Simons Kelsey V, Bower Emily S, Gillespie Suzanne M, Mills Whitney L
VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY.
VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY.
J Am Med Dir Assoc. 2021 Mar;22(3):682-688. doi: 10.1016/j.jamda.2020.07.029. Epub 2020 Sep 15.
This study aimed to further knowledge of older Veterans' experiences with transitioning to the community from Veterans Affairs nursing homes (Community Living Centers or CLCs) with emphasis on social functioning.
A qualitative study design was used in addition to administration of standardized depression and mental status screens.
Veterans (n = 18) and caregivers (n = 14) were purposively sampled and recruited from 2 rural CLCs in Upstate New York.
Semistructured interviews were completed with Veterans in the CLC prior to discharge (to explore experiences during the CLC stay and expectations regarding discharge and returning home) and in the home 2-4 weeks postdischarge (to explore daily routines and perceptions of overall health, mental health, and social functioning). Caregivers participated in 1 interview, completed postdischarge. The 9-item Patient Health Questionnaire and the Brief Interview for Mental Status were administered postdischarge.
Thematic analysis of verbatim transcriptions revealed 3 inter-related themes: (1) Veterans may experience improved social connectedness in CLCs by nature of the unique care environment (predominantly male, shared military experience); (2) Experiences of social engagement and connectedness varied after discharge and could be discordant with Veterans' expectations for recovery prior to discharge; and (3) Veterans may or may not describe themselves as "lonely" after discharge, when physically isolated. Veterans lacked moderate to severe cognitive impairment (Brief Interview for Mental Status: range = 14-15); however, they reported a wide range in depressive symptom severity postdischarge (9-item Patient Health Questionnaire: mean = 4.9, SD = 6.1, median/mode = 3, range = 0-23).
This study identified a potential for increased social isolation and disengagement after discharge from Veterans Affairs nursing homes. Nursing homes should integrate social functioning assessment for their residents, while extending care planning and transitional care to address patient-centered social functioning goals.
本研究旨在进一步了解老年退伍军人从退伍军人事务疗养院（社区生活中心或CLC）过渡到社区的经历，重点关注社会功能。
除了进行标准化的抑郁和精神状态筛查外，还采用了定性研究设计。
从纽约州北部的2个农村CLC中，有目的地抽取并招募了退伍军人（n = 18）和护理人员（n = 14）。
在退伍军人出院前（以探讨在CLC住院期间的经历以及对出院和回家的期望）以及出院后2至4周在家中（以探讨日常生活以及对整体健康、心理健康和社会功能的认知），对退伍军人进行了半结构化访谈。护理人员在出院后参加了1次访谈。出院后进行了9项患者健康问卷和简易精神状态访谈。
对逐字记录的主题分析揭示了3个相互关联的主题：（1）由于独特的护理环境（主要为男性、共同的军事经历），退伍军人在CLC中可能会体验到社会联系的改善；（2）出院后社会参与和联系的经历各不相同，可能与退伍军人出院前对康复的期望不一致；（3）退伍军人出院后身体上处于隔离状态时，可能会也可能不会将自己描述为“孤独”。退伍军人没有中度至重度认知障碍（简易精神状态访谈：范围 = 14 - 15）；然而，他们报告出院后抑郁症状严重程度差异很大（9项患者健康问卷：平均值 = 4.9，标准差 = 6.1，中位数/众数 = 3，范围 = 0 - 23）。
本研究发现退伍军人事务疗养院出院后存在社会隔离和脱离增加的可能性。疗养院应将社会功能评估纳入其居民护理中，同时扩展护理计划和过渡性护理，以实现以患者为中心的社会功能目标。
