Effectiveness of integrated person-centered interventions for older people's care: Review of Swedish experiences and experts' perspective

Mariam Kirvalidze¹, Anne-Marie Boström^{2

3

4}, Ann Liljas^{1

5}, Megan Doheny¹, Anne Hendry^{6

7}, Brendan McCormack⁸, Laura Fratiglioni^{1

9}, Sulin Ali^{1

5

10}, Zahra Ebrahimi¹¹, Sölve Elmståhl¹², Maria Eriksdotter^{3

13}, Pascal Gläske^{1

5

10}, Lena-Karin Gustafsson¹⁴, Åsa Hedberg Rundgren⁹, Helena Hvitfeldt¹⁵, Carin Lennartsson^{1

16}, Lena Marmstål Hammar^{17

18}, Gunnar H Nilsson¹⁹, Peter Nilsson²⁰, Joakim Öhlén^{11

21}, Anna Sandgren²², Annika Söderman²³, Karl Swedberg²⁴, Nicoline Vackerberg²⁵, Davide Liborio Vetrano^{1

9}, Helle Wijk^{11

26

27}, Janne Agerholm^{1

5}, Amaia Calderón-Larrañaga^{1

9}

Affiliations

¹ Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden.
² Department of Neurobiology, Care Sciences, and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden.
³ Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.
⁴ Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden.
⁵ Department of Global Public Health, Karolinska Institutet, Solna, Sweden.
⁶ International Foundation for Integrated Care (IFIC), Glasgow, Scotland, UK.
⁷ School of Health and Life Sciences, University of the West of Scotland, Glasgow, Scotland, UK.
⁸ Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, The University of Sydney, Sydney, Australia.
⁹ Stockholm Gerontology Research Center, Stockholm, Sweden.
¹⁰ Institute for Sociology, University of Duisburg-Essen, Duisburg, Germany.
¹¹ Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg Centre for Person-Centred Care - GPCC, Gothenburg, Sweden.
¹² Department of Clinical Sciences, Division of Geriatric Medicine, Lund University, Lund, Sweden.
¹³ Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Sweden.
¹⁴ School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden.
¹⁵ Norrtälje Hospital, Vårdbolaget Tiohundra, Stockholm, Sweden.
¹⁶ Swedish Institute for Social Research (SOFI), Stockholm University, Stockholm, Sweden.
¹⁷ School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
¹⁸ School of Health and Welfare, Dalarna University, Falun, Sweden.
¹⁹ Department of Neurobiology, Care Sciences, and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden.
²⁰ Myndigheten för vård- och omsorgsanalys, Stockholm, Sweden.
²¹ Palliative Care Centre, Sahlgrenska University Hospital, Gothenburg, Sweden.
²² Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
²³ Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
²⁴ Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
²⁵ Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden.
²⁶ Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden.
²⁷ Department of Quality Assurance and Patient Safety, Sahlgrenska University Hospital, Gothenburg, Sweden.

PMID: 38664991
DOI: 10.1111/joim.13784

Review

Effectiveness of integrated person-centered interventions for older people's care: Review of Swedish experiences and experts' perspective

Mariam Kirvalidze et al. J Intern Med. 2024 Jun.

. 2024 Jun;295(6):804-824.

doi: 10.1111/joim.13784. Epub 2024 Apr 25.

Authors

Affiliations

¹ Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden.
² Department of Neurobiology, Care Sciences, and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden.
³ Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.
⁴ Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden.
⁵ Department of Global Public Health, Karolinska Institutet, Solna, Sweden.
⁶ International Foundation for Integrated Care (IFIC), Glasgow, Scotland, UK.
⁷ School of Health and Life Sciences, University of the West of Scotland, Glasgow, Scotland, UK.
⁸ Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, The University of Sydney, Sydney, Australia.
⁹ Stockholm Gerontology Research Center, Stockholm, Sweden.
¹⁰ Institute for Sociology, University of Duisburg-Essen, Duisburg, Germany.
¹¹ Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg Centre for Person-Centred Care - GPCC, Gothenburg, Sweden.
¹² Department of Clinical Sciences, Division of Geriatric Medicine, Lund University, Lund, Sweden.
¹³ Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Sweden.
¹⁴ School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden.
¹⁵ Norrtälje Hospital, Vårdbolaget Tiohundra, Stockholm, Sweden.
¹⁶ Swedish Institute for Social Research (SOFI), Stockholm University, Stockholm, Sweden.
¹⁷ School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
¹⁸ School of Health and Welfare, Dalarna University, Falun, Sweden.
¹⁹ Department of Neurobiology, Care Sciences, and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden.
²⁰ Myndigheten för vård- och omsorgsanalys, Stockholm, Sweden.
²¹ Palliative Care Centre, Sahlgrenska University Hospital, Gothenburg, Sweden.
²² Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
²³ Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
²⁴ Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
²⁵ Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden.
²⁶ Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden.
²⁷ Department of Quality Assurance and Patient Safety, Sahlgrenska University Hospital, Gothenburg, Sweden.

PMID: 38664991
DOI: 10.1111/joim.13784

Abstract

Older adults have multiple medical and social care needs, requiring a shift toward an integrated person-centered model of care. Our objective was to describe and summarize Swedish experiences of integrated person-centered care by reviewing studies published between 2000 and 2023, and to identify the main challenges and scientific gaps through expert discussions. Seventy-three publications were identified by searching MEDLINE and contacting experts. Interventions were categorized using two World Health Organization frameworks: (1) Integrated Care for Older People (ICOPE), and (2) Integrated People-Centered Health Services (IPCHS). The included 73 publications were derived from 31 unique and heterogeneous interventions pertaining mainly to the micro- and meso-levels. Among publications measuring mortality, 15% were effective. Subjective health outcomes showed improvement in 24% of publications, morbidity outcomes in 42%, disability outcomes in 48%, and service utilization outcomes in 58%. Workshop discussions in Stockholm (Sweden), March 2023, were recorded, transcribed, and summarized. Experts emphasized: (1) lack of rigorous evaluation methods, (2) need for participatory designs, (3) scarcity of macro-level interventions, and (4) importance of transitioning from person- to people-centered integrated care. These challenges could explain the unexpected weak beneficial effects of the interventions on health outcomes, whereas service utilization outcomes were more positively impacted. Finally, we derived a list of recommendations, including the need to engage care organizations in interventions from their inception and to leverage researchers' scientific expertise. Although this review provides a comprehensive snapshot of interventions in the context of Sweden, the findings offer transferable perspectives on the real-world challenges encountered in this field.

Keywords: Sweden; integrated care; older people; person‐centered care.

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References

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Effectiveness of integrated person-centered interventions for older people's care: Review of Swedish experiences and experts' perspective

Affiliations

Effectiveness of integrated person-centered interventions for older people's care: Review of Swedish experiences and experts' perspective

Authors

Affiliations

Abstract

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources