Aging, Community and Health Research Group (ACHRU)

McMaster University

Funded by

Study 9

Community Assets Supporting Transitions (CAST) - A pragmatic effectiveness-implementation trial to evaluate a hospital-to-home transitional care intervention compared to usual care for older adults with multiple chronic conditions and depressive symptoms

The aim of the Community Assets Supporting Transitions (CAST) study is to determine the effects, implementation and costs of a hospital-to-home support program for older adults with depressive symptoms and multiple chronic conditions. Core components of the program will include home visits, telephone follow-up, and nurse-led care coordination. The researchers are working side-by-side with patients, caregivers and providers from three communities in Ontario to tailor the intervention to each community. The three partner sites/communities include Sudbury, Burlington and Hamilton.

The overall goal of the intervention is to improve health outcomes for older adults with depression and multiple health problems who are transitioning from hospital-to-home care by improving patients’ self-management ability, supporting families and caregivers, and building capacity for primary care and other health and non-health related providers to collaborate in delivering home and community services to these patients.

Funder: Ontario SPOR Support Unit (OSSU)

Funding is provided by the Ontario SPOR SUPPORT Unit, which is supported by the Canadian Institutes of Health Research and the Province of Ontario.

Additional funding support is being provided by the Labarge Foundation



Editorial in Journal of the American Geriatrics Society

Publication in Special patient-oriented research supplement in the Canadian Medical Association Journal (CMAJ)

Research Summary

  • Maureen Markle-Reid
    Canada Research Chair in Person-Centred Interventions for Older Adults with Multimorbidity & their Caregivers
    Scientific Co-Lead MIRA | Collaborative For Health & Aging
  • Carrie McAiney
    Associate Professor, Schlegel Research Chair in Dementia
    University of Waterloo
    School of Public Health and Health Systems
  • Ruta Valaitis
  • Rebecca Ganann
  • Jenny Ploeg
  • John Cairney
  • Kathryn Fisher
  • Amiram Gafni
  • Alain P. Gauthier
  • Gail Heald-Taylor
  • Bill Johnson
  • Nick Kates
  • John Lavis
  • Janet McElhaney
  • Lawrence Ogden
  • David Price
  • Patricia Reid
  • Lehana Thabane
  • Diana Urajnik
  • Isabelle Vedel
  • Wayne Warry
  • Cheryl Williams
  • Patricia Wilson
  • Amy Bartholomew
  • Kristina Chang
  • Carly Whitmore

Publications and Activities relating to this study:

ACHRU Research Featured in Special CMAJ Supplement

We’re pleased to have our research featured in a special patient-oriented research supplement in the Canadian Medical Association Journal (CMAJ) being released today.

Read More

Public Lecture: Enhancing Dementia Care Experiences

Dr. Carrie McAiney, the new Schlegel Research Chair in Dementia and Aging, is hosting her inaugural educational talk on June 26, 2018, in Waterloo.

Read More

New Research Summary: Evaluating a New Hospital-to-Home Care Program for Older Adults with Depressive Symptoms

Researchers are studying the application and costs of a promising new program for older adults, with multiple chronic conditions (MCC) and depressive symptoms that aims to improve overall health and reduce hospitalization.

Read More