Continuity of care for acutely unwell older adults from nursing homes.
BACKGROUND
Continuity of care (COC) for acutely unwell older adults, particularly those who are nursing home residents, who present to hospital, is complicated by the presence of co-morbid conditions, long waiting times, both for the ambulance and in the department, and poor after-hours general practitioner access.


OBJECTIVE
To present a critical review of the literature on COC for older adults from nursing homes who present to hospital and who are acutely unwell. The review will answer the following questions: (i) What is the contemporary meaning of the construct continuity of care? (ii) What is the relevance of continuity of care to the population of older adults who reside in nursing homes and present to hospital? and (iii) What models exist for promoting continuity of care to older adults who present to hospital?


METHODS
Guided by the conceptual analysis process a database search of CINAHL and MEDLINE was carried out utilizing the search terms 'continuity of care', 'older adults', 'nursing homes', 'emergency department' and 'acute illness'. A hand-search of additional references was also conducted. Retrieved articles were critically reviewed if they focused on older adult patients, the acute care/community settings and COC.


RESULTS
The contemporary meaning of the COC is that it incorporates care of an individual patient over time by bridging discrete elements in the care pathway. Four distinct models of COC were identified. These were Primary Health Care; General Practice and Primary Medical Care; Consumers; and Health Policy and Systems. All are based on the proviso that the individual is sufficiently independent to be able to coordinate their own care and to take overall responsibility.


CONCLUSIONS
The connection between COC and acutely unwell older adults who present to hospital is a prolific area for further research. In particular, the effectiveness of programmes aimed at enhancing the advanced nursing practice role and the COC process for older adults, needs investigation.
Crilly
Julia
J
Nursing and Midwifery, Research Centre for Clinical Practice Innovation, Griffith University, Gold Coast, Queensland, Australia. j.crilly@griffith.edu.au
Chaboyer
Wendy
W
Wallis
Marianne
M
D000208:Acute Disease / Q000453:epidemiology / Q000451:nursing*; D000368:Aged; D019090:Case Management / Q000458:organization & administration; D015897:Comorbidity; D003266:Continuity of Patient Care / Q000458:organization & administration*; D019091:Critical Pathways / Q000458:organization & administration; D005194:Family Practice / Q000458:organization & administration; D005851:Geriatric Nursing / Q000458:organization & administration; D006291:Health Policy; D006297:Health Services Accessibility; D006302:Health Services Research; D006760:Hospitalization; D006801:Humans; D016294:Models, Nursing; D017146:Models, Organizational; D009720:Nurse Clinicians / Q000458:organization & administration; D009722:Nurse Practitioners / Q000458:organization & administration; D024802:Nurse's Role; D009735:Nursing Homes; D010351:Patient Discharge; D010360:Patient Transfer / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration; D013597:Systems Analysis