Hospital transition care for the elderly: an integrative review

an integrative review, with publications search in the MEDLINE, PubMed, LILACS, BDENF, Index Psychology and SciELO databases, with keywords and Mesh terms: elderly, hospitalization, patient discharge, health of the elderly, and transitional care, between 2013 and 2017 in English, Portuguese and Spanish. The 14 selected articles analysis was carried out through exploratory and critical reading of titles, abstracts and results of the researches.

Results:

transitional care can prevent re-hospitalizations as they enable rehabilitation, promotion and cure of illnesses in the elderly.

Final considerations:

transitional care implies the improvement of the quality of life of the elderly person, requiring skilled health professionals who involve the family through accessible communication.

Descriptors:
Elderly; Health of the Elderly; Hospitalization; Transitional Care; Patient Discharge

Initials	Description	Analysis
P	Patient	Elderly.
I	Intervention	Care transition continuity and effectiveness of care of the elderly after hospitalization process/transfer.
C	Comparison	Consequences of non-transition supply care for the elderly after hospitalization and/or transfer to an address.
O	Outcomes	Relevance of transitional care for the elderly for promotion, rehabilitation and/or cure in health-disease.

Reference (Year)	Study location (Country/Language)	Journal title (Qualis)
A⁵ (2014)	Public hospital in the Federal District (Brazil/Portuguese)	Estudos de Psicologia (B4)
A¹² (2015)	Vlietland Hospital (Netherlands/English)	BMC Health Serv Res (A2)
A¹³ (2013)	University of Queensland School of Medicine (Australia/English)	European Journal of Internal Medicine (B1)
A¹⁴ (2015)	University of Alberta and Royal Alexandra Hospital (Canada/English)	Canadian Medical Association Journal (A1)
A¹⁵ (2016)	Nine geriatric units of the Rhône-Alpes region of France (France/English)	BMC Geriatrics (B1)
A¹⁶ (2012)	William S. Middleton Memorial Veterans Hospital (US/English)	Health Affairs (A1)
A¹⁷ (2015)	Singapore General Hospital (Singapore/English)	Health Res BMC Ser (A2)
A¹⁸ (2014)	Community teaching hospital in the Northeast US (US/English)	Journal of the American Geriatrics Society (A1)
A¹⁹ (2016)	Nursing facilities in five states using Centers for Medicare and Medicaid Service (Canada/English)	Annals of Surgery (B1)
A²⁰ (2013)	Madison VA Hospital (US/English)	International Journal of Qualitative Studies on Health and Well-being (A1)
A²¹ (2015)	Western Hospital - Australia - medical assessment unit (Australia/English)	BMC Geriatrics (B1)
A²² (2015)	San Francisco General Hospital and Trauma Center (SFGH) (US/English)	Journal of General Medicine Interm (TO 1)
A²³ (2015)	Intermediate Care Hospital (ICH) (Norway/English)	BMC Health Serv Res (A2)
A²⁴ (2014)	Community Care Access Center (CCAC) (Canada/English)	European Journal of Internal Medic (B1)

Reference	Objective	Results and recommendations of the transitional care
A5	To assess feasibility and results of the intervention focused on the family to promote functional recovery of the hospitalized person.	Involvement of patients, family members and nursing staff in the promotion of transitional care in hospitalized elderly, providing for safe hospital discharge, avoids re-hospitalizations.
A12	To identify the longitudinal relationship between experiences of elderly patients with hospital care, perceived quality integrated care and quality of life after hospitalization.	Transitional care with integrated care for elderly patients directly interfere with their quality of life after hospital discharge.
A13	To describe the quality of the transition in elderly patients frequently admitted.	Opportunities for better education of the patient and the caregiver can increase adherence to the transitional care provided to high-risk elderly.
A14	To assess the impact of weakness in re-hospitalization or death within 30 days after discharge from the intensive care units.	Transitional care can be incorporated reducing tensions and risks of re-hospitalizations, especially for those who have had prolonged periods of bed rest.
A15	To assess the impact of a transitional care program from one hospital to another, for seniors admitted to short drives.	Low quality of transitional care can result in medication errors, discontinuity of care plans, dissatisfaction for elderly patients and consequently re-hospitalizations.
A16	To assess the Transitional Care Coordination Program (C-TraC) used in a hospital in Madison.	The implementation of a viable program of transition care which reduces re-hospitalizations (C-TraC -based phone) provides a cost-effective transition of care.
A17	To assess whether a transitional care program operated by the Singapore General Hospital was effective in reducing the use of emergency room visits and hospitalizations.	Patients who undergo the transition to home care have significantly lower emergency room visits and hospitalizations.
A18	To know and analyze the perception of the elderly on hospital discharge, defined as hospital-home transition.	It is important to have planning and coordination of the transitional care and discharge to ensure the continuity of comprehensive care to the elderly.
A19	To assess elderly patients who left specialist care and to identify risk factors for not returning home and death, and development of a tool to determine the likelihood of adverse outcomes.	A better understanding of hospitalization and risk factors for non-return of the home, re-hospitalization and death should help identify intervention opportunities to improve the outcome.
A20	To explore family experiences in the hospital when an elderly patient is discharged to home care in order to identify issues that may facilitate the participation of relatives in m more efficient environment.	Aiming to positive results in the transition of care, the health team needs to develop more communication skills and collaboration to guide the family involved in the transition of care.
A21	To investigate a new approach to identify and address the needs of family caregivers after discharge of the elderly receiving care.	For effective implementation of transitional care should identify and address the needs of family caregivers after discharge of the elderly receiving such care.
A22	To assess the effect of a transition from hospital care intervention conducted by nurses on the patient's experience related to hospital in a multilingual population of hospitalized elderly.	Transitional care projects for the elderly, including nursing's role in the sense of direction, safely, ensure improvement in health and experiences of elderly in the post-discharge.
A23	To compare the use of health services by the elderly in a municipality with the transition of care for elderly patients in a county without such care.	Years after the introduction of transitional care, length of hospital stay for patients aged 60 or more was reduced considerably without increasing the number of hospitalizations or re-hospitalizations.
A24	To assess whether there is an association between the presence of caregivers and the realization of transitional care.	The six properties that characterize the needs of transitional care are: assessment of single family situation; practical information, education and training; participation in the planning process; agreement between formal and informal caregivers; time to make changes in their personal lives; and emotional preparation.

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

Stay informed of issues for this journal through your RSS reader

[1] Corresponding Author: Tânia Maria de Oliva Menezes. E-mail: tomenezes50@gmail.com