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Who Bears Responsibility for the Post-Acute Older Adult: Patient, Family or State?

02 August 2023
Volume 28 · Issue 8



This study explores the perceptions of hospital discharge coordinators on the issues raised for the post-acute older adult and their family, using the lens of assisted decision-making and advance directives.


New legislation has been developed in Ireland to support assisted decision-making and advance directives that is largely consistent with other countries around the world. The Assisted Decision-Making Act of 2015 was fully commeced in April 2023, following lengthy debate. However, there is a lot of professional uncertainty regarding how to support and integrate Advance Healthcare Directives and assisted decision-making into the care of adults and into the role of nurses working in the community.


Utilising a qualitative approach, this study conducted a series of five focus groups, with 23 participants, across the South-East of Ireland. Thematic analysis was used to interpret results. The 32-item consolidated criteria for reporting qualitative research checklist was utilised.


The central finding in this study concerned the locus of control, as well as findings on burden of care and the role of the nurse. A stark incongruence of beliefs among patient, family and State was identified.


Nurses must learn to circumnavigate the complex terrain involved in supporting the older adult’s advance decision-making and advance healthcare directives.

The COVID-19 pandemic awakened international consciousness regarding the vulnerability of the world’s elderly and, in particular, the post-acute-care elderly (Gray-Miceli et al, 2020). Internationally, legislative frameworks have been developed or reformed in recent years, to support advance care planning and assisted decision-making in healthcare (Ní Shé et al, 2018; Dowling et al, 2020). However, while different jurisdictions employ a variety of approaches, universal uncertainty remains about how to support healthcare decision-making in older adults across the geographic divides (Donnelly, 2019). International research acknowledges increased care need of the older adult following a hospital stay (Sacks et al, 2015; Lichtman et al, 2020; Vilches-Moraga, 2020; Lee et al, 2022). However, it is largely unknown who exactly provides this care to the older patient (Beard and Bloom, 2015; Kottow, 2018). Claims of ‘informal family carers’ and ‘community supports’ are evident across the literature but are largely unquantified internationally (Beard and Bloom 2015; Kottow, 2018).

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