title: [The geriatric team in transitional patient management].
abstract: The transition team has its place in pre- and postdischarge nursing and therapeutic care, on the basis of a geriatric assessment. Core members of the team are, in the sequence of the scheduled performance in-hospital, nurse, occupational therapist, physiotherapist and social worker, supplemented by a team physician. Two-thirds of all treatments were in the hospital, one-third in an outpatient setting up to 4 weeks after discharge. Cooperation with outpatient services has been good.
authors.affiliation: Geriatrisches Zentrum Bethanien am Klinikum, Universität Heidelberg.
authors.forename: P
authors.initials: P
authors.lastname: Oster
authors.forename: T
authors.initials: T
authors.lastname: Nikolaus
authors.forename: G
authors.initials: G
authors.lastname: Schlierf
authors.forename: M
authors.initials: M
authors.lastname: Gnielka
authors.forename: I
authors.initials: I
authors.lastname: Lempp-Gast
authors.forename: U
authors.initials: U
authors.lastname: Suck-Röhrig
authors.forename: U
authors.initials: U
authors.lastname: Gartner
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D002908:Chronic Disease / Q000534:rehabilitation*; D003131:Combined Modality Therapy; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D009788:Occupational Therapy; D010348:Patient Care Team; D010351:Patient Discharge; D026741:Physical Therapy Modalities
vernacular_title: Das geriatrische Team in der Ubergangsbetreuung.