Journeying Home: Elderly Patients' Experiences and Needs During Hospital Discharge‐ A Meta‐Synthesis

ABSTRACT

Background

The discharge of elderly patients with multi‐morbidity can be complex. Clarifying their perspectives and experiences during discharge is important to support their needs. However, a unified and thorough understanding of patients' experiences and needs is lacking.

Objective

To identify and synthesise knowledge of the experiences and needs of elderly patients with multi‐morbidity during discharge from hospital to home.

Method

A qualitative meta‐synthesis was conducted using Sandelowski and Barroso's method. In December 2022, relevant studies applying appropriate criteria were searched in Embase, PubMed/MEDLINE, CINAHL, PsycINFO, and PROQUEST. A follow‐up search was conducted in October 2024.

Results

Nine studies were included, and four analytical themes were identified: the feeling of getting life back, the importance of next of kin, relationships with healthcare professionals and preparation for homecoming.

Conclusion

Short‐term relations with healthcare professionals during discharge planning posed challenges in meeting some patients' relational needs and thus affected their preparation for going home. To promote a better patient relationship during discharge planning, healthcare professionals should increase their focus on patients' preferences and needs when communicating with patients using a strategy appropriate for the healthcare context.

1. Introduction

The population of elderly people with multi‐morbidity, defined as the coexistence of two or more chronic conditions, is increasing worldwide [1]. The global prevalence of multi‐morbidity ranges from 12.9% in the general population to 95.1% among people 65 years and older [2]. Alongside a growing aging population worldwide, these circumstances challenge the healthcare systems in caring for an increasing number of elderly people with multi‐morbidity and impairments [1, 2]. The care trajectories of elderly patients with multi‐morbidity are complex and complicated by deficits in activities of daily living [3], low quality of life [4], loss of function, and polypharmacy [5].

Transitioning across hospital and municipal healthcare settings makes elderly patients feel unsafe, and it is challenging for them to manage their healthcare needs and remain independent [6, 7]. Previous studies have presented different transitional care strategies such as “teach back” and “standardized discharge planning” [8], a “self‐medication program” [9], “education” and “follow‐up after discharge” [10], a “checklist” [11], and a “bedside information sheet” [12] to improve patients' preparations for self‐management and to enhance a safe hospital discharge. Recent studies using some of these strategies show improved patient‐provider communication [13], higher treatment adherence [14], and reduced readmission rates [15, 16], respectively. However, these strategies tend to have a provider‐centered framework and a strong focus on improving organisational aspects of the discharge process. Such a focus can result in an exclusion of patients' needs and a loss of individual preferences, which in turn can impact patients' experiences after discharge. The study by La Manna et al. [17] showed that elderly patients with multi‐morbidity had difficulties understanding their condition, performing activities of daily living, and managing home medication after discharge. Other studies have also shown medicine‐related challenges after discharge [18, 19, 20]. These findings show that discharge planning affects their adaption to daily life and self‐management. Additionally, findings indicate a need for personalised discharge planning and a focus on factors beyond medical care when planning the discharge [17, 18, 19, 20]. This corresponds with the vision of the World Health Organization (WHO), which emphasises that healthcare services should be organised around the needs of people, particularly for people with chronic diseases [21]. Moreover, addressing and including patients' needs in discharge planning is strongly connected to and essential for transitional care for chronically ill elderly adults [3]. Thus, discharge planning is a crucial element of the pre‐transition process.

This highlights the need to identify how elderly patients experience being discharged, what matters to them during discharge planning, and their needs during discharge planning to include their needs during discharge planning. To our knowledge, one study has solely investigated elderly patients' experiences of discharge from hospital to home [22]. This study explored experiences during discharge, at home, or at a rehabilitation unit. Some meta‐syntheses and reviews have identified patient experiences of discharge [23, 24, 25, 26]. However, these studies included elderly adults and caregivers or healthcare professionals. Additionally, studies included in the meta‐synthesis by Allen et al. [26] were published between 1992 and 2014, with one study from 2014. In Kraun and colleagues' review [24], one study concerned elderly patients with multi‐morbidity [22]. Hence, a unified and thorough understanding of patients' perspectives that can elucidate patients' general experiences and needs during discharge planning is lacking. A meta‐synthesis can provide a thorough understanding of these perspectives and assist healthcare practitioners, researchers, and policymakers in making informed decisions and guiding their interventions to better tailor these to the needs of elderly patients with multi‐morbidity.

2. Objective

The study aimed to identify and synthesise knowledge of the experiences and needs of elderly patients with multi‐morbidity during discharge from hospital to home.

