+AA
Fr
Back
Evidence Summary

What is an Evidence Summary?

Key messages from scientific research that's ready to be acted on

Got It, Hide this
  • Rating:

Transitional-care programs can improve the use of healthcare services by older adults living in the community

Weeks LE, Macdonald M, Martin-Misener R, et al. The impact of transitional care programs on health services utilization in community-dwelling older adults: A systematic review JBI Database of Systematic Reviews and Implementation Reports. 2018; 16(2): 345-384.

Review question

  • What is the impact of transitional care programs on the use of hospital and other healthcare services by older adults living in the community?

Background

  • Transitional-care programs refer to a wide range of interventions to improve the coordination and continuity of care for people being transferred between different locations or different levels of care within the same location. Transitional-care programs often aim to help patients and caregivers navigate the system, to plan their care, learn about services and answer their questions.
  • There is growing evidence that transitional-care programs could reduce unnecessary hospital admissions, readmissions and premature nursing-home placements.

How the review was done

  • A detailed search of six electronic databases was conducted to find relevant studies published up to May 2016. Studies that focused on the effect of transitional-care programs on the use of healthcare services by older adults living in the community were included in the systematic review.
  • A total of 6,315 studies were identified in searches, and 23 were included in the review after assessing their eligibility.
  • The review was funded by the School of Nursing at Dalhousie University.

What the researchers found

  • The review revealed that transitional-care programs generally began with a baseline assessment to identify patients’ and caregivers’ needs, and included support that was tailored to these needs. Common types of support included: coordinating and facilitating care across settings and providers; supporting access to health and community services; providing information and education; monitoring health; assessing the physical environment of the participant; providing support with medication; helping navigate the system; and supporting patient and caregiver empowerment, autonomy and self-management. Nurses were the most common providers delivering the transitional-care programs.
  • The review identified several key findings about transitional-care programs, including: they reduce rehospitalization rates over time; they may increase the use of primary-care services (which helps to deliver preventive care); they may reduce visits of staff providing home-care services; programs that lasted one month or less appeared to be as effective as longer interventions in reducing the use of hospital services; and they may have limited impact on the use of emergency departments and nursing homes.

Conclusion

  • Despite the diversity of transitional-care programs, research evidence shows that they can improve the use of healthcare services by older adults living in the community.



Glossary

Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

Related Web Resources

  • Dementia in long-term care

    Canadian Institute for Health Information
    Older adults with dementia may need to move into long-term care homes if they can no longer stay at home. These people have higher risk of getting physically restrained or given antipsychotic medication. Changes to policy and education have made these things happen less often.
  • Dementia in home and community care

    Canadian Institute for Health Information
    Adults with dementia that live at home have complicated care needs. This resource provides information about caregiving for a person with dementia, and about how to transition into long-term care.
  • Dehydration: Do we really know how to spot it?

    Evidently Cochrane
    It can be difficult to accurately spot signs of dehydration. Focusing on boosting hydration may be a better approach. Offer ice treats, fruits, chilled drinks, simple drinking containers, easy access to drinks and encourage visitors to make drinks to share.
DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

Register for free access to all Professional content

Register
Want the latest in aging research? Sign up for our email alerts.
Subscribe
© 2012 - 2019 McMaster University | 1280 Main Street West | Hamilton, Ontario L8S4L8 | +1 905-525-9140 | Terms Of Use