@article{ref1,
title="Care transition decisions after a fall-related ED visit: a qualitative study of patients' and caregivers' experiences",
journal="Academic emergency medicine",
year="2020",
author="Gettel, Cameron J. and Hayes, Kelsey and Shield, Renee R. and Guthrie, Kate M. and Goldberg, Elizabeth M.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="OBJECTIVE: Falls are a leading cause of injury-related emergency department (ED) visits and may serve as a sentinel event for older adults, leading to physical and psychological injury. Our primary objective was to characterize patient- and caregiver-specific perspectives about care transitions after a fall. <br><br>METHODS: Using a semi-structured interview guide, we conducted in-depth, qualitative interviews using grounded theory methodology. We included patients enrolled in the Geriatric Acute and Post-acute Fall Prevention Intervention (GAPcare) trial aged 65 years and older that had an ED visit for a fall and their caregivers. Patients with cognitive impairment (CI) were interviewed in patient-caregiver dyads. Domains assessed included the post-fall recovery period, the skilled nursing facility (SNF) placement decision-making process, and the ease of obtaining outpatient follow-up. Interviews were audio-recorded, transcribed verbatim, and coded and analyzed for a priori and emergent themes. <br><br>RESULTS: A total of 22 interviews were completed with 10 patients, eight caregivers, and four patient-caregiver dyads within the six-month period after initial ED visits. Patients were on average 83 years old, 9/14 were female, and 2/14 had CI. 6/12 caregivers were interviewed in reference to a patient with CI. We identified four overarching themes: 1) the fall as a trigger for psychological and physiological change, 2) SNF placement decision-making process, 3) direct effect of fall on caregivers and 4) barriers to receipt of recommended follow-up. <br><br>CONCLUSIONS: Older adults presenting to the ED after a fall report physical limitations and a prominent fear of falling after their injury. Caregivers play a vital role in securing the home environment, the SNF placement decision-making process, and navigating the transition of care between the ED, SNF, and outpatient visits after a fall. Clinicians should anticipate and address feelings of isolation, changes in mobility, and fear of falling in older adults seeking ED care after a fall.<br><br>This article is protected by copyright. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="1069-6563",
doi="10.1111/acem.13938",
url="http://dx.doi.org/10.1111/acem.13938"
}