2.1. Method

2.1.1. Design

The review and qualitative meta‐synthesis followed the approach outlined by Sandelowski and Barroso [27], including the four stages: comprehensive search, appraisal of primary qualitative studies, classification of findings, and synthesis of findings. In addition, the synthesis write‐up followed the four stages of identifying and synthesising findings, as outlined by Sandelowski and Barroso [27].

2.1.2. Comprehensive Search

According to Sandelowski and Barroso [27], “berry‐picking,” defined as searching for information bit by bit using different strategies, was used to retrieve all relevant studies. In this study, “berry‐picking” included a comprehensive search, footnote chasing, citation searching, author searching, and area scanning [27]. In December 2022, the first author conducted a comprehensive search in the first step of the “berry‐picking” strategy using search parameters reflecting the inclusion criteria. The search parameters comprised the following:

• Topical: The experiences and needs of elderly patients with multi‐morbidity during discharge from hospital to home.

• Population: Patients with a mean age ≥ 65 years with at least two chronic diseases. This age group was chosen because the multi‐morbidity prevalence is higher internationally for patients aged 65 and above [28].

• Temporal: Studies published between 2012 and 2022 were initially included to reflect current clinical practices and patient experiences. A follow‐up search was conducted to incorporate studies from 2023 to 2024, ensuring that the latest findings were considered. The studies selected were published in English, Danish, Swedish, and Norwegian, aligning with the researcher's language proficiency.

• Methodological: Studies reporting primary qualitative research were included [27]. According to Sandelowski and Barroso [27], primary qualitative research involves researchers' representations of how human beings understand, experience, interpret, and produce the social world as told to them by research participants. It encompasses richly detailed descriptions and in‐depth, particularised interpretations of persons and the social, linguistic, material, and other practices and events that shape their lives and are shaped by them.

The search was done in Embase, PubMed/MEDLINE, CINAHL, PsycINFO, and PROQUEST. A reference librarian from a health sciences library was consulted to select keywords and organise the search strategy to ensure a comprehensive search in all databases [27]. The search keywords were related to the study parameters topical, population, temporal, and methodological. However, since keywords included in the topical parameter limited the search, a broader search was conducted focusing on multi‐morbidity in general (population), the age group (population), the study design (methodological), and publication years (temporal), and patients' experiences and needs were looked for manually during screening. The search keywords were organised into thematic groups using a block‐building strategy (See File S1 for search strategy, including 2012–2022) [29, 30].

Studies were excluded if (a) the patients' experiences were not separately reported because it would make it impossible to identify patients' perspectives, (b) the patients were in the terminal phase or included surgical patients because their discharge process is specific, (c) the patients were discharged to other places than their home due to their dependency on care, and (d) the study findings were classified as No Findings or the study had questionable value [27] (see the section Appraisal of primary qualitative studies). The reference management software Covidence was used for screening and data extraction.

Footnote chasing, citation searching, author searching, and area scanning were used to identify further studies. Footnotes in the reference list of reports, studies, books, and anthologies were reviewed until citation redundancy was achieved. Citations were searched in the citation database Web of Science to find similar articles. Web of Science was chosen as it provides access to citations within science, medicine, and social sciences in peer‐reviewed journals, conference papers, books, and more [31]. The links “similar articles” and “related works” were explored to find other relevant articles. For author searching, PubMed, including citations aiming to improve health globally, and Web of Science were searched by author name to ascertain whether they published other work on the same topic and fugitive literature. The links “similar articles” and “related works” were used in PubMed and EMBASE for area scanning to locate studies electronically co‐located. EMBASE was chosen because it includes records not covered by PubMed [32]. The search was reported according to the framework for enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) (See File S2).

2.2. Search Outcomes

The first author screened the studies, and the inclusion of studies was determined after a full‐text screening by the first and the last author. Next, an overview of included and excluded studies was presented to the research team, and the reasons for exclusion were explained by the first author. The research team reviewed the included studies according to their aims and methods and agreed upon them through discussion in the research team. A flow diagram (Figure 1) following the preferred reporting items for systematic reviews and meta‐analysis (PRISMA) was used for summarising the study selection process [33, 34].

FIGURE 1.

Flow diagram for summarising the study selection process.

According to Sandelowski and Barroso [27], a comparative appraisal is made when all studies are found for inclusion to describe key elements of information in each study and contextualise the information. The comparative appraisal was enabled using a table that characterised studies [27]. The table covered the affiliation, setting, aim, methodology/methods, and population to describe the area studied and to preserve the context of included studies [27]. The first author undertook the table (Table 1) and discussed it with the research team.

TABLE 1.

Characteristics of the included studies (n = 9).

