospital actually reflect those faced by the patient upon returning home? How do you find a compromise when the patient wants to return home, while care providers and relatives fear for his safety? In order to answer these questions, we must offer interventions tailored to the needs of the frail patients before and after discharge, while actively involving patients and families in decisions concerning their return home.

However, these interventions will not necessarily be appropriate for all patients, applicable in all care settings, or acceptable to all stakeholders. My program proposes to offer appropriate, applicable and acceptable interventions to help plan the hospital discharge and facilitate the frail elderly's return home. Three interventions (decision support guide, technological tool, Australian discharge planning protocol) will thus be developed and adapted in collaboration with policymakers, managers, clinicians and patient representatives. The proposed approach is innovative because it aims to reduce the risks at home while promoting seniors' autonomy in decision-making on their return home. My results will help improve the organization and quality of health services for frail older patients when they return home after a hospitalization.