Effectiveness of a nurse-led hospital-to-home transitional care intervention for older adults with multimorbidity and depressive symptoms: A pragmatic randomized controlled trial

Home-based transitional cardiac telerehabilitation in older adults post coronary artery bypass grafting: A randomized controlled trial

This randomized controlled trial evaluated the effectiveness of a 12-week home-based transitional cardiac telerehabilitation (Hb-T-CTR) program on health-related quality-of-life and therapeutic self-care in older adults' post-Coronary Artery Bypass Grafting (CABG). The intervention group (n = 57) underwent Hb-T-CTR, incorporating preoperative counseling, postoperative education, a culturally adapted video, home visits, and telephone counseling, while the control group (n = 61) received standard care. Using the Coronary Revascularization Outcome Questionnaire and the Sidani Doran Therapeutic Self-Care Measure, data were collected at three time points. Results showed significant improvements in overall scores for both health-related quality of life (t1=3.386, P = 0.001; t2=4.224, P < 0.001) and therapeutic self-care (t1=7.104, P < 0.001; t2=4.242, P < 0.001) in the intervention group compared to controls. This telehealth approach provides convenient and accessible rehabilitation services for older adults' post-CABG and highlights the importance of integrating Hb-T-CTR into routine care for personalized rehabilitation. This study underscores the potential of telehealth tools in overcoming barriers and enhancing patient-centered interventions.

Factors associated with work engagement among specialist nurses in china: a cross-sectional study

BACKGROUND

The positive impacts of work engagement among specialist nurses on retention, organizational commitment, and quality of care are well-documented. However, there is a lack of research on the specific differences in work engagement among specialist nurses. Therefore, the purpose of this study is to assess the level of work engagement among specialist nurses in China and identify its influencing factors.

METHODS

A descriptive cross-sectional study was conducted in China from April to July, 2023, with 724 nurses selected from 22 hospitals through convenience sampling involved. The survey was conducted by using self-administered general information questionnaires and work engagement scales. Questionnaire Star was employed as the online data collection tool. The collected data was analyzed by using descriptive statistics and stepwise regression analysis to draw meaningful conclusions from the study.

RESULTS

Among specialist nurses in Xiamen, China, who had a response rate of 97.10%, an average work engagement score is 140.35 (SD=18.17), with the highest score for the work attitude at 4.65 (SD=0.52) and the lowest score for the work recognition at 4.09 (SD=0.85). It was shown through regression analysis that factors such as career satisfaction, involvement in challenging case discussions, marital status, gender, presence of promotion advantage and title accounted for 14.5% of the total variance in the model and were significant explanatory variables that could predict work engagement.

CONCLUSION

It is shown that specialist nurses in Xiamen, China have a high level of work engagement. It is imperative for nursing managers to prioritize the work engagement of specialist nurses, provide the specialist nurses with ample development opportunities and room for growth, and effectively promote the overall development of specialist nurses by improving work engagement in various aspects.

Engaging patients in designing a transmural allied health pathway: A qualitative exploration of hospital-to-home transitions

INTRODUCTION

The transition from hospital to home is often suboptimal, resulting in patients not receiving the necessary allied healthcare after discharge. This may, in turn, lead to delayed recovery, a higher number of readmissions, more emergency department visits and an increase in mortality and healthcare costs. This study aimed to gain insight into patients' experiences, perceptions, and needs regarding hospital-to-home transition, focusing on allied healthcare as a first step towards the development of a transitional integrated allied healthcare pathway for patients with complex care needs after hospital discharge.

METHODS

We conducted semistructured interviews with patients. Participants were recruited from universities and general hospitals in the Amsterdam region between May and July 2023. They were eligible if they (1) were discharged from the hospital minimally 3 and maximally 12 months after admission to an oncologic surgery department, internal medicine department, intensive care unit, or trauma centre, (2) received hospital-based care from at least one allied healthcare provider, who visited the patient at least twice during hospital admission, (3) spoke Dutch or English and (4) were 18 years or older. Interviews were audio-recorded and transcribed verbatim. We performed a thematic analysis of the interview data.

