Sage Journals: Discover world-class research

Abstract

Discharge nurses (DNs) play a crucial role in ensuring the safe discharge of older adults. The present study aimed to describe the experiences of DNs regarding the safe discharge of older adults with memory disorders from the hospital through a free-form writing approach. We conducted a descriptive, qualitative study with a phenomenological epistemological approach. We chose free-form writing as an appropriate method for exploring how DNs (n = 11) describe the safe discharge of an older adult with memory disorders from the hospital. The data were analysed using qualitative content analysis. In reporting, we followed the Consolidated Criteria for Reporting Qualitative Research (COREQ). We related the experiences DNs regarding the safe discharge of older adults with memory disorder to continuity of care, mental health, environment, functionality, multiprofessionality, near ones and memory disorder. The care unit should ensure the continuity of services while discharging an older adult with a memory disorder.

Keywords

discharge nursing functionality memory disorder multiprofessionalit older adults

Introduction

The number of older adults is skyrocketing worldwide, and demographic shifts are impacting society and driving up the demand for healthcare services. As life expectancy increases, the number of older adults with memory disorders will rise sharply. In the coming decades, an increasing proportion of older adults will need social and health services as their functional capacity declines, and memory disorders are one of the most common disorders of functional capacity.¹ Factors associated with hospital discharge are increasingly relevant as hospital stays for older adults are shortening, care visits are increasing and the cost of care is rising.²

The World Health Organization has outlined that older adults and their caregivers should be considered when developing individualised care and multiprofessional cooperation. The care units should pay increased attention to the needs and services of older adults with memory disorders. In 2030, dementia will affect 75 million people worldwide and 132 million by 2050. A recent review estimates that globally, nearly 9.9 million people develop dementia each year. Memory disease impairs memory, information processing and executive control. The most common memory disease is Alzheimer's disease, which affects 65–70% of people with memory disorders. Other common progressive memory diseases include cerebrovascular memory disease, Parkinson's disease, Lewy body disease and frontal lobe disease.¹

Discharge from the hospital is a process that should start upon arrival. Discharge involves assessing and monitoring the older adult's health, planning care and services, and collaborating with social and healthcare professionals to ensure continuity of care.³ Planning aims to ensure the smooth and continuous provision of services after discharge, improve older adults’ satisfaction, reduce hospital readmissions and manage healthcare costs.⁴ Individualised discharge planning, accompanied by counselling, can support older adults in living at home and improving their quality of life.⁵ Inadequate discharge planning poses significant challenges to social and healthcare services,² which can reduce older adults’ functional capacity and lead to increased hospital readmissions and higher social and healthcare costs.⁶

According to Mockford et al.,⁷ older adults with memory disorders have been found to experience frequent stress on discharge. Older adults with memory disorders are also more likely to be admitted to hospital emergency departments, and their length of stay in hospital is twice as long as that of older adults without memory disorders.⁸

Discharge nurses (DNs) play a key role in ensuring the safe, smooth, and timely discharge of older adults with memory disorders. They identify individual service needs, assist in the provision of services and create conditions for older adults to manage at home.⁹ The activities of DNs have the potential to improve the discharge of older adults with memory disorders and their compliance with care instructions, as well as the provision of necessary home services.¹⁰ There is a need for research into the discharge from hospital of older adults with a memory disorder.⁵ Research on this topic generally focuses on the discharge of older adults and the development of different discharge processes. There has been relatively little research on the discharge of older adults with memory disorders from the perspective of DNs. The results can be utilised in the development of safe discharge management from the hospital, continuing education of nursing professionals, and basic education of social and healthcare professionals.

The present study aimed to describe the experiences of DNs regarding the safe discharge of older adults with memory disorders from the hospital through a free-form writing approach.

Methods

The study employed a qualitative design with a phenomenological-hermeneutic approach, which is suitable for providing a deep and personal description of the experiences of DNs.¹¹ Free-form writings were chosen¹² as an appropriate method for exploring how DNs described the safe discharge of an older adult with memory disorders from the hospital. The research approach closely assessed the participants’ authentic experiences of the phenomenon under study through written documents.¹² The data were analysed using qualitative inductive content analysis as described by Kyngäs et al.¹¹ The study employed purposive sampling, where participants are selected deliberately.¹³ To enhance transparency and reporting quality, we followed the Consolidated Criteria for Reporting Qualitative Research (COREQ), developed by Tong et al.¹⁴ as applicable.

