Identifying the Association Between Older Adults' Characteristics and Their Health-Related Outcomes in a Transition Care Setting: A Retrospective Audit

Abstract

Introduction: Continued evaluation of Transition Care Programs (TCP) is essential to improving older adults' outcomes and can guide which older adults may benefit from undertaking TCP. The aim of this study was to audit a transition care service to identify the association between the characteristics of older adults undertaking a facility-based TCP and (i) discharge destination and (ii) functional improvement.Materials and methods: An audit (n = 169) of older adults aged 60 years and above who completed a facility-based TCP in Australia was conducted. Outcomes audited were performance of activities of daily living (ADL) measured using the Modified Barthel Index (MBI) and discharge destination. Data were analyzed using logistic regression and linear mixed modeling.Results: Older adults [mean age 84.2 (±8.3) years] had a median TCP stay of 38 days. Fifty-four older adults (32.0%) were discharged home, 20 (11.8%) were readmitted to hospital and 93 (55%) were admitted to permanent residential aged care. Having no cognitive impairment [OR = 0.41 (95% CI 0.18-0.93)], being independent with ADL at admission [OR = 0.41 (95% CI 0.16-1.00)] and a pre-planned team goal of home discharge [OR = 24.98 (95% CI 5.47-114.15)] was significantly associated with discharge home. Cases discharged home showed greater improvement in functional ability [MBI 21.3 points (95% CI 17.0-25.6)] compared to cases discharged to other destinations [MBI 9.6 points (95% CI 6.5-12.7)].Conclusion: Auditing a facility-based TCP identified that older adults who were independent in ADL and had good cognitive levels were more likely to be discharged home. Older adults with cognitive impairment also made clinically significant functional improvements.

The impact of facility-based transitional care programs on function and discharge destination for older adults with cognitive impairment: a systematic review

“…No randomized controlled trials met criteria for inclusion in the review. As well, there were four cross-sectional studies [ 30 , 47 , 53 , 56 ]. Thus, although the studies had no obvious limitations, the review only included observational studies which allow only for the determination of association and not causality.…”

“…Among the included studies, 14 (64%) were completed in the United States [ 42 , 44 – 48 , 51 , 52 , 54 , 55 , 57 , 58 , 62 , 63 ], two (9%) in Australia [ 38 , 53 ], and one (5%) each in Hong Kong [ 30 ], Italy [ 59 ], Japan [ 56 ], Norway [ 60 ], Singapore [ 61 ], and Taiwan [ 29 ]. Eighteen of the 22 articles (82%) were cohort studies, with 13 (59%) being retrospective cohort studies [ 38 , 42 , 44 , 46 , 48 , 51 , 52 , 55 , 57 – 59 , 61 , 62 ] and five (23%) prospective cohort studies [ 29 , 30 , 45 , 60 , 63 ].…”

“…Eighteen of the 22 articles (82%) were cohort studies, with 13 (59%) being retrospective cohort studies [ 38 , 42 , 44 , 46 , 48 , 51 , 52 , 55 , 57 – 59 , 61 , 62 ] and five (23%) prospective cohort studies [ 29 , 30 , 45 , 60 , 63 ]. There were also three (14%) cross-sectional studies [ 47 , 53 , 54 ] and one (5%) retrospective study design for data from a cross-sectional survey [ 56 ]. There were no RCTs or quasi-experimental studies among the included articles.…”

“…There were a variety of settings where the TCPs were conducted, with skilled nursing facilities being the most common ( n = 9) [ 42 , 44 , 45 , 51 , 52 , 54 , 58 , 62 , 63 ]. Other settings included nursing homes ( n = 7) [ 38 , 46 – 48 , 55 , 57 , 60 ]; a subacute ward in a hospital ( n = 2) [ 59 , 61 ]; a community hospital-based post-acute care unit ( n = 1) [ 29 ]; a post-acute convalescence unit ( n = 1) [ 30 ]; a transition care facility ( n = 1) [ 53 ] and geriatric intermediate care facilities ( n = 1) [ 56 ].…”

“…Among the eight studies [ 29 , 30 , 38 , 53 , 56 , 59 – 61 ] that reported on staff complement in TCPs, there were eight studies which involved nurses [ 30 , 38 , 47 , 53 , 56 , 59 – 61 ]. Six studies each involved physiotherapists [ 29 , 30 , 38 , 53 , 56 , 60 ] and occupational therapists [ 29 , 30 , 38 , 53 , 56 , 60 ] and three studies each involved physicians [ 56 , 59 , 60 ], geriatricians [ 59 – 61 ], social workers [ 38 , 53 , 56 ] and personal care workers/aides [ 30 , 47 , 53 ]. Two studies each included case managers [ 29 , 38 ], speech therapists [ 53 , 56 ], and dieticians/nutritionist [ 29 , 53 ].…”