Affiliation:
1. Regional Geriatric Program of Eastern Ontario
2. Université de Montréal
3. Glenrose Rehabilitation Hospital
4. Université de Sherbrooke
5. University of Ottawa
6. Université Laval
7. Institut universitaire de gériatrie de Montréal (IUGM) Research Center
8. North East Specialized Geriatric Centre
Abstract
Abstract
Background
When there are safety concerns, healthcare professionals (HCPs) tend to overprotect older adults and may disregard their wishes to return or remain at home. A paradigm shift is needed for HCPs to move from labelling older adults as living at risk to helping them live with risk. The Living with Risk: Decision Support Tool (LwR:DST) was developed to support older adults and HCPs with difficult decision-making regarding living with risk. The study objectives were to: 1) validate, and 2) pilot-test the LwR:DST in hospital and community settings.
Methods
The study was conducted across Canada during the pandemic. The LwR:DST’s content was validated with quantitative and qualitative data by: 1) 71 HCPs from hospital and community settings using the Delphi method, and 2) 17 older adults and caregivers using focus groups. HCPs provided feedback on the LwR:DST’s content, format and instruction manual while older adults provided feedback on the LwR:DST’s communication step. The revised LwR:DST was pilot-tested by 14 HCPs in one hospital and one community setting, and 17 older adults and caregivers described their experience of HCPs using this approach with them. Descriptive and thematic analysis were performed.
Results
The LwR:DST underwent two iterations incorporating qualitative and quantitative data provided by HCPs, older adults and caregivers. The quantitative Delphi method data validated the content and the process of the LwR:DST, while the qualitative data provided practical improvements. The pilot-testing results suggest that using the LwR:DST broadens HCPs’ clinical thinking, structures their decision-making, improves their communication and increases their competence and comfort with risk assessment and management. Our findings also suggest that the LwR:DST improves older adults’ healthcare experience by feeling heard, understood and involved.
Conclusions
This revised LwR:DST should help HCPs systematically identify frail older adults’ risks when they remain at or return home and find acceptable ways to mitigate these risks. The LwR:DST induces a paradigm shift by acknowledging that risks are inherent in everyday living and that risk-taking has positive and negative consequences. The challenges involved in integrating the LwR:DST into practice, i.e., when, how and with whom to use it, will be addressed in future research.
Publisher
Research Square Platform LLC
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