RESULTS

Nineteen patients were interviewed. Three themes emerged from the analysis. 'Allied healthcare support during transition' depicts patients' positive experiences when they felt supported by allied health professionals during the hospital-to-home transition. 'Patient and family involvement' illustrates how much patients value the involvement of their family members during discharge planning. 'Information recall and processing' portrays the challenges of understanding and remembering overwhelming amounts of information, sometimes unclear and provided at the wrong moment. Overall, patients' experiences of transitional care were positive when they were involved in the discharge process. Negative experiences occurred when their preferences for postdischarge communication were ignored.

CONCLUSIONS

This study suggests that allied health professionals need to continuously collaborate and communicate with each other to provide patients and their families with the personalized support they need. To provide high-quality and person-centred care, it is essential to consider how, when, and what information to provide to patients and their families to allow them to contribute to their recovery actively.

PATIENT OR PUBLIC CONTRIBUTION

The interview guide for this manuscript was developed with the assistance of patients, who reviewed it and provided us with feedback. Furthermore, patients provided us with their valuable lived experiences by participating in the interviews conducted for this study.

Impact of nurse-led interprofessional work in older patients with heart failure and multimorbidity: A retrospective cohort study

Background

The number of patients with multimorbidity has increased due to the aging of the global population. Although the World Health Organization has indicated that multimorbidity will be a major medical problem in the future, the appropriate interventions for patients with multimorbidity are currently unknown. This study aimed to investigate whether nurse-led interprofessional work is associated with improved prognosis in heart failure patients with multimorbidity aged ≥65 years who were admitted in an acute care hospital.

Methods

Patients who were admitted to the cardiovascular medicine ward of an acute care hospital in Osaka, Japan, and underwent nurse-led interprofessional work from April 1, 2017 to March 31, 2020, and from April 1, 2014 to March 31, 2016, were included in this retrospective cohort study. The patients were matched by age, sex, and New York Heart Association classification. The nurse-led interprofessional work was based on a three-step model that incorporates recommendations from international guidelines for multimorbidity. The primary outcome was all-cause mortality.

Results

The mean age of the participants was 80 years, and 62 % were men. The nurse-led interprofessional work group showed a significant difference in all-cause mortality compared with the usual care group (hazard ratio, 0.45; 95 % confidence interval [CI], 0.29-0.69; P < 0.001). Compared with the usual care group, the nurse-led interprofessional work group exhibited a 7 % difference in mortality rate at 1-year post-discharge (P < 0.001).

Conclusions

Nurse-led interprofessional work may reduce the all-cause mortality in older patients with heart failure and multimorbidity.

Nurse-led self-care interventions for older adults with multiple chronic conditions: A protocol for a systematic review and network meta-analysis

The importance of self-care interventions is progressively recognized, marked by a rapidly aging population that results in growing demands on costly tertiary and institutional care services, placing substantial pressure on health and social care systems. Against this background, in this study, we will provide evidence for the impact of self-care interventions on health-related quality of life by focusing on interventions led by nurses who can employ integrated approaches. Several databases, including Ovid MEDLINE, Cochrane, CINAHL, Embase, and PubMed, will be searched along with gray literature to prevent biased results. There will be no time restrictions, and all literature with English abstracts will be included. Using the Template for Intervention Description and Replication framework, we will evaluate intervention characteristics. The primary outcome will be health-related quality of life, and the secondary outcomes will be symptom burden, physical function, and cost-effectiveness. Pairwise and network meta-analyses will be performed, and network geometry and the surface under the cumulative ranking curve will be used to determine which type of nurse-led self-care intervention is best for health-related quality of life for older adults with multiple chronic conditions. We will secure study quality through PRISMA, AMSTAR 2, RoB 2.0, and the GRADE checklist. To ensure the quality of network meta-analysis, similarity will be checked based on the PICO framework. The consistency of the network meta-analysis results will be checked to ensure transitivity by using the Bayesian hierarchical framework. The study protocol is registered with PROSPERO (CRD42022365467).

