Balancing Dependence in Everyday Life- a Qualitative Study of Older Adults and Relatives’ Experiences of the Post-Discharge Home-Based Follow-Up Visit

Introduction: When older adults living with multimorbidity are hospitalised, they often require the involvement of multiple stakeholders to ensure continuity of care when transitioning from hospital to home. More interventions have been examined. This study aimed to explore how older adults and their relatives, spouses, or adult children experienced a nurse-led, cross-sectoral home-based follow-up visit after hospital discharge.

Methods: This study is grounded in critical psychological practice research. We conducted qualitative individual and family semi-structured interviews with 10 older adults, six relatives, three spouses, and three adult children. The interviews were conducted by telephone or face-to-face. The analysis was inspired by Braun and Clarke.

Results: We identified three themes: 1) Cross-sectoral home-based follow-up visit – an experience of caring and competent nurses, 2) Navigating dependency and disruption – balancing a new situation, and 3) Relatives – caught between support and caregiver burden.

Conclusion: The cross-sectoral, home-based follow-up visit was considered important by some older adults and all relatives during the transition from hospital to home, as it enhanced their sense of safety. The integration of care across healthcare settings improved cross-sectoral communication, facilitated collaboration across care settings, and ensured the secure transfer of information and mutual knowledge translation.