Interventions to optimise transitional care coordination for older people living with dementia and concomitant multimorbidity and their caregivers: A systematic review

Abstract

BACKGROUND: People living with dementia and multimorbidity are frequent uses of health, amplifying risk of adverse events and fragmented care when moving between and across care settings. OBJECTIVES: This review aims to identify interventions to support transitional care for older people living with dementia and concomitant multimorbidity and their caregivers. RESEARCH DESIGN: Systematic review was completed in accordance with PRISMA guidelines. METHODS: A systematic search from 2000 to January 2018 of Medline, CINAHL, PsycINFO and Academic Search Complete databases for studies which implemented a transitional care intervention for older people living with dementia and multimorbidity. The search terms used were: “dementia,” “multi-morbidity,” “multiple chronic conditions,” “transitional care,” and “care coordination”. RESULTS: Out of the 6053 identified abstracts, 11 studies and 13 papers were included. These studies included 1861 people living with dementia, mean age 80 years (SD 3) and 1503 caregivers, with a mean age of 69 years (SD 5). The heterogeneity of study interventions and outcome measures precluded a meta-analysis being conducted. Therefore, narrative synthesis was undertaken identifying six elements of care that optimise outcomes for people living with dementia and/or their carers; 1) unmet needs; 2) depression; 3) education and support; 4) physical decline; 5) poor quality of life and; 6) access and knowledge of community services. CONCLUSION: This review demonstrates the paucity of interventions available to improve essential elements and reduce frequency, impact and experiences of transitions for this vulnerable population. There is an increasing need for further research and development in transitional care for these vulnerable people. Impact Statement This review provokes health professionals in considering older people during care transitions with better utilisation of services and personalised plans.