RT Book, Section A1 Flint, Lynn A. A2 Williams, Brie A. A2 Chang, Anna A2 Ahalt, Cyrus A2 Chen, Helen A2 Conant, Rebecca A2 Landefeld, C. Seth A2 Ritchie, Christine A2 Yukawa, Michi SR Print(0) ID 1100065779 T1 Transitions and Continuity of Care T2 Current Diagnosis & Treatment: Geriatrics, 2e YR 2014 FD 2014 PB McGraw-Hill Education PP New York, NY SN 978-0-07-179208-0 LK accessmedicine.mhmedical.com/content.aspx?aid=1100065779 RD 2024/04/19 AB Older adults with chronic illnesses are frequently in contact with the health care system. They periodically require hospitalization for acute exacerbations of chronic illness, falls, infections, and other problems. For these patients, hospitalization often marks the beginning of a journey through a series of disconnected settings and providers. Because of this lack of connection, the journey is not smooth. Mishaps along the way are sometimes insignificant, sometimes even undetected, but others are life altering. The discussion here focuses on how this journey became so complex, the risks of the journey, and the best practices and innovations aimed at minimizing these risks.