Setting

The target group of the study consists of DNs working in hospitals in one welfare county in Northern Finland. As of 2023, municipalities transferred the responsibility for organising social services and health services to the welfare counties. In Finland, there are 21 welfare counties, which are responsible for organising social and health services for the inhabitants.

Recruitment and sample

Participants were selected using purposive sampling, a method in which participants are deliberately chosen.¹³ Inclusion criteria for participation in the study were working part-time or full-time as a DN, discharge coordinator or discharge team nurse. Additionally, the DN had to be a health professional licensed or regulated by the National Supervisory Authority for Welfare and Health, Valvira.¹⁵ This study involved DNs (n = 11), whose education was registered nurse or licensed practical nurse, working in hospitals of one welfare county in Finland. In this study, we defined DNs as nursing professionals working under the title of DN, discharge coordinator or discharge team nurse.

Data collection

For this study, we advised DNs to write about their experiences of older adults with a memory disorder discharged from the hospital to their own homes, where no 24-h care or assistance is available. We conducted data collection between November 2022 and April 2023 using a free-form writing approach. DNs received a cover letter with information about the study and a request for a consent form via email from their managers, who were the contact persons for the research group. The DNs completed the free-form writings anonymously, either on a computer or by hand. The topic of the writing was ‘My experience of safe discharge from hospital for an older adult with memory disorders’. The background questions were gender, professional title and years of work experience as a DN. The content of the free-form writings was not restricted, but we supported the writing with six guiding questions to which we asked the DN to respond in their free-form writings. The questions were: 1) What were the issues to be considered in the safe discharge of an older adult with a memory disorder? 2) What kind of support does an older adult with a memory disorder need when being discharged? 3) What challenges might be involved in discharging an older adult with a memory disorder? 4) What factors/actors supported the safe discharge of an older adult with memory, and how? 5) What kind of multidisciplinary cooperation was required to ensure the safe discharge of an older adult with memory disorders? 6) How should the safe discharge of an older adult with a memory disorder be developed? The DNs (n = 11) returned handwritten or computer-written free-form writings on paper in return boxes provided by the nurse managers or directly to the nurse managers in a sealed envelope. They then mailed the free-form writings to the researcher. Data were collected until saturation, when enough information had been gathered to support the theoretical perspective of the research question.

Data analysis

The material consisted of a total of 20 pages (A4). Ten of the papers were written on a computer, and one was handwritten. The free-form writings ranged in length from half a page to four pages. The data was analysed by the first investigator using inductive content analysis.¹¹ The first investigator started the analyses by reading through the data several times and then selecting a sentence or set of meanings as the unit of analysis. The first investigator extracted the original expressions corresponding to the research aim from the transcripts and reduced them. The total number of reduced expressions was 531. The first investigator reduced expressions with identical content, which were grouped and named according to their content into subcategories (n = 120). Then, subcategories with duplicate content were grouped and combined into upper categories (n = 37). Finally, we discussed the consensus of the analysis in the research group and combined the upper categories into eight⁸ main categories. We present an example of how the analysis proceeded in Table 1.

Table 1.

Example of the analysis process.

Example of original expression	Example of a simplified expression	Subcategory	Upper category	Main category
‘Relatives often play a big role too.’	The significant role of relatives	The role of relatives	The importance of relatives	Attention to relatives and friends
‘Finding out if the care responsibilities are going to be shared with the relatives –.’	Finding out about sharing care responsibilities with the relatives	Taking relatives into account during discharge	The importance of relatives
‘– supporting safe discharge – friends and near ones –.’	Support of friends and near ones	Support of relatives and near ones	Support and protection of relatives and near ones
‘Relatives bring security – everyday life.’	The safety that relatives bring to everyday life	The safety provided by relatives	Support and protection of relatives and near ones
‘Improving support for family caregivers.’	Improving support for family caregivers	The need for support for family caregivers	The support needs of family caregivers and spouses
‘– It is also important to consider the health situation of the spouse, whether the caregiving spouse or spouse can accommodate the client at home.’	Considering the health and coping of a spouse or family caregiver	Coping of home caregivers or spouses
‘ – Family caregivers get exhausted –.’ (T3)	Exhaustion of family caregivers	Exhaustion of family caregivers

Ethical considerations

Permission to conduct the study was obtained from the Wellbeing Services County of North Ostrobothnia. According to Finnish legislation (the Medical Research Act, no 488/1999),¹⁶ this type of research, which did not address the physical or psychological integrity of research subjects, did not require approval from an official research ethics committee.¹⁷ Good scientific practice and research ethics guidelines¹⁸ were followed at all stages of the research process. The research topic was justified from the perspective of nursing science, health policy, health service users, healthcare practice and social relevance. The researcher (RN, MHSc) had no previous affiliation with the target group. Before the actual data collection, the writing instructions were pretested with three volunteers outside the study. Participation in the study was voluntary and subjects gave informed consent to participate.

