Skip to main content

Advertisement

SpringerLink
Log in

The benefits of transitional care in older patients with chronic diseases: a systematic review and meta-analysis

  • Review
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Background

Transitional care (TC) has become increasingly important for elders with chronic diseases (CDs) discharged from hospital as the population ages. This study aims to analyze the health quality of life (HQoL) in elders received TC based on the Short Form-36 (SF-36) indicator.

Methods

PubMed, EMBASE, Web of Science and Science Direct were systematically search for studies. Studies compared HQoL used SF-36 between TC and usual care on elders discharged for CDs were included. Analysis was performed with respect to the 8 dimensions of SF-36.

Results

A total of 16 studies were included. Compared with usual care, (1) the scores of SF-36 outcomes increase as follow-up time extending; (2) transitional care significantly improved mental health, physical functioning and vitality at both short and long term after discharge; (3) transitional care only significantly improved general health and social function at long term; and role limitation due to emotional problems and bodily pain at short term; (4) transitional care significantly improved general health, mental health, physical functioning, social function and vitality for patients with hip fracture at long term.

Conclusion

TC can significantly improve physically and mentally HQoL for elder patients discharge for CDs compared with usual care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Chiu BL, Pinto JM (2018) Aging in the United States: opportunities and challenges for otolaryngology-head and neck surgery. Otolaryngol Clin North Am 51:697–704

    Article  Google Scholar 

  2. OECD (2015) Ageing in cities. OECD Publishing, Paris

    Book  Google Scholar 

  3. Jencks SF, Williams MV, Coleman EA (2009) Rehospitalizations among patients in the Medicare fee-for-service program. NEJM 361:1418–1428

    Article  Google Scholar 

  4. Buurman BM, Hoogerduijn JG, de Haan RJ et al (2011) Geriatric conditions in acutely hospitalized older patients: prevalence and one-year survival and functional decline. PLoS One 6:e26951

    Article  CAS  Google Scholar 

  5. Nasmith LBP, Baxter R, Bergman H et al (2010) Transforming care for Canadians with chronic health conditions. Canadian Academy of Health Sciences, Canada, pp 11–13

    Google Scholar 

  6. Ward BW, Schiller JS (2013) Prevalence of multiple chronic conditions among US adults: estimates from the National Health Interview Survey, 2010. Prev Chronic Dis 10:E65

    Article  Google Scholar 

  7. Sokolovsky J (2009) The cultural context of aging: worldwide perspectives. Praeger Publishers, Westport

    Google Scholar 

  8. Coleman EA, Boult C (2003) Improving the quality of transitional care for persons with complex care needs. J Am Geriatr Soc 51:556–557

    Article  Google Scholar 

  9. Naylor M, Keating SA (2008) Transitional care. Am J Nurs 108:58–63

    Article  Google Scholar 

  10. Naylor MD, Aiken LH, Kurtzman ET et al (2011) The care span: the importance of transitional care in achieving health reform. Health Aff (Millwood) 30:746–754

    Article  Google Scholar 

  11. Feltner C, Jones CD, Cené CW et al (2014) Transitional care interventions to prevent readmissions for persons with heart failure: a systematic review and meta-analysis. Ann Intern Med 160:774–784

    Article  Google Scholar 

  12. Le Berre M, Maimon G, Sourial N et al (2017) Impact of transitional care services for Chronically Ill older patients: a systematic evidence review. J Am Geriatr Soc 65:1597–1608

    Article  Google Scholar 

  13. Langhorne P, Taylor G, Murray G et al (2005) Early supported discharge services for stroke patients: a meta-analysis of individual patient’s data. Lancet 365:501–506

    Article  Google Scholar 

  14. Gwadry-Sridhar FH, Flintoft V, Lee DS et al (2004) A systematic review and meta-analysis of studies comparing readmission rates and mortality rates in patients with heart failure. Arch Intern Med 164:2315–2320

