Challenges faced by elderly people diagnosed with stroke after hospitalization period: an integrative literature review

<b>Objective:</b> To analyze evidence in the literature on the main difficulties faced by elderly people diagnosed with stroke after the hospitalization period.<br><b>Methods</b>The process for developing this integrative review will follow the subsequent steps: formulation of the research question, search for primary studies in the literature, data extraction, evaluation of studies included in the review, analysis and synthesis of the results, and presentation of the review (MENDES; SILVEIRA; GALVÃO, 2008).<br><b>Research question:</b>For the first stage of the project, the following question is proposed: What are the main difficulties faced by the elderly diagnosed with stroke after the hospitalization period? Regarding the PICO strategy, an acronym for patient, intervention, comparison, and outcomes (SANTOS; PIMENTA; NOBRE, 2007), it will be used to design the search strategy, as described in Chart 1 below:<br><b>Chart 1-</b> Elements within the PICO strategy<br><b>Acronym</b><b>Definition</b><b>Description</b><br><b>P</b>Patient or issueElderly with a diagnosis of stroke, who were hospitalized<b>I</b>Intervention or topic of interestDifficulties faced after the hospitalization period<b>C</b>ComparisonNot applicable<br><b>O</b>Outcome or resultQuality of life after the hospitalization period<br><b>Literature search: </b>The search for primary studies will be conducted online to access the databases: Latin American and Caribbean Health Sciences Literature (LILACS), National Library of Medicine and the National Institutes of Health (PubMed), Embase, in addition to an academic search engine (Google Scholar). The controlled descriptors from the Medical Subject Headings (MeSH), Embase Indexing and Emtree, and the Health Sciences Descriptors (DeCS), delimited according to each database, will be identified, to then outline a unique search strategy, adapted for each listed database. Boolean operators AND and OR will be used in the combination of cross-references among the elements of the PICO strategy, with the aim of obtaining a manageable number of studies for the conduct of the research.<br><b>Study selection: </b>To ensure methodological rigor, after conducting the search in the selected databases, the results will be exported to the reference management software (EndNote), where they will be organized and duplicate articles will be removed (MENDES; SILVEIRA; GALVÃO, 2019). For the selection of studies, they will be exported to the Rayyan software, where descriptive labels for the reasons for exclusion or inclusion of each study will be created (OUZZANI et al., 2016).<br><b>Selection criteria:</b> Primary studies addressing difficulties faced by elderly individuals diagnosed with stroke after hospitalization will be included, published in English, Portuguese, and Spanish, within the last five years (2018 to 2023). Furthermore, to ensure rigor in method execution, some recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) will be utilized (Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement, 2015).<b>Data extraction:</b> For data extraction from the selected studies, we will employ a tailored script to gather details about the original article's identification, methodological characteristics, assessment of methodological rigor, and findings. Two researchers will chart the data from the included studies using this script, while another researcher will validate the information.<br><b>Study evaluation:</b> Evaluation of the studies will be guided by two priority criteria: methodological approach (quantitative or qualitative) and strength of evidence. The method identification in each included study will be conducted using the terminology provided by the authors themselves for defining the research design. In the absence of explicit method identification, the concepts outlined by Polit and Beck (2018) will be adopted. Regarding the evidence classification system, the evidence hierarchy classification by Fineout-Overholt and Melnyk (2019) will be employed, which advocates for a different classification regarding the hierarchy of evidence, according to the type of clinical question (meaning, prognosis/prediction, etiology, and intervention/treatment or diagnosis/diagnostic test) (MELNYK; FINEOUT-OVERHOLT, 2019).<br><b>Analysis and synthesis of results:</b> The presentation of data extracted from the selected studies for the Integrative Review will be performed descriptively, through the creation of a synthesis table, which will include information regarding identification, objective, and main results found in each of them, which may be grouped into thematic categories. The discussion of results will be based on publications related to the subject.<br><b>Presentation of the integrative review:</b> The results of this study will be disseminated in the academic community in the form of a scientific article indexed in a national or international database. The synthesis of the presented knowledge aims to provide data on the main difficulties faced by elderly individuals diagnosed with stroke after hospitalization, as well as methodological limitations, knowledge gaps, and directions for future research on this topic.