Abstract
BackgroundMany hospitalized older adults cannot be discharged because they lack the health and social support to meet their post-acute care needs. Transitional care programs (TCPs) are designed to provide short-term and low-intensity restorative care to these older adults experiencing or at risk for delayed discharge. However, little is known about the contextual factors (i.e., patient, staff and environmental characteristics) that may influence the implementation and outcomes of TCPs. This scoping review aims to answer: 1) What are socio-demographic and/or clinical characteristics of older patients served by TCPs?; 2) What are the core components provided by TCPs?; and 3) What patient, caregiver, and health system outcomes have been investigated and what changes in these outcomes have been reported for TCPs?MethodsThe six-step scoping review framework and PRISMA-ScR checklist were followed. Studies were included if they presented models of TCPs and evaluated them in community-dwelling older adults (65+) experiencing or at-risk for delayed discharge. The data synthesis was informed by a framework, consistent with Donabedian’s structure-process-outcome model.ResultsTCP patients were typically older women with multiple chronic conditions and some cognitive impairment, functionally dependent and living alone. The review identified five core components of TCPs: assessment; care planning and monitoring; treatment; discharge planning; and patient, family and staff education. The main outcomes examined were functional status and discharge destination. The results were discussed with a view to inform policy makers, clinicians and administrators designing and evaluating TCPs as a strategy for addressing delayed hospital discharges.ConclusionTCPs can influence outcomes for older adults, including returning home. TCPs should be designed to incorporate interdisciplinary care teams, proactively admit those at risk of delayed discharge, accommodate persons with cognitive impairment and involve care partners. Additional studies are required to investigate the contributions of TCPs within integrated health care systems.
Highlights
Many hospitalized older adults cannot be discharged because they lack the health and social support to meet their post-acute care needs
2) What are the core components provided by Transitional care program (TCP)? 3) What patient, caregiver, and health system outcomes have been investigated and what changes in these outcomes have been reported for TCPs?
Four of 37 studies identified that the goal of the TCP was to offload patients from the hospital beds to wait in the TCP until admission to a long-term care homes (LTCH)
Summary
Many hospitalized older adults cannot be discharged because they lack the health and social support to meet their post-acute care needs. McCloskey and colleagues [4] found that mean age of this group was 79 years; 65% were women; had a mean of 4.6 chronic conditions (mainly hypertension, heart disease and diabetes); and were on multiple medications During their hospital stay, most showed functional decline (reduced mobility and ability to perform basic activities of daily living); had inadequate home support both prior to admission and following discharge from hospital; and were waiting for transfer to a long-term care facility [5]. Most showed functional decline (reduced mobility and ability to perform basic activities of daily living); had inadequate home support both prior to admission and following discharge from hospital; and were waiting for transfer to a long-term care facility [5] These older patients often developed complications (e.g., poor oral intake, confusion, infections), felt socially isolated [1] and, alongside their care partners, reported increased depressive [3], anxiety, and stress symptoms [5, 6].
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