Recovering from surgery at home--challenges for older people: most older people going home after surgery cope well and can access the help they need. But there are gaps in services that nurses could fill.

Older people having surgery and then going home to recuperate would benefit from better discharge planning, improved home support and more follow-up contact from health professionals, particularly nurses.

These are some of the conclusions reached by Christchurch nurse educator Ray Wootton following her PhD study of 13 older people having surgery and recovering at home. The basis of her PhD thesis in 2002, entitled "Recovery--a journey and a destination: A phenomenological study of older people recovering at home after surgery", the study points to the importance of health professionals appreciating and understanding the difficulties faced by older people going home after surgery; and of the importance of keeping them informed about their surgery and recovery process.

"Recovery is not a logical process, particularly for older people who might be coping with several health problems, not just one," said Wootton. "It's a shifting reality and progress is unpredictable. Often the people in my study just needed some reassurance or perhaps a reminder that taking their medication for pain was important."

Wootton's interest in doing the study, which involved several interviews with the participants over an eight-week period, was sparked by her mother and an aunt having surgery in their later years. This raised questions for her about what happened to older people after surgery and what sort of support they had or needed when they returned home. "We have an ageing population, with people now having surgery at much older ages than in previous years. Many are managing extremely well and are very keen to do the best they can for themselves; others could do with some extra support but do not always know how to get it."

Wootton began her nursing career as a surgical nurse at Princess Margaret Hospital in Christchurch. She then moved into nurse education, firstly at the Christchurch School of Nursing, then tater at Christchurch Polytechnic. She is now a staff educator at St Allisa Court Rest-home in Christchurch and has supervised students doing their master's studies at the Christchurch Polytechnic Institute of Technology. A number of themes emerged from her PhD study. One was the length of the recovery period, which for many was quite prolonged. The participants also had to deal with the possibility of death and the fact they might not reach a full recovery or, in the case of orthopaedics, gain full use of the limb that had been operated on. Dealing with ongoing pain, discomfort and/or restrictions were issues for several. "For some people, the length of time it was taking to recover caused a tot of frustration. Some did not feet they were making any progress. All had both physical and social issues to deal with, as they sought to pick up the normal routines of their lives. "They also sought to be actively involved in their recovery. They watched their diets, took exercise as recommended by their doctors, and monitored their safety and progress. They wanted to be kept informed and they wanted answers to their questions. Unfortunately they didn't always get those answers and felt at times they were not being heard. I saw a real rote for nurses here, even if it was simply to provide reassurance about any concerns they were having. Often all they needed was to know whether what they were experiencing was normal or whether their worries were genuine. They also needed people to be sensitive about the things they found embarrassing during their recovery, eg continence issues and difficulties with dressing or undressing.

"Older people today are an informed group who do not let their chronological age govern what they do and how they think. A person's biological age is more important these days than their chronological age. One 88-year-old man had a walking machine in his home and also took his dog out for a walk regularly. There should be greater recognition of people's willingness to do the best they can for themselves. "Most of the study participants wanted to return home after their surgery because they saw their homes as therapeutic environments. However, some had problems getting the support they needed when they needed it, and three people chose to spend some time in a rest-home after their surgery as they didn't have adequate support at home."

Wootton questions whether sending people home from hospital soon after their surgery really is a cheaper or better option. Keeping some people in hospital longer might ensure they received the care they needed and reduce re-admission rates.

Wootton was impressed with the participants' determination to assist with their own recoveries. Recognising the importance of maintaining a sense of humour to assist their recovery was also a common theme. "Most people saw their surgery as a necessity and hoped it would make their lives easier. Some, however, accepted they might not reach full recovery."

Wootton was moved by the willingness of her 13 interviewees to take part in the survey. "They were willing to share information about themselves, some of it very personal, because they wanted to help others going through similar experiences," she said.