Author, year, and first author affiliation	Setting	Aim	Methodology/Methods	Population
Schjødt et al. 2022 Affiliation: Nursing	Department of Endocrinology and Internal Medicine in Denmark	To explore how older medical patients experience involvement in discharge planning from a medical department.	A phenomenological hermeneutics approach. Semi‐structured interviews	Twenty patients (10 males) with comorbidities. Twelve patients lived alone. The mean age was 74 years. Patients diagnosed with dementia and patients who required terminal care were excluded.
Facchinetti et al. 2021 Affiliation: Nursing	Internal medicine, cardiology, nephrology, and multi‐specialist departments in two hospitals across Italy.	To explore the experiences of being discharged from hospital of older patients with chronic diseases at time of discharge.	A descriptive qualitative study. Face‐to‐face semi‐structured interviews.	Sixty‐five patients with one (40%) or multiple chronic diseases (60%), of which 50%,7% were women. The mean age was 77,3 years. Patients affected by cognitive impairments, in active cancer treatment, or at the end of life were excluded.
Kumlin et al. 2020 Affiliation: Nursing	Surgery and internal medicine departments at two hospitals in Norway.	To explore how elderly patients with complex health problems engage in and interact with their care trajectories across different healthcare systems where several health personnel are involved.	Explorative design. A qualitative multi‐case approach. Observations and interviews.	Eleven patients older than 65 had two or more chronic diseases and lived at home. Patients not able to give consent and patients in the terminal phase were excluded.
Lilleheie et al. 2020 Affiliation: Physiotherapy	An acute geriatric ward at a hospital in Norway	To explore the experiences of older patients above the age of 80 years of the quality of health services in the hospital and the first 30 days at home after discharge.	Phenomenological perspective. Semi‐structured individual interviews.	Eighteen patients with multiple chronic conditions lived at home and were transferred to a nursing home or their own home. The mean age was 92 years.
Allen et al. 2018 Affiliation: Nursing and midwifery	An acute general medicine ward and a subacute rehabilitation ward in Melbourne, Australia.	How do older people and their carers/families as care recipient service users, experience discharge and transitional care across the trajectories of acute, subacute, and community care?	Constructivist framework. Qualitative exploratory descriptive using semi‐structured individual interviews.	Nineteen patients (16 females) had multi‐morbidity and had experienced a transition from hospital to home. The mean age was 78,9 years. Seven carers were included. Patients and carers with cognitive impairments were excluded. Ethnicity: Australian, Dutch, and other.
Backman et al. 2018 Affiliation: Nursing	Patients home in a suburban area in Canada.	To explore the experiences of older adults with multiple chronic conditions and their family members during transitions across healthcare settings and identify potential areas for future interventions.	Socio‐ecological perspective. Descriptive qualitative study using photo walkabouts.	Nine participants with multi‐morbidity who received primary care and had experienced at least one transfer across sectors (e.g., from acute care to home) The mean age was 77,6 years. Five family members were included.
Dyrstad et al. 2015 Affiliation: Social sciences	Two emergency departments, three medical wards, one geriatric ward, and three orthopaedic wards in two Norwegian hospitals.	To explore older patients' participation during admissions to, and discharges from a hospital. Research questions: 1. How is patient participation attended to by healthcare professionals during hospital admission and discharge? 2. What are the experiences of older patients and their next of kin with patient participation in hospital admission and discharge?	Observational research design using participant observations and short conversations.	Forty‐one patients over the age of 75 with an orthopaedic diagnosis or a medical condition (e.g., chronic obstructive pulmonary disease) and polypharmacy (> 5 medications daily). Most patients had additional medical diagnoses. Twenty‐eight next of kin were included.
Neiterman et al. 2014 Affiliation: Social sciences	Patients’ homes in Southwestern Ontario, Canada.	To examine how the care transition was experienced, organized, and coordinated by patients and their informal caregivers at home.	Semi‐structured interviews.	Seventeen patients with a mean age of 79. Three patients lived alone, nine lived with their spouses, and five lived with siblings or children.
Cain et al. 2012 Affiliation: Medical	An integrated care consortium in Southern California, Colorado, and Hawaii, and patients’ homes.	To understand patient and caregiver experiences during the hospital‐to‐home transition.	An ethnographic approach including observations, video recordings, and semi‐structured interviews.	Twenty‐four patients (12 males) aged 65 or older with three or more chronic conditions. Patients were inpatients or recently discharged. Patients discharged to non‐home settings were excluded. Caregivers and family members were included.

