Learning How Older People Form Sense of Coherence through an Interpretation of Their Experiences of Decline and Serious Illness During a 30-Day Readmission : An Interpretive Description

Gagne-Henderson, Rebecca and Walshe, Catherine and Holland, Carol (2022) Learning How Older People Form Sense of Coherence through an Interpretation of Their Experiences of Decline and Serious Illness During a 30-Day Readmission : An Interpretive Description. PhD thesis, Lancaster University.

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Abstract

Background: Older people with multiple comorbidities and frailty are frequently and repeatedly readmitted to acute care hospitals within 30 days of their previous discharge from the hospital. This phenomenon takes a takes a toll upon their physical reserves and emotional stamina. These losses become serial at this time of life. As one ages there are experiences of serial losses of friends, family, other social support and physical independence. Such serial losses have been conceptualized by Antonovsky’s “General Resistance Resources” and may also affect how one views the world as predictable and manageable, a so-called “Sense of Coherence”. Understanding this Sense of Coherence in these patients may help prevent negative changes and help design appropriate interventions. Literature Review: A systematically constructed literature review using an integrative design was conducted to understand the characteristics of older adults who are readmitted to the hospital within 30 days of their las discharge. PubMed, Embase and CINAHL were searched for peer reviewed published studies investigating 30-day readmissions of people aged 65+. Found studies (n=24) primarily used quantitative cohort designs (n=23). Frailty, co-morbid conditions, and polypharmacy were common. The single qualitative study (n=3 interviews) identified that lack of communication between healthcare providers may be a concern. Further qualitative enquiry is needed to explore this phenomenon in more depth. Empirical Study: The purpose of the empirical study was to examine how 30-day readmissions, physical decline and serial losses may affect older people’s Sense of Coherence. Using an Interpretive Description design, a purposive sample of people aged 65+ at the time of a current 30-day readmission to an academic U.S. hospital was recruited. Data were collected using semi-structured interviews. Directed Content Analysis was used to evaluate and interpret the data, using concepts from Sense of Coherence as a priori codes, supplemented by inductive coding. Two new concepts were identified: Incomprehensibility and Devolving Sense of Coherence. These are new contributions to the theory of Salutogenesis and the construct of Sense of Coherence. Sense of Coherence near the end-of-life differs greatly from Sense of Coherence for those who are healthy or living with mild illness. Participants who have Comprehensibility as a result of forthright communication appear to have better manageability than those with Incomprehensibility and poor communication regarding their disease processes and prognoses. When participants suffer serial losses with Incomprehensibility it may result in a Devolving Sense of Coherence at the end-of-life.