Navigation for Elderly People With Multiple Morbidity After Hospital Discharge.

Inclusion Criteria: * Elderly individuals aged 60 or older; * With confirmed multimorbidity documented in their medical records; * Hospitalized in the SUS (Unified Health System) clinical units (5th North, 6th North, and 7th North), regardless of specialty; * Who will be discharged home; * Have telephone access and have a primary caregiver responsible for assisting with communication, in cases where the elderly person is unable to respond for themselves. Exclusion Criteria: * Elderly people hospitalized in restricted access clinical units (6th south), and those with private insurance or paying out-of-pocket (4th south); * Those transferred to another hospital service or to other institutions; * Patients who are already receiving or will receive navigation care or other safe discharge follow-up care; * Patients in palliative care.