Introduction
Healthcare systems are currently facing an increasing number of
vulnerable older patients who often require complex services and care.
Older adults living in long-term care facilities (LTCFs) represent one
of the most vulnerable groups in the geriatric
population.1 Often described as the “oldest old”,
more than 45% of them are aged over 85 years old in the United
States.1,2 This number is expected to grow further in
the upcoming years to reach 19 million by 2050 only in the United
States.3 They are expected to represent over 4% of
the total American population3 and almost 6% of the
Canadian population in thirty years.4 Older adults
living in LTCFs also typically present multiple chronic diseases and
require high levels of assistance for basic functional
tasks.2 Conditions associated with elevated care
demands or with a potentially challenging
management5,6 were found to be highly prevalent in
this setting: up to 52% of LTCFs residents live with dementia or other
related neurocognitive disorder, up to 49% with vascular diseases,
including 21% with congestive heart failure, and up to 37% with
depression.1 With this profile, older adults living in
LTCFs are also particularly at risk of poor outcomes during transitions
in care settings, such as from acute to long-term care
(LTC).7
To explain this situation, issues pertaining to gaps in information
about medical information, treatment plans, or modifications to
medications prescribed are often raised.7-9 King et al
(2013) reported that “poor quality discharge communication” is the
main barrier to a safe and well executed transition miscommunication
being associated with increased readmissions and medication errors,
delays in providing care, and decreased satisfaction of healthcare
professionals, caregivers and patients.7,10 Acute care
stays constitute dramatic interruptions in the relationships and
patterns of care previously put in place between the LTCFs staff and the
residents and their family.11 Hospital charts or
discharge forms about the procedures or investigations performed and the
modifications made to medications regimen may also not be adequately
transmitted to LTCFs during the transfer.12 As all
acute care stays are not avoidable,13-15 the
transition from acute to LTC represents a key issue for the care of the
most vulnerable of older adults: the LTCFs residents. Transitional care
interventions (TCi), such as timely medication
reconciliation,16 formal post-discharge
follow-up17-19 or early transmission of a tailored
communication forms,20,21 have emerged as an answer to
poorly executed transitions and their consequences. They commonly aim to
enhance the communication and the collaboration between the sites of
care,7 which are both particularly relevant to the
acute care to LTC transition.
Some TCi studies in older populations with complex care needs have
reported promising results on both clinical and health service use
outcomes.22 Existing reviews on TCi, even when
targeting the older population with complex care needs, however, have
focused mainly on those conducted in community-dwelling
patients.22 Furthermore, TCi reviews that did involve
the LTCF settings have evaluated transitions from long-term to acute
care settings, rather than from the acute care setting to
LTC.9 These reviews also did not distinguish between
Emergency Department (ED) visits and inpatient admission, as both were
labelled in the “hospital” category. The effects of TCi on the
transitions from acute care to a LTCF facility remains poorly studied.
Therefore, we conducted a systematic review to comprehensively explore
the effects of TCis for older adults transferred from the acute to LTC
setting.