They had the right to withdraw their consent at any time without reason. To protect the anonymity of the subjects, the transcripts were anonymised and coded with numerical identifiers. The transcripts will be stored and destroyed in accordance with the EU General Data Protection Regulation.¹⁹

Results

The participants (n = 11) consisted of registered nurses (n = 6) and licensed practical nurses (n = 3). Two of the DNs (n = 2) did not provide their background information; however, they were both registered nurses or licensed practical nurses. Eight of them were female and one was male. The participants’ work experience as DNs ranged from 3 years to 15 years.

DNs experiences of safe discharge from the hospital for an older person with memory disorders were related to following main categories: 1) to ensure the continuity of care; 2) need for home care services; 3) mental health and social services; 4) to considerate the living environment; 5) supporting functional capacity; 6) multiprofessional cooperation; 7) attention to relatives and near ones; and 8) impact of memory disorder symptoms.

Ensuring the continuity of care

In the experience of DNs, planning for the discharge of an older adult with a memory disorder from the hospital and a thorough assessment of the person's fitness to live at home had to be started well in advance. The prehospital situation, in terms of housing, daily living and functional capacity, had to be established. It was also essential to determine how the client gained access to the home, whether they had a key or someone was coming to open the door.

The client is only discharged when she/he is fit enough to manage at home on her/his own for a few hours. (T4)

The assessment of service needs and planning of the home care visits to meet the needs of an older adult with a memory disorder were considered significant. The importance of paying attention to the wishes of the older adult with a memory disorder when planning services was only marginally mentioned by DNs. Changes at discharge were anticipated, and changes in care needs were considered, because DNs were aware that the care needs of an older adult with a memory disorder might change or become more acute on discharge.

Mapping existing services and the lack of them – identifying what services the older adult needs at home to ensure safe discharge. (T9)

DNs described that the hospital should report to follow-up care on time and that the information should be up-to-date, fluent and clear. They perceived that shared information systems and a fluent flow of information contributed to a safe discharge. Disorders with information flow were perceived as a barrier to safe discharge. DNs stressed the importance of the epicrisis, follow-up care instructions and the provision of necessary medical equipment to take home from the hospital. DNs reported that instructions and treatment equipment for home care were often missing when an older adult with a memory disorder was discharged.

A big part is the flow of information, where there is still much room for improvement, e.g., the convergence of medication lists and the transfer of information between phones and devices. (T7)

The DNs felt that the burden on the healthcare system and insufficient time and staff resources negatively affected the safe discharge of older people with memory disorders. They highlighted the need for more human resources and services in health care. DNs considered it essential for an older person with a memory disorder to be cared for by familiar nurses. The frequent change of nurses posed a challenge to safe discharge, as carers may not have had time to get to know the older adult with a memory disorder.

The DNs stressed that the burden on the healthcare system and insufficient time and human resources negatively impacted the safe discharge of older adults with memory disorders. Their experiences highlighted the need for more healthcare resources and services, as well as attention to human resources, such as up-to-date training for DNs.

More nursing resources, e.g., in emergency rooms and wards, nurses have time to get to know the client –. There should also be a greater number of nurses in home care. Reducing the workload in hospitals has a direct impact on how safe it is to discharge a client. (T3)

The need for home care services

The DNs experienced that it was essential to take medication changes into account when discharging an older adult with a memory disorder and that they should receive their medication for the first 24 h after discharge from the hospital. There were often perceived shortcomings in the provision of medicines and the management of medication lists and prescriptions. According to DNs, assessing and planning the need for medication and related safety considerations were essential to the discharge. They suggested considering both timeliness and the location where to store medicines at home to ensure the safety of medication management. DNs pointed out that a person with memory disorders could hide or mix up their medicines. Needs related to medication administration and pharmacy management, such as having a previous medication history at home, the need for a new medication and the need for a pharmacy assistant, were also raised.

Whether one had already started the medication in the ward, e.g., insulin treatment, or already made changes in medication, etc. The list of medicines should be explicit and in two copies to take home, one for the client and one for home care – (T6)

The safe discharge of an older adult with memory disorders was associated with the need for assistance in eating situations, taking into account the individual's functional capacity, according to the DNs. The DNs emphasised the importance of considering the food situation at home and the need for a shop assistant and meal service when planning discharge.

