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Learn How Dr. Mary Fox is Developing Strategies to Support the Functioning of Older People with Cognitive Impairment in Rural Communities After a Hospital Stay

Older people living with cognitive impairment are a vulnerable group. They have high rates of hospital admission and are 25% more likely to be readmitted to hospital than those without cognitive impairment. Each time they get admitted to hospital, older persons living with cognitive impairment are at risk for functional declines – losses in the ability to perform activities of daily living like walking and getting dressed independently.

Because of their high rates of hospital readmission, such individuals may experience cumulative functional losses whereby they lose a bit of their independence with each hospital stay. If they do not regain their functioning within one month of coming home from the hospital, they are unlikely to ever do so. Consequently, older people with cognitive impairment need strategies they can use at home to help them recover and get back to their usual activities after a hospital stay. However, there has been very little research conducted on the topic, especially in rural communities.

How can researchers create strategies that can be used successfully at home in rural communities? What does this process look like?

Engaging Members of the Public

Dr. Mary Fox considered these questions in the latest Gateway Centre of Excellence in Rural Health (CERH) virtual lecture. On April 9th, 2024, for Season 4, Episode 8 of the virtual lecture series, Dr. Fox and an expert panel spoke about “Hospital-to-Home Transitional Care Interventions to Support Functioning in Older People in Rural Communities” 

Dr. Fox described how developing viable strategies (“interventions”) to promote physical and cognitive functioning in older people with cognitive impairment is a collaborative endeavour that requires inclusion of the perspectives of older people, their care partners, and healthcare professionals. Dr. Fox described a “participatory approach” that involves engaging members of these three groups at each stage of the study.

If you would like to register for this free, monthly lecture series, or explore our past lecture, check out our lecture series page:

Developing the Interventions

Dr. Fox and her team examined the literature and spoke with key stakeholders such as clinical leaders to understand how hospitals contribute to an older person’s physical and cognitive losses.

  • They learned that older people are often admitted through the emergency department which is a highly stressful environment both physically and cognitively, especially for an older person with a cognitive impairment.

  • Older people typically do not sleep well in the hospital; their participation in their activities of daily living such as getting dressed is restricted, and they are very sedentary. As a result, they are tired when they get home and may have trouble communicating their needs, remembering how to perform their activities of daily living, and walking, and may be more likely to fall.

From this information, the team developed physical and cognitive interventions to address these concerns and minimize decline. The physical interventions promote a person’s ability to tolerate being up following a period of inactivity, walk, and avoid falls. The cognitive interventions promote a person’s orientation and ability to sleep and communicate.

Evaluating the Interventions

The research team packaged this information into pictograms that can be used by older people and their care partners to know what to do to promote recovery after a hospital stay. Here is an example of a pictogram.

Pictogram entitled "Take rests when walking"

The research team is now evaluating the acceptability of the interventions to older people, their care partners, and healthcare professionals. Acceptability includes things like how easy it is to use the interventions and suggestions for improving them. From this evaluation, the team will modify the interventions so that they will work in rural communities. If you are interested in participating in this study, please see the study flyer.

For more information about this study, please visit

About the Presenters

Headshot of Dr. Mary Fox
Dr. Mary Fox, Associate Professor in the School of Nursing at York University

Dr. Fox is an Associate Professor in the School of Nursing at York University and a founding member of the York University Centre for Aging Research and Education. Her research interests focus on older adults, transitional care, health services delivery in rural communities, and intervention development and testing. The presentation was based on one of Dr. Fox’s current research projects, funded by the Canadian Institutes of Health Research.


Read more about Dr Fox and her research:

If you have any questions and/or queries from this past lecture, feel free to reach out: 

The panelists accompanying Dr. Fox were Ms. Ann MacLeod, a Nurse and Faculty member at the Trent/Fleming School of Nursing, Trent University, and Dr. Evelyne Durocher an Occupational Therapist and Assistant Professor in the School of Rehabilitation Science at McMaster University.

Ms. MacLeod has taught clinical and theoretical courses focusing on care of the older adult, community health, and primary care. Her research focuses on qualitative community-based approaches to study the intersection between health professionals, the volunteer sector and family in promoting older adults’ health. She discussed the process used to include people with cognitive impairment and their care partners in providing feedback on the pictograms.

Dr. Durocher’s program of research focuses on questions of occupation, autonomy, vulnerability, equity, justice, risk, and safety in relation to health and social services with older adults. She discussed the feminist theoretical concept of relational autonomy in relation to transitional care.

About Gateway Centre of Excellence in Rural Health

Founded in 2008 in the community of Seaforth, ON, Gateway CERH is a not-for-profit rural health research organization run by a community-based volunteer board of directors. Gateway CERH's main mission is to better the health and quality of life of rural residents through research, education and communication. Learn more on the Gateway CERH website at: and follow us on Instagram, Facebook, Twitter, LinkedIn and YouTube 

The views expressed in this lecture may not necessarily reflect Gateway CERH’s views or opinions, but we believe in providing a platform for a range of perspectives and thoughtful discussion. 

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