TY - JOUR
AU - M. Motsenok
AU - E. C. N. Wong
AU - R. Sothilingam
AU - M. Antunes
AU - C. Devion
AU - E. Wilson
AU - A. Knoepfli
AU - E. Elliot
AU - T. DasGupta
AU - N. Ziegler
AU - S. L. Hitzig
A1 - 
AB - INTRODUCTION: Older adults experience several transitions in care, which can be challenging and stressful. Transitional care ensures continuity of care by addressing patients' healthcare needs before discharge and providing ongoing community support. Although transitional care improves patient outcomes and reduces hospital readmissions, its role in addressing mental health (MH) needs in older adults remains underexplored. This scoping review describes the literature on the integration of allied healthcare (AHC) professionals in transitional care for older adults with MH needs. METHOD: Following PRISMA-ScR guidelines, we analyzed 14 peer-reviewed articles (2010-2024) on transitions for older adults with cognitive impairment, dementia, depression, or suicide risk. Thematic analysis identified key roles, lessons, and patient needs in transitional care provided by AHC professionals. RESULTS: AHC professionals, including social workers, occupational therapists, pharmacists, and physical therapists, contributed through discharge planning, physiotherapy, medication reviews, MH counseling, and resource navigation. For caregivers, they provided education on dementia care, behavior management, and psychosocial support, improving caregiver well-being and interactions with persons with dementia. Transitional care interventions reduced caregiver stress and, in some cases, hospital readmissions. Challenges included suboptimal medication management for persons with dementia. Key facilitators were flexible delivery methods (e.g., telehealth), tailored interventions, and dementia-specific education. CONCLUSION: AHC professionals are vital to transitional care for older adults with MH needs, offering tailored support to patients and caregivers. Enhanced integration, interdisciplinary collaboration, caregiver education, and addressing systemic barriers could improve care quality. Future research should focus on standardizing interventions and optimizing medication management.
AD - St. John's Rehab Research Program - Sunnybrook Research Institute, North York, Ontario, Canada.; Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada.; Sunnybrook Health Sciences Centre, North York, Ontario, Canada.; SPRINT Senior Care, Toronto, Ontario, Canada.; Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.; Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
AN - 41911239
BT - PLoS One
C5 - Education & Workforce; Healthcare Disparities
CP - 3
DO - 10.1371/journal.pone.0346032
DP - NLM
ET - 20260330
IS - 3
JF - PLoS One
LA - eng
N2 - INTRODUCTION: Older adults experience several transitions in care, which can be challenging and stressful. Transitional care ensures continuity of care by addressing patients' healthcare needs before discharge and providing ongoing community support. Although transitional care improves patient outcomes and reduces hospital readmissions, its role in addressing mental health (MH) needs in older adults remains underexplored. This scoping review describes the literature on the integration of allied healthcare (AHC) professionals in transitional care for older adults with MH needs. METHOD: Following PRISMA-ScR guidelines, we analyzed 14 peer-reviewed articles (2010-2024) on transitions for older adults with cognitive impairment, dementia, depression, or suicide risk. Thematic analysis identified key roles, lessons, and patient needs in transitional care provided by AHC professionals. RESULTS: AHC professionals, including social workers, occupational therapists, pharmacists, and physical therapists, contributed through discharge planning, physiotherapy, medication reviews, MH counseling, and resource navigation. For caregivers, they provided education on dementia care, behavior management, and psychosocial support, improving caregiver well-being and interactions with persons with dementia. Transitional care interventions reduced caregiver stress and, in some cases, hospital readmissions. Challenges included suboptimal medication management for persons with dementia. Key facilitators were flexible delivery methods (e.g., telehealth), tailored interventions, and dementia-specific education. CONCLUSION: AHC professionals are vital to transitional care for older adults with MH needs, offering tailored support to patients and caregivers. Enhanced integration, interdisciplinary collaboration, caregiver education, and addressing systemic barriers could improve care quality. Future research should focus on standardizing interventions and optimizing medication management.
PY - 2026
SN - 1932-6203
SP - e0346032
ST - Implementing allied healthcare professionals in transitional care for older adults with mental health needs: A scoping review
T1 - Implementing allied healthcare professionals in transitional care for older adults with mental health needs: A scoping review
T2 - PLoS One
TI - Implementing allied healthcare professionals in transitional care for older adults with mental health needs: A scoping review
U1 - Education & Workforce; Healthcare Disparities
U3 - 10.1371/journal.pone.0346032
VL - 21
VO - 1932-6203
Y1 - 2026
ER -