2.3. Appraisal of Primary Qualitative Studies

According to Sandelowski and Barroso [27], an appraisal of the included studies was conducted to make the value of the findings more visible [27]. A reading guide was developed and reflected the original reading guide by Sandelowski and Barroso [27]. The reading guide was a tool used to conduct a comprehensive overview of the included studies. The reading guide for this study consisted of nearly 100 appraisal parameters; for example, the research problem, sampling strategy, and analysis techniques. Each appraisal parameter's presence or absence and relevance were considered and addressed. Lastly, the study's strengths and flaws were considered to evaluate its value as acceptable or questionable [27]. The first author used the reading guide as an overall assessment method, and the reading guide for each study was validated in the research group. Overall, the study information was comprehensive; the form of the findings had an interpretive distance from data and illuminated patients' experiences and needs. The appraisal of studies showed an acceptable value for each study. Table 2 presents an appraisal of all studies and some of their reasons. The appraisal also indicates the contribution of each study to the current synthesis.

TABLE 2.

Appraisal of the studies.

Study	Overall appraisal	Reason for appraisal
Schjødt et al. [35]	Acceptable	The study lacked information concerning what researchers knew/believed, or came to know/believe. However, it visualised the analysis process, described the study setting, and presented detailed findings according to current practice.
Facchinetti et al. [36]	Acceptable	The study lacked information concerning what researchers knew/believed or came to know/believe, validation techniques, and a frame of reference. However, it included the researcher's reflections on the rigour and data saturation.
Kumlin et al. [37]	Acceptable	The study lacked information concerning what researchers knew/believed or came to know/believe, validation techniques, and a frame of reference, and it did not present findings in a parallel fashion. However, it provided deep insight into each patient's case and considered their influence.
Lilleheie et al. [38]	Acceptable	The study lacked information concerning what researchers knew/believed, or came to know/believe. However, it provided comprehensive patient characteristics linked to the quotations.
Allen et al. [39]	Acceptable	The study lacked information concerning the period for data collection, what the researchers knew/believed or came to know/believe, the researchers' awareness of their influence, and validation techniques. However, the authors discussed and interrogated codes, categories, and themes to evaluate data interpretations.
Backman et al. [40]	Acceptable	The study lacked information concerning what researchers knew/believed or came to know/believe, the researchers' awareness of their influence, and techniques for validation. However, data were individually and collectively analysed and discussed, and the findings contained in‐depth perspectives of participants.
Dyrstad et al. [41]	Acceptable	The study lacked information concerning what researchers knew/believed, or came to know/believe. However, it included the researcher's reflections on observer effects and bias, and the findings contained elderly patients' experiences.
Neiterman et al. [42]	Acceptable	The study lacked information concerning what researchers knew/believed or came to know/believe, validation techniques, the orientation toward the target phenomenon, the site of recruitment, and it had questionable sources of data and data collection methods. However, the study included, for example, consideration of patients' preferences for the interviews and described short‐and long‐term challenges with transition in findings.
Cain et al. [43]	Acceptable	The study lacked information concerning what researchers knew/believed or came to know/believe, the researchers' awareness of their influence. However, for example, multiple observers and a researcher who did not attend the interviews analysed and discussed the data, and the findings contained detailed patient‐centered perspectives.

2.4. Classification of Findings

Findings from the included studies were classified by the first author using a classification typology [44]. The classification typology was used to determine the level of transformation and interpretation of the findings, from no transformation to transformation close to data or far from data. The classification typology was used to emphasise the differences in the types of findings presented in the studies, not the differences in quality per se, to prevent excluding findings essential to practice [44]. The research group validated the classification of findings, and no study findings were classified as No Findings. Thus, all studies were included in the meta‐synthesis. The classification and reason for classification are presented in Table 3.

TABLE 3.

Classification of findings.

Study	Typology	Reason for typology
Schjødt et al. [35]	Thematic descriptions	The findings consisted of an overall category and sub‐categories, including an in‐depth description of the patient's experiences.
Facchinetti et al. [36]	Thematic descriptions and Thematic survey. (Predominantly Thematic descriptions. See reason for typology)	The findings described nuances of patients' experiences but did not seem very transformed, given the high number of citations. However, the findings were presented as more than just patterns by showing a narrative rendering of experiences through categories and sub‐categories.
Kumlin et al. [37]	Thematic descriptions	The findings consisted of an overall description of findings, and they were reframed into broad categories, including cases that described patients' experiences.
Lilleheie et al. [38]	Thematic descriptions	The findings were reframed into several themes that described nuances of patients' experiences in detail. The names of the themes reflected their content.
Allen et al. [39]	Thematic descriptions	The findings were reframed into several themes that described nuances of patients' experiences in detail. The names of the themes reflected their content.
Backman et al. [40]	Thematic descriptions and Thematic survey (Predominantly Thematic descriptions. See reason for typology)	The findings described nuances of patients' experiences but were very close to the data. However, findings were organised into themes and sub‐themes that did not reflect a surface classification of findings.
Dyrstad et al. [41]	Thematic descriptions	The findings were reframed into broad categories that described nuances of patients' experiences in detail. The names of the categories reflected their content.
Neiterman et al. [42]	Conceptual/thematic descriptions	The findings were reframed into one overarching theme and several underlying themes that described patients' experiences. Everyday language and a theoretical concept (social capital) were used to name the themes.
Cain et al. [43]	Thematic descriptions	The findings were reframed into several domains that described nuances of patients' experiences in detail. The names of the domains reflected their content.

