Frail older adults require a variety of health services to address the changing acuity, chronicity, and complexity of their health status. Rural dwelling older adults face additional problems due to the diversity of rural life and the limited ability of the rural health care system to meet their changing needs. The purpose of this revised ethnographic competing continuation study is to describe and analyze health care transitions of rural older adults, from a multi-dimensional perspective in several selected counties in rural Colorado, with greater emphasis placed on the Hispanic population residing in the study areas.
The specific aims are: 1) to describe the patterns of transitions of older rural residents as they move among the various levels of health care services: primary care, hospitals, nursing homes, and home care; 2) to describe the lived experience of vulnerable older rural-dwelling individuals and their families during health care transitions; 3) to explore the practice of rural health care professionals and formal and informal care providers in assisting older patients with health care transitions and assuring continuity of care; and 4) to identify problems in the process of health care transitions from the perspective of vulnerable older individuals, their families, health care providers, and the rural health care delivery system. Two long term goals evolve from the purpose and specific aims: 1) to propose nursing roles, interventions, or models of care with rural older adults and their families to facilitate health care transitions, and 2) to influence health and long term care policy impacting rural health services to improve the delivery and coordination of care for this population. Using an ethnographic design, this three year study will be conducted in two culturally and geographically different areas in Colorado in which a high proportion of the population is elderly. One of these areas includes a very high proportion of Hispanic older adults. Research methods will include: ethnographic interviews with nurses, physicians, and other formal and informal care providers, older rural residents, and family and community members; participant observations in health care, home, and community settings; photography; and examination of archival data. Analysis of ethnographic data will lead to the development of categories, domains, and themes describing patterns of health care transitions from a multidimensional perspective. Results will enable the investigators to propose nursing intervention models and to influence development of health policy toward improving the access and quality of health care provided to rural older adults. This study will make a significant contribution to the development of a nursing knowledge base about health care needs of rural elderly patients and their families.
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