According to the experience of the DNs, the older adult's basic activities of daily living (ADLs) and related assistance needed to be considered. Hygiene management was perceived to be deficient in older people with memory disorders.

If a client cannot get their clothes washed and dressed/undressed, it is clear that morning and evening visits are needed, with a caregiver to help or guide them. (T5)

DNs often described it as important to assess the need for cleaning and property maintenance services in the home before discharge to ensure the safe discharge of an older adult with a memory disorder. According to the DNs, the need for transportation, support and errands, as well as assistance with matters outside the home, needed to be identified. An older adult with a memory disorder may require a security escort upon discharge.

Cleaning assistance in the case of a detached house, yard work and other house maintenance. (T4)

Mental health and social services

DNs found that some older people with memory disorders suffered from substance abuse disorders, which compromised their health and self-care. There was a perceived need to strengthen mental health and substance abuse skills because DNs did not feel they had the necessary skills to deal with mental health and substance abuse disorders.

Mental health disorders and substance abuse are also seen in the homes of older people with memory disorders; this would need a specialist team to take on discharge/ongoing home care. (T7)

According to the experience of DNs, the need for social services and financial support was more pronounced when older people with memory disorders were discharged. They also had to take into account that the financial resources of an older adult with a memory disorder to pay for food, medicines and transport may be limited.

For those who have no relatives at all and advanced memory disorder, there should be a general trustee to take care of bills and other financial matters. (T5)

Consideration of the living environment

The DNs perceived safe discharge of an older adult with memory disorders as a generally challenging and complex task. They described the complexity of discharge as involving multiple factors and being multifaceted.

The safe discharge of an older adult with memory disorder is always a challenge. (T6)

The DNs highlighted the importance of considering the overall safety of the home environment, including its habitability and accessibility. Insecurity, the risk of falls and excessive possessions made it challenging to leave home. Additionally, one should consider the potential need for home modifications.

Safety and familiarity in the experience is essential for people with memory disorders. (T11)

DNs felt that the safe discharge of an older adult with a memory disorder should involve assessing the need for safety technology and assistive devices individually in advance, while the patient is in the hospital. They perceived home safety equipment and services as very important. Still, they identified challenges in their implementation – the installation of the equipment and the type of experts needed had to be agreed upon before discharge.

It can be challenging or even impossible to teach older adults with memory disorders how to use a medical alert bracelet, so it would be a good idea to introduce a bracelet at the earliest stage of memory disorder. In addition, some people with memory disorders tend to go out even at night, so one should install access control for them. (T10)

Supporting the functional capacity

DNs considered it essential to assess the physical capacity and risk of falls of older adults with memory disorders. The nursing staff often perceived that the physical functioning of older people with memory disorders was declining in hospitals, and they were quickly institutionalised.

The longer an older adult with memory disorders is in hospital, the more difficult it is to discharge them. Older adults with memory disorders are easily institutionalised –. (T10)

In the experience of DNs, timely assessment of the functional capacity and home rehabilitation needs of an older adult with a memory disorder, and its use in follow-up care, is essential for safe discharge. DNs described that the independence of an older person with a memory disorder, as well as its possible decline, should be considered during discharge. They also stressed the importance of assessing the need for and provision of assistive devices.

Multiprofessional cooperation

DNs considered multiprofessional cooperation necessary for the safe discharge of older adults with memory disorders, and DNs wished for the development of this approach. Closer cooperation was desired between hospital wards and various social and health professionals (such as physiotherapists and occupational therapists) because this becomes more important in the discharge of older people with memory disorders.

The planning and implementation of the move is fully a team effort –. One should involve all parties in the planning, including –. (T2)

Attention to relatives and near ones

The DNs experienced that relatives and the near ones played a vital role in the discharge of an older adult with memory disorders from the hospital. They were working with relatives and involving them in the discharge planning process, identifying ways they could assist older adults with memory disorders in their daily lives. DNs also saw the relatives as a source of support and security for older adults with memory disorders.

Relatives bring security and familiar routines to everyday life. In a home situation, there should be a familiar, safe and close relative to support you, preferably overnight. (T8)

The DNs described that carers, in particular, needed additional support in discharging an older adult with memory disorders, as well as guidance on where to seek help at home if needed. Carers were also often very lonely and exhausted.