The Trajectory of Depressive Symptoms Across Years of Community Care Utilization Among Older Adults: A 14-Year Follow-up Study Using the 'Korean Welfare Panel Survey'

OBJECTIVES

While older adults using community care services are known to be vulnerable for depression, community care utilization (CCU) may help to improve the mental health of these elderly. To date, however, it is much less clear how CCU affects depressive symptoms in the elderly population. This study focuses on the trajectory of depressive symptoms across years of CCU among older adults in Korea.

METHODS

Using the 2006-2019 Korean Welfare Panel Survey, this study is focused on elderly born in 1940 or earlier and selected 3281 persons for baseline interviews in 2006. This consisted of 35 800 person-year observations during a period of 14 years. Panel data analysis were employed to construct years of CCU.

RESULTS

After controlling for covariates, linear term of years using community care was negatively associated with depressive symptoms, but a quadratic term was positively significant. The trajectory of depressive symptoms across the years of CCU follows a U-shaped curve. Older adults in the first year of using community care reported the highest level of depressive symptoms. However, a significant and steady decrease in depressive symptoms was observed during the following 9 years of CCU, which then gradually increased. The level of depressive symptoms at the 14th year of using community care remains significantly lower than the level at the outset of its utilization.

CONCLUSIONS

This finding implies that CCU could be beneficial for improving mental health among older adults.

Effects of home visiting programmes on community-dwelling older adults with chronic multimorbidity: a scoping review

BACKGROUND

Chronic ultimorbidity is the most frequent and serious health problem in older adults. Home visiting programmes could be a strategy with potential benefits. However, there are no scoping reviews to date that examine the effects of home visiting programmes on community-dwelling older adults with chronic multimorbidity.

OBJECTIVE

To examine the effects of home visiting programmes on community-dwelling older adults with chronic multimorbidity.

METHODS

A scoping review was carried out following PRISMA-ScR reporting guidelines. The search was conducted in six databases (PubMed/Medline, Cochrane, CINAHL, Web of Science, Scopus and EMBASE) between October 2021 and April 2022.

RESULTS

Four RCTs with 560 patients were included. The visits were carried out by nurses, nursing students, volunteers, and other healthcare professionals. The interventions varied in the number of visits, frequency, duration of follow-up, and whether or not they were combined with other strategies such as telephone calls. Discrepancies were found in the effects of the interventions on quality of life, self-efficacy, self-rated health, and use and cost of health and social services.

CONCLUSION

This review shows that home visiting programmes could have potential benefits for older adults with chronic multimorbidity. However, its results have been inconclusive. There is a need for high quality studies involving a larger number of patients, in which home visits are the main intervention.

Health Care Utilization Following Interventions to Improve Social Well-Being: A Systematic Review and Meta-analysis

Importance

It has been suggested that interventions that aim to improve social well-being may contribute to decreased health care use; however, such evidence has not been fully systematically synthesized.

Objective

To systematically review and meta-analyze available evidence on the associations between psychosocial interventions and health care utilization.

Data Sources

Medline, Embase, PsycInfo, Cumulated Index to Nursing and Allied Health Literature, Cochrane, Scopus, Google Scholar, and reference lists of systematic reviews were searched from inception until November 31, 2022.

Study Selection

Included studies were randomized clinical trials reporting on both health care utilization and social well-being outcomes.

Data Extraction and Synthesis

The reporting of the systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Full-text and quality assessments were conducted by 2 reviewers independently. Multilevel random-effects meta-analyses were used to synthesize the data. Subgroup analyses were conducted to examine the characteristics associated with decreased health care use.

