Aging, Community and Health Research Group (ACHRU)

McMaster University

Funded by

core 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 depression 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 Health Sciences North (Sudbury), Joseph Brant Hospital (Burlington) and Hamilton Health Sciences (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)

Additional funding support is being provided by the Labarge Foundation



Publication in Journal of the American Geriatrics Society

Research Summary

  • Maureen Markle-Reid
    Canada Research Chair in Aging, Chronic Disease and Health Promotion Interventions
    Associate Professor, McMaster University School of Nursing
    Department of Health Research Methods, Evidence, and Impact (HEI)
  • Carrie McAiney
    Associate Professor
    McMaster University
    Department of Psychiatry & Behavioural Neurosciences
  • 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
  • Agata Drozd
  • Tracey Chambers
  • Kristina Chang
  • Carly Whitmore

Publications and Activities relating to this study:

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.

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Rebecca Ganann Receives Respected Postdoctoral Fellow Leadership Award

We are very proud to announce Rebecca Ganann, is a recipient of the 2017 FHS Research Plenary Postdoctoral Fellow Leadership Award.

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Meet our Postdoctoral Fellow Rebecca Ganann

Rebecca Ganann is inspired to involve patients and the public in research and she will have the opportunity to do just that during her Postdoctoral fellowship at the ACHRU.

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