Many people with memory disorders also have a caregiving spouse at home. It is also crucial to consider the health of the spouse, whether the spouse can take the client home at all. (T3)

Impact of memory disorder symptoms

The experiences of DNs with changes in the perceptual abilities of people with memory disorders and impaired functional control showed that the older adults with memory disorders did not necessarily recognise the home and relatives. The DNs raised concerns about an older adult with a memory disorder running away from home and not being able to cope with everyday tasks. The DNs found it challenging when the older adult with a memory disorder did not understand how to call for help when needed. They were concerned about the increase in mental health symptoms and confusion of the person with a memory disorder on discharge.

Transitions are always ‘confusing’ for people with memory disorders. Particularly if there has been a long period of hospitalisation, the client may experience a momentary increase in confusion –. (T3)

The DNs pointed out that the memory symptoms and difficulties in producing and understanding the speech of an older adult with a memory disorder posed challenges to communication with caregivers. The change in environment associated with discharge could harm the sleep–wake rhythms of individuals with memory disorders, which are often disturbed.

The DNs described that the associated symptoms of memory disorder sometimes caused reluctance to receive services. They stressed the importance of considering the impact of the stage of memory loss of older adults with memory disorders on their ability to cope at home. The DNs expressed that a safe discharge required a sensitive and professional approach to the person with memory disorder, as well as guidance that had to be adapted to the stage of the memory disease.

Discussion

In this study, we have described discharge DNs’ experiences of safe discharge from the hospital for an older adult with a memory disorder. The discharge of an older adult with memory disorders was generally perceived as complex and challenging, similar to a previous study.²⁰ At the organisational and managerial level, the hospital and careers at home should pay special attention to collaboration between work units and the sharing of skills and knowledge, as this supports learning and development.²¹

Our findings indicated that planning for the safe discharge requires an assessment of home readiness, an understanding of the home situation, and time and resources. The ultimate challenge is the healthcare burden highlighted by DNs, which is also supported by previous studies on reducing hospital stays and increasing earlier discharges.²

The DNs highlighted that the opinions of older adults with memory disorders are rarely consulted during the discharge process. Likewise, in a study by Mabire et al.,² planning for discharge emphasised coordination across health professionals and organisational practices, rather than the wishes of the older adults. The above is partly due to professionals’ efforts to remove uncertainty and increase safety, while inadvertently limiting the older person's involvement in decision-making.^2,20 Planning for discharge in collaboration with an older adult with a memory disorder could be challenging because of cognitive impairment,²² which could prolong the time to discharge.²³ Planning for discharge therefore did not meet the wishes and needs of the older adult with a memory disorder.⁷

DNs highlighted the challenges of up-to-date information flow between healthcare providers. They also experienced shortcomings in obtaining the necessary treatment tools, as well as the epicrisis and follow-up care instructions from the hospital. Hansson et al.²⁴ also identified gaps in communication between different healthcare professionals in the context of discharging older people. The safe discharge of an older adult with a memory disorder requires effective communication and knowledge of information systems from various professionals.⁶ Healthcare organisations do not have uniform information systems, and information do not transfer from one organisation to another. From a patient safety perspective, the transfer and development of information needs to be improved. The findings suggest that home care and support services should always be planned according to the individual needs of an older adult with a memory disorder at the time of discharge. Previous studies have similarly found the relevance of home-based support services, such as home care,^4,7 in the discharge process.

DNs emphasised the importance of accounting for medication changes and ensuring access to medication during the first 24 h post-discharge for older adults with memory disorders, while also noting frequent shortcomings in medication provision and prescription management. Previous literature strongly emphasises that managing medication for people with memory disorders during the discharge phase requires clear guidance and multidisciplinary support.²⁵ DNs emphasised that safe discharge planning for older adults with memory disorders necessitates careful consideration of their functional capacity, support with daily activities and adequate nutrition. One should also address ADLs for safe discharge planning. A previous study strongly supports these findings, highlighting that safe discharge for older adults with memory disorders requires comprehensive planning that addresses nutrition, hygiene, daily functioning and access to support services.²⁶

One of the key findings of the study indicated that mental health and substance abuse disorders among older adults with memory disorders can make safe discharge difficult. DNs highlighted the need for multiprofessional reinforcement of knowledge of mental health and substance abuse, a finding also noted in a study by Redwood et al.²⁰ The results of the study showed that the mental and social functioning of older people with memory disorders needs to be considered more carefully from the perspective of the care staff, which has also been found in previous research.²³

The focus on a safe home environment for older adults with memory disorders and how to cope with it was a key issue raised by the nurses in this study, which aligns with previous studies.⁶ The care personnel should assess the safety and suitability of the home before discharging the patient from the hospital, which is not always straightforward or possible. The results showed that older individuals with memory disorders required guidance on the use of various types of home safety equipment, which was also perceived as a challenge. According to Blazun,²⁷ learning to use safety equipment can be supported by gradual and motivation-based teaching, which home care professionals could do.

