Community Models of Care: A Scoping Review

A rapid review exploring nurse-led memory clinics

AIMS

To systematically explore the structures, functions, outcomes, roles and nursing credentials of memory clinics where nurses autonomously lead diagnosis and postdiagnostic care.

DESIGN

A systematic rapid review was conducted.

DATA SOURCES

MEDLINE (Ovid), CINAHL Full-Text (EBSCO) and EMBASE were systematically searched in December 2019 with no timeframe limitations imposed.

REVIEW METHODS

The modified PRISMA checklist was used as a guide to facilitate the review. Articles identified were screened and assessed for inclusion criteria, and screening of reference lists of included studies was also completed.

RESULTS

Six articles, published between 2011-2019, including two case studies, two descriptive reports, one qualitative study and one programme evaluation were included in the review. Nurse-led memory clinics were situated in community centres, on university campuses, hospitals and in general practitioners' offices. The services offered included assessment, diagnosis and treatment/postdiagnostic care. Nurse credentials included advanced practice nurses and a community psychiatric nurse who was a non-medical prescriber. Overall, there was low quantity and quality of evidence to evaluate outcomes.

Internet Programming to Reduce Loneliness and Social Isolation in Aging

Loneliness and social isolation in older adults carry mortality risks similar to cigarette smoking. The study aim was to use a Culturally Informed Healthy Aging (CIHA) assessment process in Housing and Urban Development (HUD) communities of older adults (N = 262). Through the CIHA assessment process, older adults identified pertinent health problems and the study team developed a health intervention, an Internet Information Station (IIS). The IIS pilot study included computer lesson participation (n = 261), written feedback (n = 42), and the revised University of California, Los Angeles (R-UCLA) Loneliness Scale (n = 11). Increased confidence with technology and connectedness were reported, and a significant difference in "There is no one I can turn to" was observed (IIS compared to non-IIS). The IIS remains an active site for interaction 1-year post intervention. These pilot results supplement the research on older adult engagement in problem identification, intervention design, and outcomes measurement.

TARGET

Older adults living in HUD communities.

INTERVENTION DESCRIPTION

Through CIHA assessment, health problems were identified, and the IIS was developed and implemented.

MECHANISMS OF ACTION

Lessons were developed (e.g., computer basics, connecting with technology, open forum) and evaluated. Pre and post lesson, the R-UCLA Loneliness Scale measured social isolation and loneliness.

OUTCOMES

Older adults were engaged in problem identification, program development, and implementation. Feelings of connectedness improved; however, program evaluation with the R-UCLA scale was difficult to obtain. [Research in Gerontological Nursing, 13(5), 233-242.].

Core components and impact of nurse-led integrated care models for home-dwelling older people: A systematic review and meta-analysis

BACKGROUND

Integrated care models are highly recommended to overcome care fragmentation in the multimorbid older population. Nurses are potentially ideally situated to fulfil the role as care coordinator to guide integrated care. No systematic review has been conducted specifically focusing on the impact of nurse-led integrated care models for older people in community settings.

OBJECTIVES

To identify core components of nurse-led integrated care models for the home-dwelling older population; to describe patient, service and process outcomes; and to evaluate the impact of these care models on quality of life, activities of daily living, hospitalisation, emergency department visits, nursing home admissions and mortality.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

English, Dutch, French, German and Spanish articles selected from PubMed and CINAHL, hand-search of reference lists of the included articles and grey literature.

REVIEW METHODS

A systematic search was conducted to identify prospective experimental or quasi-experimental studies detailing nurse-led integrated care models in the older home-dwelling population. Study characteristics and reported outcomes were tabulated. The core components of the models were mapped using the Sustainable intEgrated chronic care modeLs for multi-morbidity: delivery, FInancing, and performancE (SELFIE) framework. A random effects meta-analysis was conducted to study the overall effectiveness of the included care models on health-related quality of life, activities of daily living, hospitalisation, emergency department visits, nursing home admissions or mortality. Risk of bias was appraised using the revised Cochrane risk-of-bias tool for randomized trials and ROBINS-I tool for non-randomized studies.

RESULTS

Nineteen studies were included studying a total of 22,168 patients. Core components of integrated care for multimorbid patients such as the involvement of a multidisciplinary team, high risk screening, tailored holistic assessment and an individualized care plan, were performed in a vast majority of the studies; however variability was observed in their operationalisation. Twenty-seven different patient, provider and service outcomes were reported, ranging from 1 to 13 per study. The meta-analyses could not demonstrate a beneficial impact on any of the predefined outcomes. Most included studies were of high risk for several biases.

CONCLUSION

The summarized evidence on nurse-led integrated care models in home-dwelling older people is inconclusive and of low quality. Future studies should include key components of implementation research, such as context analyses, process evaluations and proximal outcomes, to strengthen the evidence-base of nurse-led integrated care.