2.5. Synthesis of Findings

The richness of the findings determined the synthesis method [45, 46]. The findings' classifications were thematic or conceptual/thematic descriptions providing descriptive accounts of patients' experiences [45, 46]. Thus, findings were synthesised using thematic synthesis by Thomas and Harden [47]. The synthesis was an inductive process that included three stages: coding and developing descriptive and analytical themes. First, all text in the results‐ or findings section illuminating elderly patients' experiences and needs during discharge was coded line‐by‐line by the first author. During coding, the first author ensured that the codes preserved the meaning and content of each sentence, and as each study was coded, the codes were added to the collection of codes. The line‐by‐line coding was done manually and resulted in 309 codes. Next, the codes were reviewed and discussed with the last author. In the second stage, similarities between the codes were examined, and related codes were grouped into descriptive themes using Excel. The codes and descriptive themes were frequently discussed with the research team, and descriptive themes were condensed to ensure that related descriptive themes were expressed within one descriptive theme. During this stage, it was found that codes either confirmed or refuted/disproved each other [27]. It was challenging to determine how codes refuted each other, as codes described different experiences, and the experiences did not refute per se. Therefore, the definition of refutation used in this synthesis was an experience different from another. Finally, the first author wrote a draft summary of the findings across the descriptive themes and discussed it with the research group [47]. The summary of the findings is presented in the findings.

The findings from the descriptive themes provided knowledge of patients' experiences and needs during discharge planning. However, several descriptive themes were developed through these findings and were related to each other. For example, a descriptive theme named Patient‐health professional cooperation was strongly related to the descriptive theme Relationships with healthcare professionals. Thus, though analytical themes in the third synthesis stage are unnecessary if the findings align with the study's aim [47], the first author clustered some descriptive themes because they were connected and generated analytical themes to identify patients' experiences and needs more clearly. The research team discussed and refined the analytical themes' content, division, and name.

3. Findings

3.1. Study Characteristics

The synthesis included nine studies (Table 3). The studies were published from 2012 to 2022 and were conducted in Australia [39], Canada [40, 42], Denmark [35], Italy [36], Norway [37, 38, 41], and the United States of America [43]. Data were predominantly collected in hospital departments [35, 36, 37, 38, 39, 41, 42], but also in patients' homes [40, 43]. The data collection method used were interviews [35, 36, 38, 39, 42], photo walkabouts and conversations [40], or a combination of interviews and observations [37, 41, 43]. Five studies collected data from patients [35, 36, 37, 38], and four studies collected data from patients and caregivers: next of kin or family members [39, 40, 41, 43]. The number of included patients ranged from 9–65, and their average age varied from 65 to 92 years. In total, the studies included the experiences and needs of 224 patients.

3.2. The Analytical Themes

Based on the thematic synthesis, the following analytical themes were identified: the feeling of getting life back, the importance of next of kin, relationships with healthcare professionals, and preparation for homecoming. A duality of experiences was identified when discharged. Some patients greatly desired to go home and were excited about leaving the hospital and continuing their usual activities. Other patients became aware of their health challenges and concerns related to the progress of the disease and further treatment. Moreover, the importance of support from the next of kin for the patients was found. The next of kin appeared as advocates for some patients by coordinating and negotiating their discharge planning. Other patients experienced the next of kin as controlling. The thematic synthesis also described how a caring relationship between patients and healthcare professionals depended on attention and acknowledgment. Additionally, the thematic synthesis highlighted how patients' experiences during discharge preparation were influenced by organisational factors, healthcare professionals' behaviours and communication, and patients' preferences for independence and involvement during discharge planning. The analytical themes are presented in Figure 2.

FIGURE 2.

Analytical themes.

3.2.1. The Feeling of Getting Life Back

During discharge planning, some patients expressed excitement about going home. They were tired of hospitalisation and could finally see the “light at the end of the tunnel” ([36], p2420). Being discharged to their home meant that they could continue with their daily life and routines [36]. The excitement of going home could be so great that it outweighed physical needs and influenced the communication exchange and understanding of information during discharge for some patients [43]. As a patient expressed:

I was so anxious to leave. I was like, ‘Yeah, yeah, let's do this. I'm all packed. I've got one foot out the door.’ At home, I got ready to take my medication; the discharge instructions didn't jibe with what the doctor wrote. It was as much my fault as anyone's because I was rushing to get home [43]

On the other hand, being discharged evoked worries concerning the progress of the disease and further treatment, and patients did not feel physically capable of going home [36, 41]. As a patient stated: “I am nervous about the idea of going home” ([36], p2420). Patients reflected on their lives with chronic conditions and became aware of their frailty due to age and chronicity [36]. Their frailty was also caused by the daily isolation at home and feeling unimportant. Whether excited or worried about discharge, health was their main priority. Their health was connected to the feeling of safety, the management of their condition, and being able to fulfil other daily needs [36].

