Navigation roles support chronically ill older adults through healthcare transitions: a systematic review of the literature

Abstract

What is known about this topic dSystem navigator roles for high-risk patients generally target populations whose medical condition and circumstances require support in accessing appropriate care. Concludes that the heterogeneity of models and interventions precludes direct comparison, but that navigators may be effective in assisting older patients as they transition between healthcare settings and in diverting older patients with serious and persistent medical conditions, from higher levels of care. AbstractTransitions between various healthcare services are potential points for fragmented care and can be confusing and complicated for patients, formal and informal caregivers. These challenges are compounded for older adults with chronic disease, as they receive care from many providers in multiple care settings. System navigation has been suggested as an innovative strategy to address these challenges. While a number of navigation models have been developed, there is a lack of consensus on the desired characteristics and effectiveness of this role. We conducted a systematic literature review to describe existing navigator models relevant to chronic disease management for older adults and to investigate the potential impact of each model. Relevant literature was identified using five electronic databases -Medline, CINAHL, the Cochrane database, Embase and PsycINFO between January 1999 and April 2011. Following a recommended process for health services research literature reviews, exclusion and inclusion criteria were applied to retrieved articles; 15 articles documenting nine discrete studies were selected. This review suggests that the role of a navigator for the chronically ill older person is a relatively new one. It provides some evidence that integrated and coordinated care guided by a navigator, using a variety of interventions such as care plans and treatment goals, is beneficial for chronically ill older adults transitioning across care settings. There is a need to further clarify and standardise the definition of navigation, as well as a need for additional research to assess the effectiveness and cost of different approaches to the health system.

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT

“…196 There are some previous community care navigation or home-based nursing services that have covered the domains found within our work and previous work, using care co-ordination, signposting or providing psychosocial support. 197,198 However, although older people felt that this was valuable, 199 few of these services were targeted at a mildly frail population, were sustained over time and focused on motivating people to maintain or change health-promoting behaviours, which was raised as a particular challenge in this population. Therefore, the newly developed HomeHealth service has the potential to fill these gaps within health promotion services for frailty prevention.…”

Janus at the Crossroads: Perspectives on Long-term Care Trajectories for Older Women With Dementia in a Canadian Context

“…Reducing unnecessary transitions is a recognized solution supporting quality of life and minimizing the likelihood of negative health outcomes (Manderson et al, 2012). It is difficult to quantify whether our mothers experienced more care-related transitions than other women with dementia.…”

“…For some, the slower pace of change can make it harder to recognize their palliative status, thereby restricting access to specialized, end-oflife services when needed (Covinsky et al, 2003). Research also indicates that persons with dementia experience more care transitions than others (Coleman & Boult, 2003) and have a higher risk of adverse events such as medication errors, hospitalizations, stress and anxiety, and other problems than those without the disease (Manderson et al, 2012). Although most individuals with dementia are cared for at home, the progression of the disease often leads to higher levels of care (McCabe, You, & Tatangelo, 2016), with increased likelihood of institutionalization over time (Eska et al, 2013).…”

Is Australian primary care practice equipped to provide multimorbidity care?

“…Multiple long term conditions are associated with a wide range of adverse outcomes for individuals and the health system. These included: increased health service use (14,56,79,(89)(90)(91)(92), polypharmacy (56,90,(93)(94)(95)(96), hospital admissions (14,79,89,90,97,98), out-of-pocket expenses (99-103), and psychological distress (79,93,(104)(105)(106), along with reductions in physical functioning (79,(107)(108)(109)(110)(111)(112), quality-of-life (14,79,(113)(114)(115)(116)(117), employability (118)(119)(120),and continuity of care (56,93,121,122).…”

“…This burden is compounded by lack of collaboration and coordination between providers, and provision of contradictory or incomplete advice (93,205,(207)(208)(209). Care may be fragmented and incomplete as patients transition from one clinician to another (13,20,93,111,121,(207)(208)(209)(210).…”