    Article  Google Scholar 

  15. Crotty M, Unroe K, Cameron ID et al (2010) Rehabilitation interventions for improving physical and psychosocial functioning after hip fracture in older people. Cochrane Database Syst Rev 1:CD007624

    Google Scholar 

  16. Asadi-Lari M, Tamburini M, Gray D (2004) Patient’s needs, satisfaction, and health related quality of life: towards a comprehensive model. Health Qual Life Outcomes 2:32

    Article  Google Scholar 

  17. Weinberger M, Samsa GP, Hanlon JT et al (1991) An evaluation of a brief health status measure in elderly veterans. J Am Geriatr Soc 39:691–694

    Article  CAS  Google Scholar 

  18. Lyons RA, Perry HM, Littlepage BN (1994) Evidence for the validity of the Short-form 36 Questionnaire (SF-36) in an elderly population. Age Ageing 23:182–184

    Article  CAS  Google Scholar 

  19. Shyu YI, Liang J, Wu CC et al (2010) An interdisciplinary intervention for older Taiwanese patients after surgery for hip fracture improves health-related quality of life. BMC Musculoskelet Disord 11:225

    Article  Google Scholar 

  20. Varma S, McElnay JC, Hughes CM et al (1999) Pharmaceutical care of patients with congestive heart failure: interventions and outcomes. J Pharmacotherapy 19:860–869

    Article  CAS  Google Scholar 

  21. Mayo NE, Wood-Dauphinee S, Côté R et al (2000) There’s no place like home: an evaluation of early supported discharge for stroke. Stroke 31:1016–1023

    Article  CAS  Google Scholar 

  22. Harrison MB, Browne GB, Roberts J et al (2002) Quality of life of individuals with heart failure: a randomized trial of the effectiveness of two models of hospital-to-home transition. Med Care 40:271–282

    Article  Google Scholar 

  23. Huang TT, Liang SH (2005) A randomized clinical trial of the effectiveness of a discharge planning intervention in hospitalized elders with hip fracture due to falling. J Clin Nurs 14:1193–1201

    Article  Google Scholar 

  24. Lotus SY-I, Jersey L, Chi-Chuan W et al (2005) A pilot investigation of the short-term effects of an interdisciplinary intervention program on elderly patients with hip fracture in Taiwan. J Am Geriatr Soc 53:811–818

    Article  Google Scholar 

  25. Mitchell C, Walker J, Walters S et al (2005) Costs and effectiveness of pre- and post-operative home physiotherapy for total knee replacement: randomized controlled trial. J Eval Clin Pract 11:283–292

    Article  Google Scholar 

  26. Allegrante JP, Peterson MG, Cornell CN et al (2007) Methodological challenges of multiple-component intervention: lessons learned from a randomized controlled trial of functional recovery after hip fracture. Hss j 3:63–70

    Article  Google Scholar 

  27. Antonicelli R, Testarmata P, Spazzafumo L et al (2008) Impact of telemonitoring at home on the management of elderly patients with congestive heart failure. J Telemed Telecare 14:300–305

    Article  Google Scholar 

  28. Lin PC, Wang CH, Chen CS et al (2009) To evaluate the effectiveness of a discharge-planning programme for hip fracture patients. J Clin Nurs 18:1632–1639

    Article  Google Scholar 

  29. Shyu YIL, Kuo LM, Chen MC et al (2010) A clinical trial of an individualised intervention programme for family caregivers of older stroke victims in Taiwan. J Clin Nurs 19:811–818

    Article  Google Scholar 

  30. Shyu Y-IL, Liang J, Wu C-C et al (2010) An interdisciplinary intervention for older Taiwanese patients after surgery for hip fracture improves health-related quality of life. J BioMed Central 11:225

    Google Scholar 

  31. Kamyuet WF, HM Sikying MY et al (2011) Effects of a health-social partnership transitional program on hospital readmission: a randomized controlled trial. J Soc Sci Med 73:960–969