3.2.2. The Importance of Next of kin

The next of kin supported the patients by planning assistive devices before discharge [42], and patients relied on their next of kin and trusted them with care information, making patients feel supported and protected, especially when they felt weak [35, 36]. In these situations, it was challenging for patients to provide and remember information when feeling weak [41]. Here, the next of kin was a resource to help them remember the information and provide information about the patient [35]. As one patient expressed:

Well, it means a lot because four ears hear better than two. Sometimes, you don't feel well, and then you don't get all the information, right? [35]

When the next of kin included the patient's viewpoint, it supported patient participation and involvement during discharge planning [35]. Moreover, the next of kin advocating for the patients was helpful during disagreements between the doctor and the patient. The next of kin took control of the situation and negotiated on the patient's behalf [39]. To some patients, the next of kin was not necessary for discharge planning, or they experienced that the next of kin controlled the discharge planning by organising home care and conversing with healthcare professionals without them [35]. Some patients experienced healthcare professionals excluded the next of kin during discharge planning. Upon discharge, the healthcare professionals did not invite the next of kin to the doctor's rounds. Instead, they were usually informed about decisions on the day of discharge [41].

3.2.3. Relationships With Healthcare Professionals

Patients experienced caring nurses and trusted the healthcare professionals' opinions about treatment and health during discharge planning [36]. Their trust in healthcare professionals made them feel accompanied in their care, creating care continuity and a trusting relationship [36]. However, the trust and the caring relationship with healthcare professionals were affected when patients experienced impersonal contact with them or when they did not pay attention. During discharge, some patients experienced short‐term relationships with healthcare professionals, and the discharge planning process made it challenging to interact with them [37, 39, 43]. Other patients experienced few and busy healthcare practitioners in the department [35], and healthcare practitioners had limited time to engage with patients [35, 37].

The communication between patients and healthcare professionals affected some patients' involvement in discharge planning and their understanding of the plan after discharge. Three studies showed that patients had trouble understanding and recalling what the doctor said [35, 37, 41]. In other studies, factors such as doctors not listening to patients or engaging them in discharge planning [35, 39, 40] and a lack of clear and comprehensive information [38] challenged the communication. Additionally, challenges were experienced with written communication as patients needed help understanding it due to medical terminology or because it was too general [41]. As one patient stated:

It was easy to understand the oral information from the doctor, but in the written documents, professional medical language was used, and it was hard to understand. The doctor did not explain the content of the written paper and I am not sure about further treatment, but I think I'm supposed to take antibiotics at home [41]

In contrast, other studies highlighted positive communication experiences and patients experienced everyday language in the written information and that verbal and written information helped them remember [35, 41, 43]. These experiences contributed to some patients' involvement during discharge planning [35, 41]. Some patients described the need for a caring relationship with healthcare practitioners. Such a relationship depended on healthcare practitioners' behaviour. Patients wanted healthcare practitioners to have an attentive role where they included patients, considered their needs, and took the time to listen and talk about their condition and life situation during discharge planning [35, 36, 39]. One patient expressed:

I believe it's their job to make sure that we meet in some way. Well, dialogue sounds so fancy, but we meet anyway in a way that we both feel that we have done something for each other [35]

In addition, some patients needed care continuity involving consistent nursing care, preparation for what to expect, and daily planning to feel reassured in their transition [39]. Furthermore, trust between the patient and the healthcare professional was fundamental for some patients. The trust enabled patients to put their lives in the hands of healthcare professionals [36].

3.2.4. Preparation for Homecoming

In the studies by Dyrstad et al. [41] and Kumlin et al. [37], patients were suddenly moved to other wards or units while prepared for discharge. Also, patients experienced healthcare professionals who were pressured to discharge patients due to a shortage of beds. Furthermore, on the day of discharge, the focus of the healthcare professionals was activities, such as examinations and education in self‐care simultaneously, which determined the interaction with the patients [37, 39, 43]. They provided patient education on, for example, health conditions, mobility, and technical aspects through written instructions that were either talked through or had a cursory recitation [39, 43]. Though intensely focused on teaching patients, several studies showed that patients needed to be better informed about and involved in their discharge plans, as patients experienced being unprepared for discharge due to sudden discharge arrangements [38, 40, 41, 42]. Consequently, some patients had little time to prepare for returning home, causing hectic preparations and increasing fear and anxiety [40, 42]. As one patient stated:

