Key result
Cross-sectoral home visits enhance feelings of safety and care continuity for discharged older adults.
Why the study?
When older adults with multimorbidity are hospitalised, ensuring continuity of care requires multiple stakeholders, but how they and their relatives experience nurse-led, cross-sectoral home follow-up visits was unclear.
A cross-sectoral, home-based follow-up visit by nurses shortly after hospital discharge is valued by older adults and their relatives for enhancing safety and care continuity.
Introduction: When older adults living with multimorbidity are hospitalised, they often require the involvement of multiple stakeholders to ensure continuity of care when transitioning from hospital to home. More interventions have been examined. This study aimed to explore how older adults and their relatives, spouses, or adult children experienced a nurse-led, cross-sectoral home-based follow-up visit after hospital discharge. Methods: This study is grounded in critical psychological practice research. We conducted qualitative individual and family semi-structured interviews with 10 older adults, six relatives, three spouses, and three adult children. The interviews were conducted by telephone or face-to-face. The analysis was inspired by Braun and Clarke. Results: We identified three themes: 1) Cross-sectoral home-based follow-up visit – an experience of caring and competent nurses, 2) Navigating dependency and disruption – balancing a new situation, and 3) Relatives – caught between support and caregiver burden. Conclusion: The cross-sectoral, home-based follow-up visit was considered important by some older adults and all relatives during the transition from hospital to home, as it enhanced their sense of safety. The integration of care across healthcare settings improved cross-sectoral communication, facilitated collaboration across care settings, and ensured the secure transfer of information and mutual knowledge translation.
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Beck et al. (2026) studied Hospital discharge in older adults with multimorbidity (n=16). Nurse-led, cross-sectoral home-based follow-up visit was evaluated on Experiences of the post-discharge home-based follow-up visit (qualitative themes). The cross-sectoral home-based follow-up visit enhanced the feeling of safety and continuity of care for older adults and their relatives during the transition from hospital to home.
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