| The ability to function in one's environment is essential in maintaining independence. Yet, older people are often confronted with unexpected acute health episodes that diminish function, requiring admission to intensive care units (ICU) followed by either voluntary or involuntary relocation. Very little qualitative prospective research has been conducted in this area. The continual interplay between a person's functional trajectory following an unexpected acute health event, and the locational trajectory from hospitalization through rehabilitation and discharge remains poorly understood. This study examines change in self-reported function and perceptions of the experience from the perspective of older participants, ages 65 – 97, as they progress through unexpected acute health episodes, admission to ICU, changes in functional abilities, and release to various settings. A purposive sample of 10 participants was interviewed five times each over a time period of 24 months. A grounded theory approach was employed to develop a conceptual model that describes and explains the evolving function-location relationship, as a means of better understanding the event-recovery trajectory, and of improving care decisions. Findings revealed five main themes that were surrounded by the use of prior life experiences as the participants searched for stability. First, there was a mismatch of expectations and realities concerning the ICU experience and functional capacity. Second, as health changes were experienced over time, there was a fluidity of perceptions concerning one's health and medical care. Third, there were uncertainty and fear of the unknown concerning health, death, finances, and independence. Fourth, social comparisons were applied as the concept of "normal" was used. And fifth, religion and prayer were used as adaptive devices and coping mechanisms in the reestablishment of equilibrium.;Keywords. Functional Dynamics, Locational Trajectory, Fluidity of Perceptions, Intensive Care Unit, Relocation. |