    Article  Google Scholar 

  32. Mayo NE, Scott S (2011) Evaluating a complex intervention with a single outcome may not be a good idea: an example from a randomised trial of stroke case management. Age Ageing 40:718–724

    Article  Google Scholar 

  33. Shyu Y-IL, Liang J, Tseng M-Y et al (2013) Comprehensive and subacute care interventions improve health-related quality of life for older patients after surgery for hip fracture: a randomised controlled trial. Int J Nurs Stud 50:1013–1024

    Article  Google Scholar 

  34. Chow SK, Wong FK (2014) A randomized controlled trial of a nurse-led case management programme for hospital-discharged older adults with co-morbidities. J Adv Nurs 70:2257–2271

    Article  Google Scholar 

  35. Wong FK, Chow SK, Chan TM et al (2014) Comparison of effects between home visits with telephone calls and telephone calls only for transitional discharge support: a randomised controlled trial. Age Ageing 43:91–97

    Article  Google Scholar 

  36. Chen HM, Tu YH, Chen CM (2017) Effect of continuity of care on quality of life in older adults with chronic diseases: a meta-analysis. Clin Nurs Res 26:266–284

    Article  Google Scholar 

  37. Shyu YI, Kuo LM, Chen MC et al (2010) A clinical trial of an individualised intervention programme for family caregivers of older stroke victims in Taiwan. J Clin Nurs 19:1675–1685

    Article  Google Scholar 

  38. Facchinetti G, D’Angelo D, Piredda M et al (2020) Continuity of care interventions for preventing hospital readmission of older people with chronic diseases: a meta-analysis. Int J Nurs Stud 101:103396

    Article  Google Scholar 

  39. Mabire C, Dwyer A, Garnier A et al (2016) Effectiveness of nursing discharge planning interventions on health-related outcomes in discharged elderly inpatients: a systematic review. JBI Database Syst Rev Implement Rep 14:217–260

    Article  Google Scholar 

  40. Naylor MD, Kurtzman ET, Pauly MV (2009) Transitions of elders between long-term care and hospitals. Policy Polit Nurs Pract 10:187–194

    Article  Google Scholar 

Download references

Funding

The authors have no funding.

Author information

Authors and Affiliations

  1. Huiqiao Medical Center, Nanfang Hospital Affiliated Southern Medical University, Guangzhou, 510515, Guangdong, China

    Danfeng Zou, Li Wang, Jia Li, Lihui Li & Xiao Wei

  2. Department of Orthopedics, Zhujiang Hospital Affiliated Southern Medical University, No. 253 Gongye Road, Haizhu District, Guangzhou, 510282, Guangdong, China

    Li Huang

Authors
  1. Danfeng Zou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Li Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jia Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lihui Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xiao Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Li Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Danfeng Zou contributed to conceptualization and study design; Li Wang and Jia Li contributed to electronic search; Lihui Li and Xiao Wei contributed to data extraction and analysis; Danfeng Zou and Li Huang contributed to data interpretation; Li Huang contributed to manuscript writing; all authors have reviewed and approved the final version of the submitted manuscript.

Corresponding author

Correspondence to Li Huang.

Ethics declarations

Conflict of interest

The authors declared no conflict of interest with the present manuscript.

Statement of human and animal rights

This article (ACER-D-21-00458R1: The benefits of transitional care in older patients with chronic diseases: a systematic review and meta-analysis) was based on previous published studies involved no humans and/or animals, and as such, this article have no ethical issue for human and animal rights.

Ethical approval

Not applicable.

Informed consent

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 2845 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zou, D., Wang, L., Li, J. et al. The benefits of transitional care in older patients with chronic diseases: a systematic review and meta-analysis. Aging Clin Exp Res 34, 741–750 (2022). https://doi.org/10.1007/s40520-021-01973-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-021-01973-1

Keywords

Search

Navigation