An integrated hospital-to-home transitional care intervention for olderadults with stroke and multimorbidity: A feasibility study

摘要

Stroke is the leading cause of death and adult disability in Canada. Eighty percent ofolder adults (≥65 years) who have suffered a stroke will return to their homes, and 60%will require ongoing rehabilitation. The transition between hospital and home is oftenfragmented, leading to adverse health outcomes, hospital readmissions, and increasedhealth-care costs. This study examined the feasibility of a 6-month integratedtransitional care stroke intervention (TCSI), and explored its effects on healthoutcomes, patient and provider experience, and cost in 30 community-living older adults(≥55 years) with stroke and multimorbidity (≥2 chronic conditions) using outpatientstroke rehabilitation services.