The results of the study endorsed that the importance of maintaining physical functioning was taken into account more than mental, social, and cognitive functioning at discharge. The potential of restorative care and its models did not emerge in the results either. It is noteworthy that both ageing and memory disorders impair functional capacity, and functional disorders have been found particularly in those who have returned to the hospital within 30 days.²⁸ Comprehensive restorative care and its continuity should therefore be ensured after discharge. DNs also reminded that older people with memory disorders become institutionalised quickly and their physical functioning deteriorates, especially during extended hospital stays. In a similar vein, Stockwell-Smith et al.²⁹ demonstrated that discharge planning should start on time at the hospital and should not prolong hospitalisation but ensure continuity of care at home.

DNs considered multiprofessional cooperation, similar to Zurlo and Zuliani,⁶ who have stated the importance of the roles and collaboration of different professional groups in the discharge of an older adult with a memory disorder. Different phases of care, multiple teams and a high number of different professional groups have been found to contribute to increased anxiety among older people,² as well as stress and relatives⁷ at discharge. Multiprofessionalism should therefore have a subtle outward appearance. Developing multiprofessional collaboration can improve the quality of discharge management and reduce the length of hospital stays and hospital readmissions.³⁰

The importance of relatives and near ones was highlighted in the experiences of DNs. The two-way exchange of information with loved ones was perceived as necessary in the discharge process, as also found in a study by Redwood et al.²⁰ Consistent with Stockwell-Smith et al.,²⁹ relatives and near ones were perceived as resources for care, and often also wished to be involved in the discharge. However, relatives experienced gaps in communication and access to information about post-discharge care.²⁰ The right to self-determination of an older adult with a memory disorder should be a priority in communication situations.³¹ It is noteworthy that not all older people with memory disorders have the support of relatives and near ones during discharge.

The results suggested that, during discharge, an older adult with a memory disorder may experience a momentary increase in symptoms associated with memory loss, which can pose a challenge to safe discharge. DNs found that, in particular, the transition between hospital and home increased confusion and disrupted sleep patterns. On the other hand, the associated symptoms of memory disorder are also influenced by a long period of hospitalisation, which has been shown to put older people at risk of disorders such as confusion and reduced independence and self-confidence.²² Similarly, in people with memory disorder, generalised depression may manifest as behavioural disturbances, sleep disturbances, loss of appetite or withdrawal.²⁸ Recognising the memory symptoms of an older person with memory loss can help to target support in an individualised way.

Our study implicated that DNs can facilitate safe discharge by clear verbal instructions on discharge and their special knowledge and skills. Based on previous knowledge, a lack of understanding of the guidance received by older people with memory disorders increases the risk of adverse events at discharge, such as medication errors.³² Guidance for self-care was almost lacking in the results. A study by Palonen et al.⁵ found that discharge guidance should be improved by considering the older person's agency in their care. Unhurriedly encountering an older person with memory disorders helps to identify individual needs and maintain a sense of security, which are essential for safe discharge and service planning. Taking individual resources and wishes into account supports quality and safety of discharge³³ and adherence to care.³⁴

Strengths and limitations

The trustworthiness of the present study is supported by its alignment with established qualitative research practices. The phenomenological-hermeneutic approach, as described by Kyngäs et al.,¹¹ is well-suited for capturing the depth and nuance of the lived experiences of DNs, particularly in complex care transitions involving older adults with memory disorders. The use of free-form writings, following Chase,¹² enabled participants to express their perspectives authentically and reflectively, enhancing the credibility of the data. This method has been recognised for its ability to access personal meaning-making in professional narratives. The data analysis followed the principles of inductive content analysis,¹¹ a method widely accepted in the nursing and health sciences for its systematic yet flexible structure. Purposive sampling, as outlined by Stratton,¹³ ensured that participants were selected based on their relevance to the phenomenon under study, thereby strengthening the study's dependability.

