Older adults' experiences of transitions between care settings at the end of life in England: a qualitative interview study.
BACKGROUND
Providing care that is shaped around the needs of patients, carers, and families is a challenge in the last months of life, as moves between home and institutions may be frequent. Despite this, there have been few studies of end-of-life transitions in the U.K.


OBJECTIVE
To explore older adults' experiences as they move between places of care at the end of life.


METHODS
In-depth qualitative interviews and thematic analysis of the data were performed. Thirty adults aged between 69 and 93 years took part. All were judged by their physicians to be in the last year of life, diagnosed with heart failure (13), lung cancer (14), and stroke (3). Sixteen participants were from the lowest socioeconomic groups.


RESULTS
Four themes were identified from the data relating to 1) the prioritization of institutional processes, 2) support across settings, 3) being heard, and 4) dignity. As they moved between different settings, much of the care received by older adults was characterized by inflexibility and a failure of professional carers to listen. Liaison between and within services was not always effective, and community support after a hospital admission was perceived to be, on occasions, absent, inappropriate, or excessive.


CONCLUSIONS
Qualitative study of transitions provides valuable insights into end-of-life care, even in countries where there are few financial barriers to services. This study has highlighted a need for continued attention to basic aspects of care and communication between professionals and with patients.
Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom. barbara.hanratty@york.ac.uk
Barbara
B
Hanratty
Louise
L
Holmes
Elizabeth
E
Lowson
Gunn
G
Grande
Julia
J
Addington-Hall
Sheila
S
Payne
Jane
J
Seymour
D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D005260:Female; D006301:Health Services Needs and Demand; D006760:Hospitalization; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D062209:Patient Handoff; D061214:Patient Safety; D017060:Patient Satisfaction; D036301:Qualitative Research; D013727:Terminal Care / Q000523:psychology*