I didn't know what to do. I was near tears at one point because I just didn't know what to do…and then I got a little agitated with the doctor because, you know, they're telling me one thing and then something else, and it just…emotionally, it…I didn'tknow whether to cry or scream [40]

Furthermore, some patients' preferences shaped their experiences of involvement and preparation for going home. In three studies [35, 36, 38], patients preferred the healthcare professionals to be in charge, particularly when their disease inhibited it. Patients trusted their opinions in these studies and wanted them to be decision‐makers without being included. As one patient expressed:

It's okay that they decide. Because you are so tired. And, after all, it is the doctors' decision [38]

Other patients wanted to be independent at home and prepare themselves for independence during discharge planning. They sought and shared information about their life situation to build a partnership with healthcare professionals [35, 39] or learned self‐care by observing nurses during care routines and actively participating during discharge planning [37, 39, 41].

In five studies [35, 36, 38, 39, 40], patients highlighted the need to be prepared for discharge. They stressed the need for information, support, and cooperation to maintain independence at home and avoid relapse [36]. Additionally, patients needed information about health conditions and disease management [35, 36, 38, 39], changes in medication and their reasons [39, 40], follow‐up care [40], and support to meet their fundamental needs, such as diet [36].

4. Discussion

This meta‐synthesis of nine qualitative studies [35, 36, 37, 38, 39, 40, 41, 42, 43] identified the analytical themes: the feeling of getting life back, the importance of next of kin, relationships with healthcare professionals, and preparation for homecoming. The analytical themes showed differences in how patients preferred to be involved in discharge planning. Some patients actively involved themselves or their next of kin to get comprehensive information about their condition and self‐care; some preferred not to be involved. Patients who did not want to be involved trusted healthcare professionals' opinions. This reflects study findings from Hestevik et al. [48], Hvalvik and Dale [49], and Tobiano et al. [50], which showed elderly patients' reliance on and acceptance of decisions made by health professionals affecting their involvement. Thus, trust in healthcare professionals can be one way to explain some patients' lack of involvement during discharge planning.

Other reasons for not being involved could be trust in authorities [48] or limited resources [51]. Our findings also showed that short‐term relationships between some patients and healthcare professionals limited patient involvement due to impersonal contact, limited time, not listening to patients, and a focus on patient education. Additionally, our findings showed limited involvement of some next of kin. Our findings related to the next of kin are congruent with the study by Uhrenfelt and colleagues [52], where the next of kin were not involved in the discharge or experienced little collaboration. Moreover, our findings align with the systematic review by Joo and Liu [23], illustrating that elderly patients with chronic diseases have challenges meeting clinicians, healthcare providers not listening and answering questions, and self‐management education as a barrier in hospital‐to‐home transitions due to self‐management challenges. Communicative challenges during discharge were also found in the study by Nielsen et al. [53], where elderly patients felt unheard, and in Blakey et al. [54] study, where some patients felt that their needs were ignored or they could not remember talking with health professionals. Furthermore, these two studies found that healthcare professionals' busyness affected communication, which is consistent with Schjødt et al. [35] study in the current meta‐synthesis. Healthcare professionals' being busy could have contributed to patients not wanting to be involved in discharge planning [55]. Unstable relationships between healthcare professionals could also hinder transitional care [25]. This might also affect the communication between patients and healthcare professionals, as reorganising healthcare professionals might increase the possibility of impersonal contact and missing information needed to answer patients' questions.

