Empowering Older People and Informal Caregivers in Transitional Care Decision-Making

Transitional care is often poorly managed. Older people with multifaceted care needs are often in need of medical treatment and personal or daily care assistance. Transfers across care levels for these care-dependent older people increase the risk of adverse events. Insufficient involvement in decision-making or uneducated transitional care decision-making of informal caregivers and the older people themselves can lead to poor outcomes of care, such as adverse events, low satisfaction with care, high costs and inefficacy.  AIM - to gain insight into older people’s and informal caregivers’ experiences, views, and needs in transitional care decision-making and to explore how to empower them in transitional care decision-making.  METHODS - These objectives were first achieved by conducting comprehensive systematic reviews to provide an overview of older people’s and informal caregivers’ experiences, views, and needs in transitional care decision-making and empowerment interventions in transitional care decision-making. Then, qualitative studies(in-depth interviews and focus groups) were conducted (in Flanders) in order to explore older people’s and informal caregivers’ experiences, views, and needs in transitional care decision-making and to explore how to enable their empowerment in transitional care decision-making. At the end of the project, we prioritised empowerment interventions in transitional care decision-making (using a nominal group technique) based on the available evidence and stakeholders' voices. The overall conclusion from this thesis is that older people’s and informal caregivers’ experiences with transitional care decision-making indicate their need for autonomy and free choice concerning their level of involvement in decision-making. Furthermore, they want to be informed, proactively supported, and recognised in decision-making. Healthcare professionals have a fundamental role in enabling empowerment at the time of care transitions. Multicomponent person-centred interventions that address the periods prior to, during, and after the transition are needed for older people’s and informal caregivers’ empowerment in transitional care decision-making.