Main Outcomes and Measures

The outcome of interest was health care utilization, including primary, emergency, inpatient, and outpatient care services. Social well-being was measured as social support, social participation, social relationships, community support, social integration, or loneliness.

Results

A total of 41 studies were retrieved from 18 969 citations; 37 studies were eligible for meta-analysis. Data were analyzed for 7842 participants, including 2745 older adults, 1579 young women considered to be at risk of social and mental health disadvantages, 1118 people with chronic illnesses, 1597 people with mental illnesses, and 803 caregivers. The odds ratio (OR) random-effects model showed an overall reduction in health care use (OR, 0.75; 95% CI, 0.59 to 0.97), but the standardized mean difference (SMD) random effect model showed no association. An improvement in health care utilization was observed in association with social support interventions (SMD, 0.25; 95% CI, 0.04 to 0.45) but not in loneliness interventions. Subgroup analysis indicated a reduced length of inpatient visits (SMD, -0.35; 95% CI, -0.61 to -0.09) and number of emergency care visits (OR, 0.64; 95% CI, 0.43 to 0.96) following the intervention. However, an increase in outpatient care associated with psychosocial interventions was observed (SMD, 0.34; 95% CI, 0.05 to 0.62). The largest reductions in health care use were associated with interventions among caregivers (OR, 0.23; 95% CI, 0.07 to 0.71) and individuals with mental illnesses (OR, 0.31; 95% CI, 0.13 to 0.74).

Conclusions

These findings suggest that psychosocial interventions were associated with most measures of health care utilization. As the association differed by participant and intervention delivery characteristics, these characteristics should be considered in the design of future interventions.

Transitional care strategies at emergency department for elderly patients: A multicentre study in Singapore

Introduction

Transitional care strategies (TCS) initiated for elderly patients prior to emergency department (ED) discharge are important for ensuring effective transition to other care settings. Such strategies have been shown to reduce avoidable acute admissions. This first nationwide study is targeted at public acute hospital EDs in Singapore, and aims to characterise TCS for ED-discharged elderly patients and understand the experiences of healthcare staff in the delivery of TCS.

Method

Seven key informants (KIs), one per ED, completed an online structured questionnaire and semi-structured video conference interview from 8 May to 31 August 2021. The KIs were ED specialists and an ED-trained senior staff nurse who were knowledgeable in geriatric emergency care and had contributed to at least one elder-related TCS. Field notes were compiled, transcribed, anonymised and analysed using thematic analysis.

Results

All 7 EDs have TCS as "usual care" available during office hours, at no extra cost to patients. Common components of TCS include screening, evaluation with comprehensive geriatric assessment, health education and follow-up telecare. TCS implementation was facilitated by organisational support in terms of established protocols and communication platforms, training and collaboration of a multidisciplinary team, and caregiver involvement. Obstacles faced include fragmented communication between personnel, limited resources, and poor buy-in from stakeholders.

Conclusion

Understanding the heterogeneous characteristics of ED-TCS at various hospitals will aid the development of service typology and identify service opportunities. Provider experiences grouped into themes help to inform future strategies for TCS implementation. More research is needed to evaluate patient outcomes and cost-effectiveness of TCS.

Effectiveness of continuity of care in reducing depression symptoms in elderly: A systematic review and meta-analysis

BACKGROUND

Depression affects 10%-20% of older adults worldwide. The course of late-life depression (LLD) is often chronic, with a poor long-term prognosis. Lower treatment adherence, stigma, and suicide risk lead to significant challenges in the continuity of care (COC) for patients with LLD. Elderly patients with chronic diseases can benefit from COC. As a common chronic disease of the elderly, whether depression can also benefit from COC has not been systematically reviewed.

METHODS

Systematic literature search in Embase, Cochrane Library, Web of Science, Ovid, PubMed and Medline. Randomized Controlled Trials (RCTs) on the intervention effects of COC and LLD, published on 12 April 2022, were selected. Two independent researchers made research choices based on consensus. An RCT with COC as an intervention measure for the elderly with depression 60 years old was the inclusion criteria.

