Aging, Community and Health Research Group (ACHRU)

McMaster University

Funded by

Study 15

Optimizing Hospital-to-Home Transitions for Older Adults with Stroke and Multmorbidity: A Pragmatic Effectiveness-Implementation Trial of an Integrated Transitional Care Intervention

This project focuses on improving the experience and quality of transitioning from hospital-to-home for older adults with stroke and multimorbidity. The overall goal of this research project is to adapt, implement and evaluate a novel person and family-centred hospital-to-home transitional care intervention for older adults with stroke and multimorbidity and their caregivers. 

This 6-month intervention will be delivered by an interprofessional team of healthcare providers from an outpatient stroke rehabilitation team, including a registered nurse, occupational therapist, physiotherapist, social worker, and speech language pathologist.


  • 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
  • Mark Bayley
  • Marla Beauchamp
  • Jill Cameron
  • Kathryn Fisher
  • Rebecca Fleck
  • Amiram Gafni
  • Rebecca Ganann
  • Michelle Nelson
  • Jenny Ploeg
  • Jennifer Salerno
  • Lehana Thabane
  • Carly Whitmore