Person-centredness and attention to the occupational participation of older people within discharge practices - does this happen? A scoping review

Abstract

Background: Person-centred practice puts people at the forefront of care, attention and planning. Healthcare policies highlight that participation and input from patients should be increased and become more authentic so that patient participation is grounded within a holistic approach. However, older people’s autonomy and opportunity to participate in healthcare decisions seem to be at risk due to cultural prejudice and stereotyping that perceive all older people as frail, thereby limiting person-centred practice and occupational participation during discharge practices. Discharge practice is a complex and vulnerable transition for patients. Ensuring person-centred practice and occupational participation of older people in transitional discharge practices may prove challenging due to multi-faceted factors. Aim: The scoping review aimed to discover how and if, a person-centred approach which also considers occupational participation, was detectable within discharge practices for older people from hospital to community. Method: The scoping review followed Arksey and O’Malley’s structural framework. Ten articles were eventually selected and included in the study followed by a consultation exercise with respondents who were practitioners in this area. Findings: Attention to person-centredness and occupational participation of older people during the discharge process was found to be a complex and multi-faceted process with many issues affecting implementation and ability to work in a person-centred manner. Environmental factors of time constraints and capacity, as well as assumptions of frailty and reduced ability of older people to participate in decision-making affected the ability to work in a person-centred way with opportunity of older people to participate in discharge processes. Furthermore, person-centred practice was found to have different meaning amongst occupational therapists. Conlusion: To ensure that person-centred practice and occupational participation is carried out by healthcare professionals, a regular process of reviewing practice seems necessary for individual and collective learning to happen and therefore avoid unreflective work practice which may result in professional dominance and minimal involvement of older people in the multifaceted processes of discharge.