title: "Missing pieces"--functional, social, and environmental barriers to recovery for vulnerable older adults transitioning from hospital to home.
abstract: OBJECTIVE
  To describe barriers to recovery at home for vulnerable older adults after leaving the hospital.
  
  
  METHODS
  Standard qualitative research techniques, including purposeful sampling of participants according to age, sex, race, and English proficiency, were used to ensure a wide breadth of experiences. All participants were interviewed in their native language (English, Spanish, or Chinese). Two investigators independently coded interviews using the constant comparative method. The entire research team, with diverse backgrounds in primary care, hospital medicine, geriatrics, and nursing, performed thematic analysis.
  
  
  METHODS
  Urban public safety-net teaching hospital.
  
  
  METHODS
  Vulnerable older adults (low income and health literacy, limited English proficiency) enrolled in a larger discharge interventional study.
  
  
  METHODS
  Qualitative data (participant quotations) were organized into themes.
  
  
  RESULTS
  Twenty-four individuals with a mean age of 63 (range 55-84), 66% male, 67% nonwhite, 16% Spanish speaking, 16% Chinese speaking were interviewed. An overarching theme of "missing pieces" was identified in the plan for postdischarge recovery at home, from which three specific subthemes emerged: functional limitations and difficulty with mobility and self-care tasks, social isolation and lack of support from family and friends, and challenges from poverty and the built environment at home. In contrast, participants described mostly supportive experiences with traditional focuses of transition, care such as following prescribed medication and diet regimens.
  
  
  CONCLUSIONS
  Hospital-based discharge interventions that focus on traditional aspects of care may overlook social and functional gaps in postdischarge care at home for vulnerable older adults. Postdischarge interventions that address these challenges may be necessary to reduce readmissions in this population.
authors.affiliation: Division of Hospital Medicine, University of California at San Francisco, San Francisco, California.
authors.forename: S Ryan
authors.initials: SR
authors.lastname: Greysen
authors.forename: Doug
authors.initials: D
authors.lastname: Hoi-Cheung
authors.forename: Veronica
authors.initials: V
authors.lastname: Garcia
authors.forename: Eric
authors.initials: E
authors.lastname: Kessell
authors.forename: Urmimala
authors.initials: U
authors.lastname: Sarkar
authors.forename: Lauren
authors.initials: L
authors.lastname: Goldman
authors.forename: Michelle
authors.initials: M
authors.lastname: Schneidermann
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Critchfield
authors.forename: Edgar
authors.initials: E
authors.lastname: Pierluissi
authors.forename: Margot
authors.initials: M
authors.lastname: Kushel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care; D004779:Environment Design; D005260:Female; D006699:Home Care Services; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011203:Poverty; D036301:Qualitative Research; D020127:Recovery of Function; D012307:Risk Factors; D064876:Safety-net Providers; D012944:Social Support; D035862:Vulnerable Populations
keywords: discharge care; qualitative methods; transitions of care; vulnerable seniors