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The transition of chronically ill adolescents and young adults to adult health care is poorly managed, leading to poor outcomes due to insufficient disease knowledge and a lack of requisite skills to self-manage their chronic disease. This review analyzed 33 articles published between 2009 and 2019 to identify factors associated with transition readiness in adolescents and young adults with chronic diseases, which can be used to design effective interventions. Studies were predominantly cross-sectional survey designs that were guided by interdisciplinary research teams, assessed adolescents and young adults ages 12–26 years, and conducted in the outpatient setting. Modifiable factors, including psychosocial and self-management/transition education factors, and non-modifiable factors, including demographic/ecological and disease factors, associated with transition readiness were identified. Further research is necessary to address gaps identified in this review prior to intervention development, and there is a need for additional longitudinal studies designed to provide perspective on how transition readiness changes over time. [ABSTRACT FROM AUTHOR]

This article describes our recommendation fo r adapting hospital-based RED (Reengineered Discharge) processes to skilled nursing facilities (SNFs). Using focus groups, the SNFs' discharge processes were assessed twice additionally, research staff then recorded field notes documenting discussions about facility discharge processes as they related to RED processes. Data were systematically analyzed using thematic analysis to identify recommendations fo r adapting RED to the SNF setting including (a) rapidly identifying, involving, and preparing family/caregivers to implement a patient focused SNF discharge plan; (b) reconnecting patients quickly to primary care providers; and (c) educating patients at discharge about their target health condition, medications, and impact of changes on other chronic health needs. Limited SNF staff capacity and corporatelevel policies limited adoption of some key RED components. Transitional care processes such as RED, developed to avoid discharge problems, can be adapted fo r SNFs to improve their discharges. [ABSTRACT FROM AUTHOR]

The article discusses the nursing home admissions and role of physicians in the rehabilitation, medical care and end-of-life care of older patients in the U.S. Among the factors that led to delay in nursing home admission based on studies were comprehensive geriatric assessment and home visits to determine modifiable risk factors. The importance of recognizing risk factors for admission to planning for the future care needs of older adults is noted. Physicians are encouraged to advise prospective residents and their families to speak to staff and residents at nursing homes. It recommends the American Medical Directors Association (AMDA) as a resource for the continuing education of physicians in nursing home care.

Purpose: In this article a description is given of the use of adult protective services (APS) as a “safety net” by healthcare team members (HCTMs) when concerns were evident about an older adult's hospital discharge decisions. Design and Methods: The study had a descriptive qualitative design and participants' perceptions of discharge destination decisions were explored. A total of 13 semi-structured interviews were conducted with 7 HCTMs, who were the primary discharge planners for 13 frail older adults. Findings: Themes that emerged were safety, “reconciling the differences,”“letting them fail,” having confidence in the family caregiver, and weighing the options. If HCTMs did not view the older adults' discharge decisions as safe, they would first try to persuade the older adults to change their minds, and if that failed, they would report the older adult to APS for follow-up. Conclusions: The APS system does not augment, nor does it replace, adequate hospital discharge planning. The use of the APS system as a safety net at the time of hospital discharge is a symptom of a grave problem that will only worsen as the number of elderly adults increases and adds stress to an already overburdened healthcare system. Clinical Relevance: Access to health and social services at the time of hospital discharge is essential to the health and well-being of frail older adults; major gaps in services must be identified and corrected. [ABSTRACT FROM AUTHOR]

An editorial is presented on the adult health care to improve transition for youth with chronic disease. Topics inlcude the recognition that adolescents and young adults living with chronic diseases have unique needs when they transition from the pediatric to the adult health care setting, the transition being a process that involves stakeholders from both pediatric and adult health care settings, and the majority of research on this transition has been conducted by pediatric researchers.

Background: Transition to adult healthcare is a critical time for adolescents and young adults (AYAs) with sickle cell disease, and preparation for transition is important to reducing morbidity and mortality risks associated with transition. Objective: We explored the relationships between decision-making involvement, self-efficacy, healthcare responsibility, and overall transition readiness in AYAs with sickle cell disease prior to transition. Methods : This cross-sectional, correlational study was conducted with 50 family caregivers-AYAs dyads receiving care from a large comprehensive sickle cell clinic between October 2019 and February 2020. Participants completed the Decision-Making Involvement Scale, the Sickle Cell Self-Efficacy Scale, and the Readiness to Transition Questionnaire. Multiple linear regression was used to assess the relationships between decision-making involvement, self-efficacy, healthcare responsibility, and overall transition readiness in AYAs with sickle cell disease prior to transition to adult healthcare. Results : Whereas higher levels of expressive behaviors, such as sharing opinions and ideas in decision-making, were associated with higher levels of AYA healthcare responsibility, those behaviors were inversely associated with feelings of overall transition readiness. Self-efficacy was positively associated with overall transition readiness but inversely related to AYA healthcare responsibility. Parent involvement was negatively associated with AYA healthcare responsibility and overall transition readiness. Discussion : While increasing AYAs' decision-making involvement may improve AYAs' healthcare responsibility, it may not reduce barriers of feeling unprepared for the transition to adult healthcare. Facilitating active AYA involvement in decision-making regarding disease management, increasing self-efficacy, and safely reducing parent involvement may positively influence their confidence and capacity for self-management. [ABSTRACT FROM AUTHOR]