This project identifies seniors living in isolation and connects them to support services through a network of community based organizations. With a focus on at-risk seniors in target neighbourhoods and hospitals, this project connects individuals in need with existing services and social opportunities across the Greater Hamilton area.
This research project is a collaboration of investigators in Ontario, Quebec, and Alberta to support stronger primary care for older adults living with frailty. Effective assessment of frailty will allow older adults to remain in their homes and communities. Primary care clinicians will use the Assessment Urgency Algorithm tool, which uses a scale of one to six, to determine frailty level. This ensures a client is connected to the right type of service, at the right time.
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An effective referral management system working together to reduce social isolation of seniors by helping caregivers and care providers access focused community services available in the Greater Hamilton area. By connecting all available services in our community, we can deliver better coordinated care, closer to home, to reduce the risks associated with isolation and loneliness in seniors.