RESULTS

A total of 10 RCTs involving 1557 participants were identified in this study. The findings showed that: (1) COC significantly reduced depressive symptoms compared to usual care (standardized mean difference [SMD] = -0.47, 95% confidence interval: -0.63 to -0.31), with the best improvement at 3- to 6-month follow-up; (2) The reduction in depressive symptoms was more pronounced for patients with comorbid chronic conditions with LLD (SMD = -0.93, 95% CI: -1.18 to -0.68); (3) COC was more effective than other regions for LLD in Europe and the Americas (SMD = -0.84, 95% CI: -1.07 to -0.61); and (4) COC had a positive impact on the quality of life of patients with LLD (SMD = 0.21, 95% CI: 0.02-0.40).

LIMITATIONS

The included studies included several multi-component interventions with widely varying methods. Therefore, it was almost impossible to analyze which of these interventions had an impact on the assessed outcomes.

CONCLUSIONS

This meta-analysis shows that COC can significantly reduce depressive symptoms and improve quality of life in patients with LLD. However, when treating and caring for patients with LLD, health care providers should also pay attention to timely adjustments of intervention plans according to follow-up, synergistic interventions for multiple co-morbidities, and actively learning from advanced COC programs at home and abroad to improve the quality and effectiveness of services.

The effectiveness of tele-transitions of care interventions in high-risk older adults: A systematic review and meta-analysis

BACKGROUND

Chronically ill older patients are often vulnerable to detrimental health outcomes and have increased risk of preventable readmission. Tele-transitions of care interventions utilizing telecommunications and surveillance technologies help monitor patients' conditions after discharge to prevent negative health outcomes.

OBJECTIVES

This systematic review and meta-analysis aimed to identify and synthesize available evidence on the effectiveness of tele-transitions of care interventions on various health outcomes in older adults at high risk for readmission discharged from acute setting.

METHODS

Published, unpublished studies and gray literatures were identified through searching PubMed, Medline, Embase, PsycINFO, Cochrane Library, CINAHL, Scopus, ProQuest Dissertations and theses and Google Scholar from inception to December 2021. Only randomized controlled trials published in English language assessing tele-transitions of care interventions on high-risk older adults were included. Meta-analyses were performed using random-effects model in RevMan 5.4. Sensitivity and subgroup and narrative analyses were conducted.

RESULTS

Fourteen studies were included, of which thirteen were considered for meta-analyses. Tele-transitions of care interventions were effective in reducing readmission rate (RR = 0.59, 95%CI 0.50-0.69, z = 6.28, p < 0.00001), mortality rate (RR = 0.72, 95%CI 0.53-0.98, z = 2.12, p = 0.03), and improving health-related quality of life (SMD = 0.24, Z = 2.04, p = 0.04). However, reduction of emergency department visit (RR = 1.10, 95%CI 0.59-2.06, z = 0.31, p = 0.76) and improvement of functional status (SMD = -0.06, Z = 0.19, p = 0.85) was not observed following intervention. Subgroup analysis found that the positive effects of tele-transitions of care interventions persist up to 180 days even after the intervention.

CONCLUSION

This systematic review and meta-analysis concluded that tele-transitions of care interventions have promising effects on readmission, mortality rate and health-related quality of life. Tele-transitions of care interventions are cost-effective and suitable for large-scale implementation in healthcare settings.

REGISTRATION

The protocol was registered on PROSPERO (CRD42022295665).

TWEETABLE ABSTRACT

Systematic review demonstrates that monitoring older patients at high risk of readmission, following discharge from hospital, using telecommunication and surveillance technologies significantly reduces readmission and mortality rates and improves their quality of life.

Effects of a transitional care intervention on readmission among older medical inpatients: a quasi-experimental study

PURPOSE

To evaluate the effect of a transitional care intervention (TCI) on readmission among older medical inpatients.

