Older Persons' Transition in Care

OPTIC Research Program


Older Persons' Transition in Care


We are investigating care transitions experienced by residents of nursing homes. The specific aim is to clearly define a successful transition from nursing home (NH) to Emergency Department (ED) via emergency medical services (EMS) or inter-hospital transfer (IHT).

We also sought to determine costs of transfers from system and family/resident perspectives; to develop a practical tool to assess transfer success, in terms of quality of care and avoidable complications; and to analyze the influence of organizational factors in key practice locations (nursing homes, pre-hospital transport services, and emergency departments) on transfer success. The initial OPTIC 4-phase study occurred over a 36-month period (starting Nov 2009) as a partnership between Alberta and British Columbia involving the University of Alberta, University of British Columbia Okanagan, Alberta Health Services, and Interior Health Authority.

All transfers of residents over one year from the nursing home, via the emergency medical system to the emergency department were studied, as well as further in-depth analyses of nursing homes with the highest referral rates. The residents, their families, transport crews, physicians and staff were interviewed to create a picture of the resident’s care in each of the three settings and to describe a successful transition.  

The results of this study include the development of tools (T3, OPTICS) used to measure successful transitions of nursing home residents to the emergency department and back to the nursing home. This will help improve quality of care and reduce the burden on busy emergency departments. This knowledge will help managers make better informed decisions and will improve the lives of the frail elderly who experience these transitions.

Key Findings

Optic 2016 Participant's Report

Canadian Institutes for Health ResearchUniversity of British Columbia Okanagan   University of Alberta   Interior Health Athority      Alberta Hertitage Foundation for Medical Research

Michael Smith Foundation for Health Research    BC Network for Aging Research    University Hospital Foundation Logo      Alberta Health Services Logo


Robinson CA. Bottorff JL. Lilly MB. Reid C, Abel Lo, M, Cummings, GG. (2012). Stakeholder perspectives on transitions of nursing home residents to hospital emergency departments and back in two Canadian provinces.

Journal of Aging Studies. doi:10.1016/j.jaging.2012.06.001



Cummings GG, Reid RC, Estabrooks CA, Norton PG, Cummings GE, et al (2012). Older Persons’ Transition in Care (OPTIC): A study protocol. 

BMC Geriatrics. 12:75. DOI: 10.1186/1471-2318-1275 2013: Highly Accessed on Biomed Central.


The Older Persons’ Transitions in Care (OPTIC) study:  What have we learned so far?  Aging and Wellness Symposium, Institute for Healthy Living and Chronic Disease Prevention, Kelowna, British Columbia