Furthermore, adherence to the COREQ,¹⁴ enhanced transparency and confirmability, allowing readers to assess the methodological rigour and contextual grounding of the findings. Taken together, these methodological choices reflect a coherent and well-documented research process that aligns with best practices in qualitative inquiry, supporting the trustworthiness and transferability of the results. Despite having only 11 participants, the data gathered proved to be rich and saturated. Based on a systematic review, saturation can be reached with a relatively small number of participants, mainly when research objectives are narrowly defined, as in the case of our study.³⁵

Conclusions

Discharging older adults with memory disorders is a complex and multidimensional process that demands careful planning and coordination. Successful discharge requires assessing an individual's functional capacity, ensuring continuity of care and access to appropriate services, and considering their home environment and support network. Improved safety and continuity of care support the quality of life for older adults and reduce the burden on their loved ones. Multiprofessional collaboration, precise information flow and attention to the specific needs and preferences of both the older adult and their loved ones are essential. The education of social and healthcare professionals should include comprehensive training on the safe discharge of older adults with memory disorders. Future research should focus on the experiences of older adults, their families, and the professionals involved in discharge planning, with particular emphasis on enhancing multiprofessional cooperation.

Footnotes

Acknowledgements

We thank the discharge nurses who made this study possible.

ORCID iDs

Heidi Siira

Sinikka Lotvonen

Funding

The authors received no financial support for the research, authorship and/or publication of this article.

Declaration of conflicting interests

The author declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

References

World Health Organisation WHO. Global action plan on the public health response to dementia 2017–2025. Assessed 2 March 2025, 9789241513487-eng.pdf

Mabire

Dwyer

Garnier

, et al. Meta-analysis of the effectiveness of nursing discharge planning interventions for older inpatients discharged home. J Adv Nurs 2018; 74: 788–799. doi:10.1111/jan.13475

Skerry

Kervin

Hanson

, et al. Investigating areas for improvement in the transition from hospital-to-home for frail older adults: A mixed methods study. J Patient Saf Risk Manage 2022; 27: 275–284. doi:10.1177/25160435221135115

Gonçalves-Bradley

Lannin

Clemson

, et al. Discharge planning from hospital. Cochrane Database Syst Rev 2022; 2: CD000313. https://doi-org.pc124152.oulu.fi:9443/10.1002/14651858.CD000313.pub5

Palonen

Kaunonen

Helminen

, et al. Discharge education for older people and family members in the emergency department. A cross-sectional study. Int Emerg Nurs 2015; 23: 306–311.

Zurlo

Zuliani

. Management of care transition and hospital discharge. Ageing Clin Exp Res 2018; 30: 263–270. doi:10.1007/s40520-017-0885-6

Mockford

Seers

Murray

, et al. The development of service user-led recommendations for health and social care services on leaving hospital with memory loss or dementia – the SHARED study. Health Expect 2016; 20: 495–507. doi:10.1111/hex.12477

Draper

Karmel

Gibson

, et al. The hospital dementia services project: Age differences in hospital stays for older people with and without dementia. Int Psychogeriatr 2011; 23: 1649–1658. doi:10.1017/S1041610211001694

Scott

. Emergency discharge teams offer an essential service. Emerg Nurse 2018; 26: 5. doi:10.7748/en.26.4.5.s1

10.

Bowden

Keniston

McBeth

, et al. Discharge Today: The Efficacy of a Multidisciplinary Discharge Team. J Gen Intern Med 2022; 37: 1578–1581. DOI:10.1007/s11606-021-07043-6

11.

Kyngäs

Kääriäinen

Elo

. The Trustworthiness of Content Analysis. In Kyngäs

Mikkonen

Kääriäinen

(eds.) The application of content analysis in nursing science research. Springer; 2019, 41–48. https://link.springer.com/chapter/10.1007/978-3-030-30199-6_5

12.

Chase

. Narrative Inquiry. Toward theoretical and methodological maturity. In: Denzin

Lincoln

(eds) The SAGE handbook of qualitative research. 5th edition. Sage Puplications Inc, 2018, pp.546–560.

13.

Stratton

. Purposeful Sampling: Advantages and Pitfalls. Prehospital Disas Med (PDM) 2024; 39: 121–122. 10.1016/j.socscimed.2021.114523

14.

Tong

Sainsbury

Craig

. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qualityl Health Care 2007; 19: 349–357.

15.

National Supervisory Authority. Frontpage | Valvira. 2025.

16.

Medical Research Act, no 488/1999. https://www.finlex.fi/en/laki/kaannokset/1999/en19990488.pdf

17.

