Components of the transitional care model (TCM) to reduce readmission in geriatric patients: a systematic review. Morkisch Nadine,Upegui-Arango Luz D,Cardona Maria I,van den Heuvel Dirk,Rimmele Martina,Sieber Cornel Christian,Freiberger Ellen BMC geriatrics BACKGROUND:Demographic changes are taking place in most industrialized countries. Geriatric patients are defined by the European Union of Medical Specialists as aged over 65 years and suffering from frailty and multi-morbidity, whose complexity puts a major burden on these patients, their family caregivers and the public health care system. To counteract negative outcomes and to maintain consistency in care between hospital and community dwelling, the transitional of care has emerged over the last several decades. Our objectives were to identify and summarize the components of the Transitional Care Model implemented with geriatric patients (aged over 65 years, with multi-morbidity) for the reduction of all-cause readmission. Another objective was to recognize the Transitional Care Model components' role and impact on readmission rate reduction on the transition of care from hospital to community dwelling (not nursing homes). METHODS:Randomized controlled trials (sample size ≥50 participants per group; intervention period ≥30 days), with geriatric patients were included. Electronic databases (MEDLINE, CINAHL, PsycINFO and The Cochrane Central Register of Controlled Trials) were searched from January 1994 to December 2019 published in English or German. A qualitative synthesis of the findings as well as a systematic assessment of the interventions intensities was performed. RESULTS:Three articles met the inclusion criteria. One of the included trials applied all of the nine Transitional Care Model components described by Hirschman and colleagues and obtained a high-intensity level of intervention in the intensities assessment. This and another trial reported reductions in the readmission rate (p < 0.05), but the third trial did not report significant differences between the groups in the longer follow-up period (up to 12 months). CONCLUSIONS:Our findings suggest that high intensity multicomponent and multidisciplinary interventions are likely to be effective reducing readmission rates in geriatric patients, without increasing cost. Components such as type of staffing, assessing and managing symptoms, educating and promoting self-management, maintaining relationships and fostering coordination seem to have an important role in reducing the readmission rate. Research is needed to perform further investigations addressing geriatric patients well above 65 years old, to further understand the importance of individual components of the TCM in this population. 10.1186/s12877-020-01747-w

Risk factors of geriatric depression among elderly Bangladeshi people: A pilot interview study. Disu Tasnim Rahman,Anne Nusrat J,Griffiths Mark D,Mamun Mohammed A Asian journal of psychiatry Globally, geriatric depression (GD) has been recognized to be one of the most prevalent problems among the elderly. However, there is an only one previous Bangladeshi study addressing the issue. Consequently, the present study investigated GD and its associated risk factors. A semi-structured face-to-face interview was conducted among 168 self-reported healthy elderly residents (59.5% female) aged 60-80 years in Patuakhali city and the neighboring village. Measures included the Geriatric Depression Scale-15, socio-demographic variables, psychosocial factors, physical health-related factors, lifestyle factors, and dietary factors. Results showed the GD prevalence rate was 36.9% (n = 62). Risk factors for GD included living in a rural area, having no history of chronic disease, having a history of previous personal and/or family depression, not engaging in daily life activities, not exercising regularly, having no hobbies, having a poor diet, and not engaging in religious practices regularly. The GD prevalence rate was generally higher compared to previous studies in other countries. This may have been due to the inclusion criterion of selecting self-reported healthy elderly individuals. It is recommended that a nationally representative study is carried out to assess the actual figure of GD in Bangladesh. The findings are helpful for depression-reducing intervention programs. 10.1016/j.ajp.2019.07.050

Depression and cardiovascular disease in elderly: Current understanding. Zhang Yaxin,Chen Yujing,Ma Lina Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia Geriatric depression is a major public health problem and has an especially large effect on health when comorbid with a chronic medical condition. Hypertension, coronary heart disease, and diabetes are accompanied by a high incidence of depression and can affect the treatment and prognosis. Depression is a highly prevalent risk factor for incident of and is associated with morbidity and mortality of cardiovascular disease. In addition to the proactive and effective control of primary diseases, efforts should also be made to improve patients' psychological and social function. Current evidence on antidepressive therapy in patients with coronary diseases is limited. A better understanding of pathophysiological mechanisms underpinning depression and cardiovascular disease as well as the complex biological crosstalk of cardiovascular disease complicated with depression is particularly important for future therapeutic strategies. The following review is on current understanding of geriatric depression and cardiovascular disease. 10.1016/j.jocn.2017.09.022

