How is complexity measured and detected among community dwelling older people aged 65 years and over? A scoping review

Abstract

AimTo identify and explore tools that measured and detected complexity of care among community dwelling people aged 65 years and older.Data SourcesDatabases were searched for articles published up to 23 September 2022 including CINAHL, EMBASE and MEDLINE, Cochrane database for trials and grey literature.MethodsA scoping review was conducted and reported in accordance with the PRISMA guidelines. Eligible articles included those with participants aged over 65 years, living in the community and studies that included care complexity detection or assessment and how this related to care delivered. Covidence was used to screen titles, abstracts and full‐text articles.ResultsEighteen full texts were reviewed; four studies were included in the final review. All selected studies included people aged over 65 years living in the community. A high level of reliability for the items included in the interventions was found. The selected studies included tools for assessing older person's needs with nurses involved in the assessment.ConclusionThe review identified four tools for measuring complexity in community dwelling older people. Two tools have the capacity to objectively measure complexity due to the holistic nature of items included and appear easy to use to support clinical judgement decisions.ImpactThe review places a spotlight on the concept of complexity and highlights the lack of definition of care complexity. The synthesized result highlights the need to explore detection of care complexity of older people further and consider ways of supporting clinical judgement and decision making of community nurses. The use of a validated tool may enhance clinical judgement regarding care complexity and may lead to a more consistent and timely approach to care.Patient or Public ContributionDuring the development phase, the study was presented to a consumer group from the researcher's workplace.Prospero RegistrationCRD42022299336.

Improving quality of care through detection for care complexity amongst community-dwelling older people receiving community nursing support: The ImPaCt study Randomised Controlled Trial

“…In community nursing services around the world there are various assessment processes and tools, but their efficacy has not been comprehensively examined (Boak et al, 2023;Lyndon et al, 2021). The role of the community nurse goes beyond the immediate needs of the client and includes with consideration of meeting the broader healthcare needs (Lyndon et al, 2021), which can be strengthened by adopting a systematic, objective assessment approach.…”

“…We conducted a scoping review to explore complexity of care of older people and how complexity of care was detected. The review demonstrated there are limited studies on the detection of the complexity of care, even though there was reference to the need to explore the concept further (Boak et al, 2023). The review found two comprehensive tools for objectively measuring complexity.…”

“…Whilst there is a need to recognise and consider complexity of care of older people in the community, a definition of this complexity is not well published in literature (Thomas, 2017). Through a scoping review a definition of complexity of care was found that has been adopted for this trial (Boak et al, 2023):…”