UBC Theses and Dissertations
Exploring the experience of early discharge after transcatheter aortic valve implantation for older adults and their informal caregivers Knoll, Jennifer Katherine
Transcatheter aortic valve implantation (TAVI) has emerged as the gold standard of care for high risk individuals living with severe symptomatic aortic stenosis. Increasing experience, smaller vascular access devices and standardized care pathways have resulted in shorter lengths of stay after TAVI. Early discharge could be beneficial in this population due to higher rates of adverse events for older adults admitted to hospital. Due to high co-morbid burden of the TAVI population, it is essential to explore patient and caregiver experience to help understand how and if the complex discharge planning needs of this patient population are being met. The purpose of this study was to explore the experience of early discharge (≤72 hours) after TAVI for older adults and their informal caregivers. This study used data collected as part of a larger research program examining the experience of undergoing TAVI from time of referral to four months post-procedure. Interpretive description was employed as the method of inquiry. Semi-structured interviews conducted with ten older adults who underwent TAVI and nine informal caregivers were analyzed through inductive, thematic analysis. This process revealed three main themes and associated sub-themes: (1) Preparing for TAVI and planning for discharge: sources of information, planning for convalescence and hopeful for relief, (2) Early recovery - Transitioning home: readiness for discharge, effects of early complications, and (3) Longer-term recovery - Adjusting to life after TAVI: feeling grateful, managing expectations of recovery. Participants tended to focus on the procedure itself with little attention paid to preparing for their transition home. Though many felt well prepared to transition from hospital to home, older adults who experienced early complications and their caregivers expressed the need for more information and access to health care professionals for support. Finally, though all participants were grateful to have undergone TAVI, some experienced their recovery within the context of unmet expectations, perceptions of advancing age and comorbidities. Further research to study possible transitional care models to support early discharge as well as increased focus on identifying those at risk for early complications through individualized care planning guided by comprehensive geriatric assessments were recommended.
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