What do older people want from integrated care? Experiences from a South Australian co-design case study.

OBJECTIVES: The challenges of improving the integration of care for older people with complex care needs are well recognised. Evidence suggests that solutions should be co-designed with older people to ensure they are contextually relevant and person-centred. METHODS: As a first step in a co-design project to improve integrated care for older people, seven interviews and three workshops were held with older people and service providers. Data collected via recordings, notes and journey maps were inductively analysed. RESULTS: Five themes were identified: relationships and roles, patient capacity and safety, information and systems, multiway communication, and transitions and flow. This created a more holistic and person-centred picture of integrated care than typically derived from published literature. CONCLUSIONS: Older people perceive integrated care from relational, organisational, informational and individual viewpoints. This reinforces the central importance of adopting a person-centred, as opposed to health system-focused, approach to designing and implementing integrated care solutions.

What does integrated care mean from an older person's perspective? A scoping review.

OBJECTIVE: To systematically map and synthesise the literature on older adults' perceptions and experiences of integrated care. SETTING: Various healthcare settings, including primary care, hospitals, allied health practices and emergency departments. PARTICIPANTS: Adults aged ≥60 years. INTERVENTIONS: Integrated (or similarly coordinated) healthcare. PRIMARY AND SECONDARY OUTCOME MEASURES: Using scoping review methodology, four electronic databases (EMBASE, CINAHL, PubMed and ProQuest Dissertation and Theses) and the grey literature (Open Grey and Google Scholar) were searched to identify studies reporting on older adults' experiences of integrated care. Studies reporting on empirical, interpretive and critical research using any type of methodology were included. Four independent reviewers performed study selection, data extraction and analysis. RESULTS: The initial search retrieved 436 articles, of which 30 were included in this review. Patients expressed a desire for continuity, both in terms of care relationships and management, seamless transitions between care services and/or settings, and coordinated care that delivers quick access, effective treatment, self-care support, respect for patient preferences, and involves carers and families. CONCLUSIONS: Participants across the studies desired accessible, efficient and coordinated care that caters to their needs and preferences, while keeping in mind their rights and safety. This review highlights the salience of the relational, informational and organisational aspects of care from an older person's perspective. Findings are transferable and could be applied in various healthcare settings to derive patient-centred success measures that reflect the aspects of integrated care that are deemed important to older adults and their supporters.

Achieving Integrated Care for Older People: Shuffling the Deckchairs or Making the System Watertight For the Future?

Integrated care has been recognised as a key initiative to resolve the issues surrounding care for older people living with multi-morbidity. Multiple strategies and policies have been implemented to increase coordination of care globally however, evidence of effectiveness remains mixed. The reasons for this are complex and multifactorial, yet many strategies deal with parts of the problem rather than taking a whole systems view with the older person clearly at the centre. This approach of fixing parts of the system may be akin to shuffling the deckchairson the Titanic, rather than dealing with the fundamental reasons why the ship is sinking. Attempts to make the ship more watertight need to be firmly centred on the older person, pay close attention to implementation and embrace approaches that promote collaborative working between all the stakeholders involved.

What integrated care means from an older person's perspective? A scoping review protocol.

INTRODUCTION: According to the 2013 WHO Global Forum on Innovation for Ageing Populations, disabilities and morbidities associated with ageing could be minimised by accessing preventive care. One way of improving the management of multimorbidity in the older population is through the provision of 'integrated care'. Although integrated care means different things to different people, it typically symbolises continuity in care, thus preventing older patients' from falling through gaps in the health care system. Many initiatives have attempted to improve the integration of care; however, these are typically designed from a particular policy or system perspective. Relatively little is known about patient expectations and experiences of integrated care, which is vital for developing and implementing better models of care. The proposed scoping review aims to map literature on older patients'' views, expectations, experiences and perspectives of integrated care. METHODS AND ANALYSIS: Multiple electronic databases including PubMed, Web of Science, Embase, PsychInfo, Google Scholar, Cochrane Library, CINAHL and ProQuest Dissertations will be searched for appropriate articles between August and December 2017. Reference lists of selected articles will also be searched for similar articles. Two experienced researchers will conduct an initial search of the literature to identify relevant articles. Abstracts of the identified articles will be reviewed collectively by two researchers to identify potential further studies. Full texts of the potential studies will be sourced and screened for the inclusion criteria. Appropriate qualitative and quantitative methods will be used to extract data from each included study. ETHICS AND DISSEMINATION: The scoping review will synthesise findings from studies reporting on patients' views and expectations of integrated care. This review expects to find information relating to facilitators and barriers of integrated care from an older person's perspective. The findings from the review will be applied when working with stakeholders representing older people, healthcare, aged care and community providers, researchers and policy makers to develop and evaluate a more locally tailored and person-centred approach to integrated care.

Beliefs, suffering, and healing: a clinical practice model for families experiencing mental illness.

PURPOSE: Mental illness often changes families' lives and relationships forever. A Family Systems Nursing framework is proposed for working collaboratively with families. CONCLUSIONS: The Illness Beliefs Model (Wright & Bell, 2009) offers clinicians ways to target illness beliefs that may perpetuate or, alternatively, soften suffering. PRACTICE IMPLICATIONS: We have learned from families that it is often not the family member with the illness who is suffering most, but rather, other family members. The complexity of "relational suffering" challenges mental health nurses to acquire knowledge and skills to work with families to soften physical, emotional, relational, and spiritual suffering.