Transitions in care from hospital to primary care for older patients with chronic diseases (CD) are complex and lead to increased mortality and service use. In response to these challenges, transitional care (TC) interventions are being widely implemented. They encompass education on self-management, discharge planning, structured follow-up and coordination among the different healthcare professionals. We conducted a systematic review to determine the effectiveness of interventions targeting transitions from hospital to the primary care setting for chronically ill older patients.. Randomized controlled trials were identified through Medline, CINHAL, PsycInfo, EMBASE (1995-2015). Two independent reviewers performed the study selection, data extraction and assessment of study quality (Cochrane "Risk of Bias"). Risk differences (RD) and number needed to treat (NNT) or mean differences (MD) were calculated using a random-effects model. From 10,234 references, 92 studies were included. Compared to usual care, significantly better outcomes were observed: a lower mortality at 3 (RD: -0.02 [-0.05, 0.00]; NNT: 50), 6, 12 and 18 months post-discharge, a lower rate of ED visits at 3 months (RD: -0.08 [-0.15, -0.01]; NNT: 13), a lower rate of readmissions at 3 (RD: -0.08 [-0.14, -0.03]; NNT: 7), 6, 12 and 18 months and a lower mean of readmission days at 3 (MD: -1.33; [-2.15, -0.52]), 6, 12 and 18 months. No significant differences were observed in quality of life. In conclusion, TC improves transitions for older patients and should be included in the reorganization of healthcare services.

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Identifying those least willing to receive COVID-19 vaccine is critical for increasing uptake via targeted outreach. We conducted a survey of 23,819 Canadian Longitudinal Study on Aging participants from September 29 to December 29, 2020, to assess factors associated with COVID-19 vaccine willingness and reasons for willingness or lack thereof. Among adults aged 50-96 in Canada, 84.1% (95% CI: 83.7-84.6) were very or somewhat willing to receive COVID-19 vaccine; 15.9% (95% CI: 15.4-16.3) were uncertain or very or somewhat unwilling. Based on logistic regression, those who were younger, female, had lower education and income, non-white, and lived in a rural area were less willing. After controlling for these factors, recent receipt of influenza vaccine (aOR=14.3; 95% CI: 12.5-16.2) or plans to receive influenza vaccine (aOR=10.5; 95% CI: 9.5-11.6) compared to not planning to was most strongly associated with COVID-19 vaccine willingness. Willingness was also associated with believing one had never been infected with SARS-CoV-2 and experiencing negative pandemic consequences. Safety concerns were most common. Our comprehensive assessment of COVID-19 vaccine willingness among older adults in Canada, a prioritized group due to risk of severe COVID-19 outcomes, provides a roadmap for conducting outreach to increase uptake, which is urgently needed.

Following elective abdominal surgery, elderly patients who experience a greater number and more severe postoperative complications take longer to return to their preoperative functional status.

Strong, institutional commitment to quality surgical care, as well as appropriate strategies for older patients, may have mitigated the impact of frailty on recovery. Further research is needed to examine the role of frailty in the surgical recovery process.