title: Transitional care programs: who is left behind? A systematic review.
abstract: OBJECTIVE
  Older adults are at risk of rehospitalization if their care transitions from hospital-to-home are not properly managed. The objective of this review was to determine if older patient populations recruited for randomized controlled trials of transitional care interventions represented those at greatest risk of rehospitalization following discharge. Relevant risk factors examined were cognitive impairment, depression, polypharmacy, comorbidity, length of stay, advanced non-malignant diseases, and available social support.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Hospital to home.
  
  
  METHODS
  Older hospitalized adults.
  
  
  METHODS
  For inclusion, articles were required to focus on hospital-to-home transitions with a self-care component, have components occurring both before and after discharge, and a randomized controlled trial design. Articles were excluded if participants had a mean age under 55 years, or if interventions focused on developmental disabilities, youth, addictions, or case management, or were solely primary-care based.
  
  
  RESULTS
  Following title, abstract, and full review by two authors, 17 articles met inclusion criteria. Risk factors for rehospitalization were often listed either as exclusion criteria or were not reported at baseline by the studies. One study included patients with all identified risk factors for rehospitalization.
  
  
  CONCLUSIONS
  These data suggest that published studies of transitional care interventions do not often include older adults at highest risk of rehospitalization, raising concerns about the generalizability of their results. Studies are needed that evaluate interventions that explicitly address the needs and characteristics of these patients.
authors.affiliation: School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: Emily
authors.initials: E
authors.lastname: Piraino
authors.forename: George
authors.initials: G
authors.lastname: Heckman
authors.forename: Christine
authors.initials: C
authors.lastname: Glenny
authors.forename: Paul
authors.initials: P
authors.lastname: Stolee
keywords: care transitions; comorbidity; rehospitalization; self-care; systematic review