How Do Older People Experience Person-Centred Integrated Care? An Integrative Review Of The Evidence

Rationale, Aims and Objectives

‘Person-centred integrated care’ (PCIC) emerged in literature, policy and practice to meet the increasing care needs of an older population living longer with increased levels of chronic illness, multimorbidity and at enhanced risk of care fragmentation. Most evaluations of PCIC have been service-centred, rather than person-centred, and there is a lack of research on the effects of integrated care on patients, especially older people.

This integrative review sought to identify and synthesise available evidence on older people’s PCIC experiences, asking what empirical literature was available on the PCIC experiences of older people.

Specifically, the objectives were: i) to ascertain how empirical literature defines integrated care and conceptualises person-centredness in the context of integrated care; ii) to explore how PCIC impacts on older people’s care experiences; iii) to identify the main components of older people’s positive PCIC experiences; and iv) to identify the barriers to the successful provision of PCIC for older people.

Research Findings

Findings included: i) definitions and components of integrated care and conceptualisations of person-centredness in the context of integrated care; ii) older people’s positive PCIC experiences featured: coordination; continuity and relational care; involvement in care, including effective communication and information about care; and holistic care; iii) integrated care optimises care when successfully delivered, however, older people’s experiences were mixed; and iv) barriers included a lack of integrated care frameworks developed from patients’ perspectives, poor communication and information and staff shortages and turnover leading to discontinuity, limited time for meaningful interactions and follow-up care.

Policy Implications

Studies highlighted PCIC, as opposed to disease-specific and service-centred integrated care, as crucial for older people living with multiple and complex conditions to avoid fragmentation and cater for diverse and complex needs, leading to higher satisfaction with care and feelings of respect and equality.

While PCIC optimises care experiences, its evaluation is challenged by multiple conceptualisations and lack of engagement with service users.

Industry Recommendations

Integrated care models and framework must incorporate patient and carer perspectives into service design and evaluation. Implications for service design include the importance of prioritising experiences of continuity and coordination, relational care and holistic assessment and ensuring sufficient time for meaningful communication and interactions between older people, carers and staff.