Grant: Project Grant

During and after a hospital stay, older people with dementia are at risk of losing the ability to function independently in everyday activities like getting up and dressing themselves. If they do not get back to functioning independently within one month of coming home, they are unlikely to ever do so. Transitional care refers to the healthcare services people receive to ensure their needs continue to be met as they move from hospital to home. Most transitional care studies excluded older people with dementia and their families and did not focus on helping people get back to functioning in everyday activities. In addition, the few studies that focused on functioning excluded rural communities. These exclusions have resulted in gaps in knowledge to guide practice and policy for this population. This study will address these gaps. We reviewed the research literature and found six practical care strategies that are likely to be helpful. In this study, we will invite older people with dementia who were discharged from hospital and their families in rural areas in Ontario and Nova Scotia to tell us what they think about the care strategies. We will ask them if the care strategies fit their needs and how to improve the care strategies so that they better fit their needs. Then, we will bring these care strategies forward to healthcare providers who give transitional care in rural Ontario and Nova Scotia. We will invite the healthcare providers to tell us what they think about the care strategies, what they would need to provide them, and how to adjust their delivery so that healthcare providers can help older people with dementia and their families learn about the care strategies and participate in them. We will use the results to refine the care strategies so that they become part of transitional care in rural areas and help older people with dementia and their families learn how to promote functioning at home after a hospital stay.