Our findings showed how organisational factors often affected discharge planning. Some patients experienced being moved to other wards or discharged due to a lack of beds. Another study showed that the need to free up beds dominated decisions about discharging elderly patients with complex diseases [56]. It is also congruent with the study by Coatsworth‐Puspoky et al. [57], where patients, for example, felt tricked or rushed out, and the findings by Nielsen et al. [53] study, where patients were surprised by discharge. These circumstances of discharge planning and the related experiences can result from healthcare services' priority of efficiency and reducing costs –a priority with justifiable reasons. Elderly patients with multi‐morbidity have been associated with more emergency department visits and hospitalisations [58]. Bed management, including earlier discharge, has been one way to increase the efficiency of resources and reduce costs [58]. Prioritising efficiency could impact healthcare professionals' behaviour and explain the short‐term relationship experienced by some patients. The impact of such efficiency on patients was also highlighted in our findings. Some patients and next of kin were not included in the discharge planning. Patients' need for continuity, consistency, cooperation, a trusting relationship, preparation for what to expect, inclusion, information, support, the healthcare professionals' consideration of their needs, and being listened to were unmet. Internationally, it is emphasised that care delivery is patient‐centred [21, 59]. One of the core elements of this approach is patient involvement, which, for example, enhances patients' knowledge and sense of control and improves their condition [60]. In nursing care, the care must be provided according to the patient's preferences and needs, and patient involvement is thus required and essential in nursing practice [61, 62]. According to the Fundamentals of care framework [59], being involved, informed, consistent, and having continuity in care are some of the patients' fundamental needs. Additionally, the relationship between the nurse and patient determines whether the patient's fundamental care needs can be met [59]. Looking at our findings, the short‐term relationship challenged the nurses' ability to be present, know the patient's needs, keep the patients' trust, anticipate care based on the patient's needs, and continuously evaluate patients' needs‐ all core elements to establish a relationship [60]. This showed that time‐limited nurse–patient encounters during discharge planning hampered the circumstances for establishing or maintaining relationships with some patients. Consequently, fulfilling these patients' fundamental care needs was challenged during discharge planning. Thus, patient involvement in discharge planning might not only be determined by their preferences. Healthcare professionals can face barriers caused by organisational prioritisation, compromising the patient's needs, and an individualised patient approach when planning the discharge. Bridging the individualisation and organisational context might require rethinking the practice of transitional care to achieve individualised, standardised discharge. Individualised standardisation strategies can be developed with healthcare professionals to create a better‐fitting strategy for the work environment [63]. In addition, what patients need and what matters to them can be included more actively in discharge documentation and handover reports for a common individualised focus [64]. However, a bottom‐up approach might be needed for individualised standardisation strategies, as leadership and political support are crucial for implementation.

5. Strengths and Limitations

According to Sandelowski and Barros's [27] concepts of theoretical, pragmatic, descriptive, and interpretive validity, this meta‐synthesis has some strengths and limitations. Theoretical validity was ensured by conducting the meta‐synthesis systematically following Sandelowski and Barroso [27] and the thematic synthesis method. In addition, quotations ensured authenticity in interpretations, contributing to the theoretical validity. The included studies in the meta‐synthesis were from high‐income countries and did not provide information on whether the patients had an Asian or African ethnic background. Thus, findings might only apply to similar contexts and specific ethnicities, reducing the meta‐synthesis's pragmatic validity [27]. A comprehensive search was conducted by working closely with a reference librarian to enhance the descriptive validity. However, only studies published in English, Danish, Swedish, and Norwegian were included, which could cause relevant studies to be missing and limit the diversity of studies. The descriptive validity was maintained by identifying and characterising information from included studies using a reading guide [27]. On the other hand, the meta‐synthesis did not address the quality of the included studies. Consequently, the included studies can be of poor quality. However, the validation of individual appraisal of the studies by the last author, discussion and review of codes by the last author, regular discussions in the research group about the output of the synthesis, and validation of themes and findings in the research group provided descriptive and interpretive validity [27]. Finally, an audit trail was written, including narrative text optimising the meta‐synthesis's validity [27].

6. Conclusion

This meta‐synthesis provided a fully integrated description of the experiences and needs of elderly patients with multi‐morbidity when discharged from the hospital to home. Short‐term relations with healthcare professionals during discharge planning posed challenges in meeting some patients' relational needs and thus affected their preparation for going home. To promote a better patient relationship during discharge planning, healthcare professionals should increase their focus on patients' preferences and needs when communicating with patients. However, communication success might require considering the healthcare professionals' context, as organisational factors can influence the patients' discharge planning. Further studies are needed to develop and test strategies for discharge planning that include patients' perspectives and are appropriate for the healthcare context. Future research could involve patients and healthcare professionals in developing a communication tool focused solely on patients' needs. This tool could help patients express their needs during discharge planning while helping healthcare professionals identify patients' needs more efficiently within the clinical context.

Author Contributions

Sara Shamim: project administration, conceptualization, methodology, investigation, resources, formal analysis, validation, writing – original draft, visualization, writing – review and editing. Gitte Bunkenborg: supervision, conceptualization, methodology, formal analysis, validation, writing – review and editing. Mette Geil Kollerup: supervision, conceptualization, methodology, formal analysis, validation, writing – review and editing. Connie Berthelsen: supervision, conceptualization, methodology, investigation, formal analysis, validation, writing – review and editing.

Ethics Statement

This type of study in Denmark does not require ethical approval.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

File S1: Search strategy from Medline.

File S2: ENTREQ checklist.

Shamim S., Bunkenborg G., Kollerup M. G., and Berthelsen C., “Journeying Home: Elderly Patients' Experiences and Needs During Hospital Discharge‐ A Meta‐Synthesis,” Scandinavian Journal of Caring Sciences 39, no. 3 (2025): e70113, 10.1111/scs.70113.

Data Availability Statement

Research data are not shared.