Effectiveness of a nurse-led hospital-to-home transitional care intervention for older adults with multimorbidity and depressive symptoms: A pragmatic randomized controlled trial. Markle-Reid Maureen,McAiney Carrie,Fisher Kathryn,Ganann Rebecca,Gauthier Alain P,Heald-Taylor Gail,McElhaney Janet E,McMillan Fran,Petrie Penelope,Ploeg Jenny,Urajnik Diana J,Whitmore Carly PloS one OBJECTIVE:To evaluate the effectiveness of a nurse-led hospital-to-home transitional care intervention versus usual care on mental functioning (primary outcome), physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health service use costs in older adults with multimorbidity (≥ 2 comorbidities) and depressive symptoms. DESIGN AND SETTING:Pragmatic multi-site randomized controlled trial conducted in three communities in Ontario, Canada. Participants were allocated into two groups of intervention and usual care (control). PARTICIPANTS:127 older adults (≥ 65 years) discharged from hospital to the community with multimorbidity and depressive symptoms. INTERVENTION:This evidence-based, patient-centred intervention consisted of individually tailored care delivery by a Registered Nurse comprising in-home visits, telephone follow-up and system navigation support over 6-months. OUTCOME MEASURES:The primary outcome was the change in mental functioning, from baseline to 6-months. Secondary outcomes were the change in physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health service use cost, from baseline to 6-months. Intention-to-treat analysis was performed using ANCOVA modeling. RESULTS:Of 127 enrolled participants (63-intervention, 64-control), 85% had six or more chronic conditions. 28 participants were lost to follow-up, leaving 99 (47 -intervention, 52-control) participants for the complete case analysis. No significant group differences were seen for the baseline to six-month change in mental functioning or other secondary outcomes. Older adults in the intervention group reported receiving more information about health and social services (p = 0.03) compared with the usual care group. CONCLUSIONS:Although no significant group differences were seen for the primary or secondary outcomes, the intervention resulted in improvements in one aspect of patient experience (information about health and social services). The study sample fell below the target sample (enrolled 127, targeted 216), which can account for the non-significant findings. Further research on the impact of the intervention and factors that contribute to the results is recommended. TRIAL REGISTRATION:clinicaltrials.gov Identifier: NCT03157999. 10.1371/journal.pone.0254573

Post-hospitalization transitional care needs of depressed elderly patients: models for improvement. Tew James D Current opinion in psychiatry PURPOSE OF REVIEW:In the weeks immediately following psychiatric hospital discharge, severely depressed elderly patients are at risk of 'falling through the cracks' in a complex health care system: becoming lost to follow-up, receiving inadequate care, or requiring prompt readmission. The purpose of this review is to highlight recent literature on the comorbid physical health problems and complex care needs of elderly patients hospitalized for depression. This paper will also review recent initiatives to improve the quality of care transitions for elderly patients discharged from medical hospitals that may be adaptable to a severely depressed population. RECENT FINDINGS:Due to shorter hospital stays, comorbid physical health problems, and limitations in functional capacity, severely depressed elderly patients discharged from psychiatric hospitals have complex service needs, and numerous barriers to care, immediately following hospital discharge. There is a lack of research specifically addressing the transitional care needs of this population. Improvement interventions assigning transitional care providers to chronically medically ill elderly patients immediately after medical hospital discharge have shown decreased rates of rehospitalization and emergency services utilization, and appear to be cost-effective. SUMMARY:Further research is needed to adapt successful transitional care interventions targeting chronically ill elderly patients in medical hospitals to severely depressed elderly patients being discharged from psychiatric hospitals. 10.1097/01.yco.0000186813.01202.ec