How do older people experience person-centred integrated care? An integrative review of the evidence.

The phenomenon of ‘person-centred integrated care’ (PCIC) emerged in literature, policy and practice to meet the increasing care needs of a growing older population. This population is living longer with increased levels of complex chronic illness and multimorbidity and at enhanced risk of care fragmentation. Person-centeredness is considered a core element of integrated care and quality care (WHO, 2021) and integrated care is central to person-centred care (PCC) (Institute of Medicine, 2001). Despite the desirability of the PCIC approach, progress has been slow (Greenfield et al, 2014; Riste et al, 2018). Evaluations of PCIC have tended to be service-centred in terms of their focus on outcomes and assessment of successful practice, rather than person-centred (Liljas et al, 2019; Berntsen et al, 2018; Greenfield et al, 2014). There is a marked lack of research on the effects of integrated care and its person-centred outcomes on service users (Baxter et al, 2018), including older people. There is also a recognised knowledge gap regarding experiences of PCIC or PCC in the context of integrated care. This knowledge gap is particularly true for older people, with few qualitative research studies focusing on their lived experiences of and perspectives on PCIC.

Integrative review methodology (Whittemore and Knafl, 2005) was applied to explore the extent and type of evidence in relation to older people’s experiences of PCIC. The timeframe for this review, 2014-2024, reflected the emergence of the concept of PCIC. This included literature on experiences of PCC or person-centredness within integrated care contexts. This review synthesised empirical literature on the experiences of older people of PCIC from five databases: Medline, PsycInfo, CINAHL, Embase and Web of Science, using subject headings and free text search terms adapted for each database. From a total of 595 studies, thirty-six were included in the review. The Person-centred Practice Framework (Slater, McCance and McCormack, 2017-2021) was used in analysis of findings regarding person-centredness.

Findings included: i) multiple definitions and components of integrated care and varied conceptualisations of person-centredness in the context of integrated care; and ii) positive PCIC experiences for older people as featuring: experiences of coordination; continuity; relational care; being involved in care, including effective communication and information about care; and personalised holistic care. Integrated care optimised care experiences and is especially suited older people. However, older people’s experiences of integrated care were mixed. Barriers to this care included a lack of frameworks for integrated care developed from patients’ perspectives and rather adopting professional, organisational and service perspectives; poor communication and information about care; and staff shortages and turnover leading to discontinuity, limited time for meaningful interactions, and deficits in follow-up and transitional care. Evaluation of PCIC is challenged by multiple, diverse understandings of integrated care, person-centredness in integrated care contexts, and PCIC, as well as the lack of frameworks focusing on patients’ experiences. This review informs PCIC models of care centred on optimising patients’ care experiences of person-centeredness and integration, which incorporate perspectives of older people in evaluation, and ideally design stages, of care delivery and process improvement.