Freeman Shannon, Bishop Kristen, Spirgiene Lina, Koopmans Erica, Botelho Fernanda C, Fyfe Trina, Xiong Beibei, Patchett Stacey, MacLeod Martha
School of Nursing, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada.
Faculty of Health Sciences, Health and Rehabilitation Sciences, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada.
BMC Health Serv Res. 2017 Oct 4;17(1):689. doi: 10.1186/s12913-017-2571-y.
Long-term care facilities (LTCFs) are often places where persons with complex health needs that cannot be met in a community setting, reside and are cared for until death. However, not all persons experience continuous declines in health and functioning. For some residents who experience improvement in personal abilities and increased independence, transition from the LTCF to the community may be an option. This scoping review aimed to synthetize the existing evidence regarding the transition process from discharge planning to intervention and evaluation of outcomes for residents transitioning from LTCFs to the community.
This review followed a five-stage scoping review framework to describe the current knowledge base related to transition from LTCFs to community based private dwellings as the location of the discharge (example: Person's own home or shared private home with a family member, friend, or neighbour). Of the 4221 articles retrieved in the search of 6 databases, 36 articles met the criteria for inclusion in this review.
The majority of studies focussed on an older adult population (aged 65 years or greater), were conducted in the USA, and were limited to small geographic regions. There was a lack of consistency in terminology used to describe both the facilities as well as the transition process. Literature consisted of a broad array of study designs; sample sizes ranged from less than 10 to more than 500,000. Persons who were younger, married, female, received intense therapy, and who expressed a desire to transition to a community setting were more likely to transition out of a LTCF while those who exhibited cognitive impairment were less likely to transition out of a LTCF to the community.
Findings highlight the heterogeneity and paucity of research examining transition of persons from LTCFs to the community. Overall, it remains unclear what best practices support the discharge planning and transition process and whether or not discharge from a LTCF to the community promotes the health, wellbeing, and quality of life of the persons. More research is needed in this area before we can start to confidently answer the research questions.
长期护理机构（LTCFs）通常是那些有复杂健康需求且在社区环境中无法得到满足的人居住和接受护理直至去世的地方。然而，并非所有人的健康和功能都会持续下降。对于一些个人能力得到改善且独立性增强的居民来说，从长期护理机构过渡到社区可能是一种选择。本综述旨在综合现有证据，内容涉及从出院计划到对从长期护理机构过渡到社区的居民进行干预及评估结果的整个过渡过程。
本综述遵循五阶段范围综述框架，以描述与从长期护理机构过渡到社区私人住所（作为出院地点，例如：本人自己的家或与家庭成员、朋友或邻居合住的私人住所）相关的当前知识基础。在对6个数据库进行检索后获取的4221篇文章中，有36篇符合纳入本综述的标准。
大多数研究聚焦于老年人群体（65岁及以上），在美国开展，且局限于小地理区域。用于描述机构以及过渡过程的术语缺乏一致性。文献包括广泛的研究设计；样本量从不足10到超过50万不等。年龄较轻、已婚、女性、接受强化治疗且表示希望过渡到社区环境的人更有可能从长期护理机构转出，而那些表现出认知障碍的人从长期护理机构过渡到社区的可能性较小。
研究结果凸显了对从长期护理机构过渡到社区的人群进行研究的异质性和匮乏性。总体而言，目前仍不清楚哪些最佳实践可支持出院计划和过渡过程，以及从长期护理机构出院到社区是否能促进这些人的健康、幸福和生活质量。在我们能够自信地回答这些研究问题之前，该领域需要更多研究。
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