Introduction

Healthcare systems are currently facing an increasing number of vulnerable older patients who often require complex services and care. Older adults living in long-term care facilities (LTCFs) represent one of the most vulnerable groups in the geriatric population.1 Often described as the “oldest old”, more than 45% of them are aged over 85 years old in the United States.1,2 This number is expected to grow further in the upcoming years to reach 19 million by 2050 only in the United States.3 They are expected to represent over 4% of the total American population3 and almost 6% of the Canadian population in thirty years.4 Older adults living in LTCFs also typically present multiple chronic diseases and require high levels of assistance for basic functional tasks.2 Conditions associated with elevated care demands or with a potentially challenging management5,6 were found to be highly prevalent in this setting: up to 52% of LTCFs residents live with dementia or other related neurocognitive disorder, up to 49% with vascular diseases, including 21% with congestive heart failure, and up to 37% with depression.1 With this profile, older adults living in LTCFs are also particularly at risk of poor outcomes during transitions in care settings, such as from acute to long-term care (LTC).7
To explain this situation, issues pertaining to gaps in information about medical information, treatment plans, or modifications to medications prescribed are often raised.7-9 King et al (2013) reported that “poor quality discharge communication” is the main barrier to a safe and well executed transition miscommunication being associated with increased readmissions and medication errors, delays in providing care, and decreased satisfaction of healthcare professionals, caregivers and patients.7,10 Acute care stays constitute dramatic interruptions in the relationships and patterns of care previously put in place between the LTCFs staff and the residents and their family.11 Hospital charts or discharge forms about the procedures or investigations performed and the modifications made to medications regimen may also not be adequately transmitted to LTCFs during the transfer.12 As all acute care stays are not avoidable,13-15 the transition from acute to LTC represents a key issue for the care of the most vulnerable of older adults: the LTCFs residents. Transitional care interventions (TCi), such as timely medication reconciliation,16 formal post-discharge follow-up17-19 or early transmission of a tailored communication forms,20,21 have emerged as an answer to poorly executed transitions and their consequences. They commonly aim to enhance the communication and the collaboration between the sites of care,7 which are both particularly relevant to the acute care to LTC transition.
Some TCi studies in older populations with complex care needs have reported promising results on both clinical and health service use outcomes.22 Existing reviews on TCi, even when targeting the older population with complex care needs, however, have focused mainly on those conducted in community-dwelling patients.22 Furthermore, TCi reviews that did involve the LTCF settings have evaluated transitions from long-term to acute care settings, rather than from the acute care setting to LTC.9 These reviews also did not distinguish between Emergency Department (ED) visits and inpatient admission, as both were labelled in the “hospital” category. The effects of TCi on the transitions from acute care to a LTCF facility remains poorly studied. Therefore, we conducted a systematic review to comprehensively explore the effects of TCis for older adults transferred from the acute to LTC setting.