Abstract
Older adults living with dementia are at risk for more complex health care transitions than individuals without this condition, non-impaired individuals. Poor quality care transitions have resulted in a growing body of qualitative empirical literature that to date has not been synthesized. We conducted a systematic literature review by applying a meta-ethnography approach to answer the following question: How do older adults with dementia and/or their caregivers experience and perceive healthcare transition: Screening resulted in a total of 18 studies that met inclusion criteria. Our analysis revealed the following three categories associated with the health care transition: (1) Feelings associated with the healthcare transition; (2) processes associated with the healthcare transition; and (3) evaluating the quality of care associated with the health care transition. Each category is represented by several themes that together illustrate an interconnected and layered experience. The health care transition, often triggered by caregivers reaching a “tipping point,” is manifested by a variety of feelings, while simultaneously caregivers report managing abrupt transition plans and maintaining vigilance over care being provided to their family member. Future practice and research opportunities should be more inclusive of persons with dementia and should establish ways of better supporting caregivers through needs assessments, addressing feelings of grief, ongoing communication with the care team, and integrating more personalized knowledge at points of transition.
Highlights
Concerns of poor quality health care transitions among persons with complex care needs are well documented in the literature (Cheek et al, 2006; Coleman, 2003)
Individuals who develop dementia often require more care and have more health care transitions when compared to older adults without this condition (Callahan et al, 2015a, 2015b)
A systematic search and review of the qualitative literature revealed a layered understanding of the care transitions experiences and perceptions of some people living with dementia and mostly their caregivers
Summary
Concerns of poor quality health care transitions among persons with complex care needs are well documented in the literature (Cheek et al, 2006; Coleman, 2003). Patients older than 65 years with cognitive and functional impairment are at risk for poor transitions (Gruneir et al, 2012; Mondor et al, 2017). There is a well-established association between multimorbidity (chronic disease burden) and dementia and health care utilization (Mondor et al, 2017; Public Health Agency of Canada, 2014). Individuals who develop dementia often require more care and have more health care transitions when compared to older adults without this condition (Callahan et al, 2015a, 2015b). Health care transitions have been identified as an issue for people living with dementia in research and practice for many years and have become an area of focus in national strategies and guidelines (Public Health Agency of Canada, 2019; Scottish Government, 2017). Frequent transitions of locations can interrupt continuity of care, impact negatively on patient experiences, contribute to ineffective communication, and increase delirium and falls (Chenoweth et al, 2015; Goldberg et al, 2015)
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