Ethics Committee of Human Sciences. University of Oulu, 2025. https://www.oulu.fi/en/university/faculties-and-units/eudaimonia-institute/ethics-committee-human-sciences

18.

World Medical Association. World medical association declaration of Helsinki ethical principles for medical research involving human subjects. JAMA 2013; 310: 2191–2194. doi:10.1001/jama.2013.281053

19.

Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons concerning the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC. Assessed 3 March 2025. Regulation – 2016/679 – EN – gdpr – EUR-Lex.

20.

Redwood

Brant

Maluf

, et al. How latent patterns of interprofessional working may lead to delays in discharge from hospital of older people living with frailty – “Patient more confused than usual?”. Ageing Soc 2023; 43: 576–597. https://pure-oai.bham.ac.uk/ws/files/134290885/Redwood_et_al_Ageing_and_Society_2021.pdf

21.

Kakemam

Liang

. Guidance for management competency identification and development in the health context: a systematic scoping review. BMC Health Serv Res 2023; 23: 421. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-023-09404-9

22.

Bauer

Fitzgerald

Koch

. Hospital discharge as experienced by family carers of people with dementia: A case for quality improvement. J Healthc Qual 2011; 33: 9–16. 10.1111/j.1945-1474.2011.00122.x

23.

Reig-Garcia

Bonmatí-Tomàs

Suñer-Soler

, et al. Evaluation and perceptions of a nursing discharge plan among nurses from different healthcare settings in Spain. BMC Health Serv Res 2022; 22: 1–10. 10.1186/s12913-022-08109-9

24.

Hansson

Svensson

Ahlström

, et al. Flawed communications: health professionals’ experience of collaboration in the care of frail elderly patients. Scand J Public Health 2018; 46: 680–689. 10.1177/1403494817716001

25.

Tomlinson

Cheong

Fylan

, et al. Success care transition for older people: a systematic review and meta -analysis of the effect of interventions that support medication continuity. Age Ageing 2020; 49, 558–569. doi:10.1093/ageing/afaa002

26.

Provencer

Clemson

Wales

, et al. Supporting at-risk older adults transitioning from hospital to home: who benefits from an evidence-based patient-centered discharge planning intervention? Post-hoc analysis from randomised trial. BMC Geriatr 2020; 20: 84. 10.1186/s12877-020-1494-3

27.

Blazun

. Elderly People ´s Quality of Life with Information and Communication Technology (ICT): Toward a Model of Adaptation to ICT in Old Age. PhD dissertation, University of Eastern Finland, 2013. http://urn.fi/URN: ISBN:978-952-61-1164-3

28.

Laura

Melvin

Yoong

. Depressive symptoms and malnutrition are associated with other geriatric syndromes and increase risk for 30-day readmission in hospitalised older adults: a prospective cohort study. BMC Geriatr 2022; 22: 1–13. doi:10.1186/s12877-022-03343-6

29.

Stockwell-Smith

Moyle

Marshall

, et al. Hospital discharge processes involving older adults living with dementia: An integrated literature review. J Clin Nurs 2018; 27: e712–e725. doi:10.1111/jocn.14144

30.

Knight

Thompson

Mathie

, et al. Seamless care? Just a list would have helped!’ Older people and their carers’ experiences of support with medication on discharge home from hospital. Health Expect 2011; 16: 227–291. 10.1111/j.1369-7625.2011.00714.x

31.

Act (1992/785). Act on the status and rights of patients · translations of Finnish acts and decrees. 17.8.1992/785. Assessed 4 March 2025 785/1992 | Legislation | Finlex.

32.

Sawan

Jeon

Bond

, et al. Caregivers’ experiences of medication management advice for people living with dementia at discharge. J Eval Clin Pract 2021; 27: 1252–1261. DOI:10.1111/jep.13551

33.

Lenaghan

. Transitional care and empowerment of the older adult. Geriatr Nurs 2019; 40: 148–153. 10.1016/j.gerinurse.2018.07.005

34.

Alberti

Nannini

. Patient comprehension of discharge instructions from the emergency department: a literature review. J Am Assoc Nurse Pract 2013; 25: 186–194. 10.1111/j.1745-7599.2012. 00767.x

35.

Hennink

Kaiser

. Sample sizes for saturation in qualitative research: A systematic review of empirical tests. Soc Sci Med 2022: 114523. 10.1016/j.socscimed.2021.114523

The experiences of discharge nurses on the safe hospital discharge of older adults with memory disorders: A qualitative study