Support after hospital discharge for older adults with multiple health conditions
This study tests a navigation program to support older adults with multiple health conditions after they leave the hospital, with the goal of improving their recovery and well-being at home.
Summary written for real people, not researchers, by Clin2.
Who can take part
- You must be 60 years or older.
- You must have two or more chronic health conditions (like diabetes and heart disease) listed in your medical record.
- You are being discharged from one of the participating hospital units (5th North, 6th North, or 7th North) in the SUS (public health system).
- You will be going home (not to another facility).
- You or your primary caregiver must have access to a telephone for communication.
Quick eligibility check
Answer a few plain-language questions, based on this study's own requirements, to get a preliminary sense of fit.
Similar studies
Other trials that look related to this one.
This study is designing and testing a person-centered plan to help you use your medicines correctly when you leave the hospital. It involves you, your family or caregiver, and your usual healthcare team to reduce medication problems across care settings.
This trial tests a program that helps older adults get back on their feet after a serious illness in the intensive care unit (ICU). A recovery navigator will work with you and your GP to plan your care after you leave the hospital.
This study tests a telehealth program that provides support and follow-up care to frail older adults after they leave the hospital. The program uses video calls and digital tools to help you recover safely at home.
This trial tests a program that helps older adults leaving a community hospital get extra social support and a smoother transition back home. It may improve wellbeing by connecting you with community activities and resources.
This study looks at ways to improve care and support for older adults with mild memory problems or dementia after they leave the hospital and go home with home care services. It may help you by providing extra help and resources during your recovery at home.
This trial tests a digital program that helps patients make a smoother, safer transition from hospital to home. It may help with understanding next steps after discharge and coordinating care after you leave the hospital.
Hear when a new Multimorbidity trial opens
We’ll email you when one opens — at most once a week, no account needed, unsubscribe anytime.