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

Abstract

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.

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

“…Therefore, the long‐term benefits of COC for patients with LLD need to be further explored and need to be viewed more critically. While studies have not found a positive effect of COC on depressive symptoms, COC has been shown to help people with LLD gain more information about health and social services, making them feel more secure and happy 38,49 . Subjective well‐being is one of the main components affected by depression 62 .…”

“…While studies have not found a positive effect of COC on depressive symptoms, COC has been shown to help people with LLD gain more information about health and social services, making them feel more secure and happy. 38,49 Subjective well-being is one of the main components affected by depression. 62 The wellbeing of older adults is closely related to mental health, physical health, and quality of life and is used as an indicator of successful aging.…”

“…In the field of psychiatry, COC has been found to improve treatment adherence, improve health outcomes, reduce readmission rates, and improve quality of life in patients with serious mental illnesses such as schizophrenia. [32][33][34][35] However, the effects of COC in LLD are inconclusive, with some researchers suggesting that COC can significantly improve quality of life and depressive symptoms in patients with LLD [36][37][38] ; others suggesting that the effects of COC on patients with LLD are limited. 39 Although COC is more readily recognized in the older population.…”

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

“…Following this, the methods associated with the implementation study are provided. A more detailed description of the study, and findings from the effectiveness trial, are provided elsewhere [28,29].…”

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

“…Some studies have focused on either the pre- or post-discharge periods, while others have focused on both. Other studies have targeted specific diagnoses or patient groups [ 10 , 13 – 15 ]. The effects of TCIs on readmission rates vary.…”