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The Importance Of Transition Care

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Cassandra, I agree with you. As Tew (2012) explains, it is very important to highlight that elderly patients with severe cognitive and psychiatric disturbances represent a particularly challenging population. "By 2030, one-fifth of the U.S. population will be age 65 or older, and the prevalence of dementia in this group is estimated to be as high as 12 percent to 14 percent" (Plassman et al., 2007). After been hospitalized for a period of time, the transition back to the nursing home of an older adult with dementia can often trigger anxiety and aggressive behavior, because the distress caused by the relocation. "Patients who appeared stable decompensate temporarily following transfer back to the community" (Tew, 2012). Often, older adults with dementia are stabilized during hospitalization, but after discharge, the nursing home receives a disturbed patient. …show more content…
Communication between both facilities it is critical to prevent negative impacts on the demented patients’ health and support between caregivers is essential for a better understanding of the patients’ behavior during transition. The transition care model offers a transitional care nurse, who provides bi-directional communication between the nursing home and the hospital staff during discharge and post-discharge follow-up. The transitional nurse attends four weekly treatment team meetings, develop reports for the day of transfer, which includes valuable information about the behavioral management strategies to use. Also, the transitional nurse offers telephone follow-up for up to two weeks following transfers offering support, problem solving, reassurance, and to relay clinical questions to the discharging physician for

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