Integrated Care Models for Older People: An Umbrella Review

Abstract

This umbrella review aimed to synthesize evidence on the key elements of care models integrating health and social services for older people and the evidence about what works in such models and their mechanisms of change. A literature search was performed using six electronic databases: Ovid MEDLINE, Ovid Embase, CINAHL, AgeLine, PsycINFO and Cochrane Database of Systematic Reviews. A narrative synthesis was used for reporting. We included 19 eligible reviews 14 of which focused on the integration of health and social care, four on integrating health care services, and one on integrating health and residential aged care. The findings show a focus on delivery of clinical care (micro), with limited focus on organizational (meso) and broader system (macro) levels of integration. The main outcomes of integrated care models (ICMs) reported in the reviews were measurements of hospital admission rates, quality of life, and uptake of community services. The key mechanisms for the success of ICMs are coordinated care, patient-centeredness, co-location, commitment and shared vision across implementing partners, and strong leadership shaping organizational cultural support for implementing the model.