METHODS

This non-randomised quasi-experimental study was conducted at Horsens Regional Hospital in Denmark from 1 February 2017 to 31 December 2018. Inclusion criteria were patients ≥ 75 years old admitted for at least 48 h. First, patients were screened for eligibility. Then, the allocation to the intervention or control group was performed according to the municipality of residence. Patients living in three municipalities were offered the hospital-based intervention, and patients living in a fourth municipality were allocated to the control group. The intervention components were (1) discharge transportation with a home visit, (2) a post-discharge cross-sectorial video conference and (3) seven-day telephone consultation. The primary outcome was 30-day unplanned readmission. Secondary outcomes were 30- and 90-day mortality and days alive and out of hospital (DAOH).

RESULTS

The study included 1205 patients (intervention: n = 615; usual care: n = 590). In the intervention group, the median age was 84.3 years and 53.7% were females. In the control group, the median age was 84.9 years and 57.5% were females. The 30-day readmission rates were 20.8% in the intervention group and 20.2% in the control group. Adjusted relative risk was 1.00 (95% confidence interval: 0.80, 1.26; p = 0.99). No significant difference was found between the groups for the secondary outcomes.

CONCLUSION

The TCI did not impact readmission, mortality or DAOH. Future research should conduct a pilot test, address intervention fidelity and consider real-world challenges.

TRIAL REGISTRATION

Clinical trial number: NCT04796701. Registration date: 24 February 2021.

Comorbidity and Management of Concurrent Psychiatric and Medical Disorders

Aging increases susceptibility to medical and psychiatric comorbidity via interrelated biological, psychological, and social mechanisms. Mental status changes or other psychiatric symptoms occurring in older adults with medical disorders most often result from delirium, depression, or the onset of Alzheimer's disease and related dementias (ADRD). Clinicians can use evidence-based tools to evaluate such symptoms including the 4A's Test for delirium, the Saint Louis University Mental Status Exam, and the Geriatric Depression Scale. Innovative models such as collaborative care can improve the outcome of care of older adults with medical disorders requiring treatment for depression or ADRD..

Implementation of the Community Assets Supporting Transitions (CAST) transitional care intervention for older adults with multimorbidity and depressive symptoms: A qualitative descriptive study

Background

Older adults with multimorbidity experience frequent care transitions, particularly from hospital to home, which are often poorly coordinated and fragmented. We conducted a pragmatic randomized controlled trial to test the implementation and effectiveness of Community Assets Supporting Transitions (CAST), an evidence-informed nurse-led intervention to support older adults with multimorbidity and depressive symptoms with the aim of improving health outcomes and enhancing transitions from hospital to home. This trial was conducted in three sites, representing suburban/rural and urban communities, within two health regions in Ontario, Canada.

Purpose

This paper reports on facilitators and barriers to implementing CAST.

Methods

Data collection and analysis were guided by the Consolidated Framework for Implementation Research framework. Data were collected through study documents and individual and group interviews conducted with Care Transition Coordinators and members from local Community Advisory Boards. Study documents included minutes of meetings with research team members, study partners, Community Advisory Boards, and Care Transition Coordinators. Data were analyzed using content analysis.

Findings

Intervention implementation was facilitated by: (a) engaging the community to gain buy-in and adapt CAST to the local community contest; (b) planning, training, and research meetings; (c) facilitating engagement, building relationships, and collaborating with local partners; (d) ensuring availability of support and resources for Care Transition Coordinators; and (e) tailoring of the intervention to individual client (i.e., older adult) needs and preferences. Implementation barriers included: (a) difficulties recruiting and retaining intervention staff; (b) difficulties engaging older adults in the intervention; (c) balancing tailoring the intervention with delivering the core intervention components; and (c) Care Transition Coordinators’ challenges in engaging providers within clients’ circles of care.

Conclusion

This research enhances our understanding of the importance of considering intervention characteristics, the context within which the intervention is being implemented, and the processes required for implementing transitional care intervention for complex older adults.