The number of older people living with complex health conditions is increasing, with the majority of
these managed in primary and community settings. Many models of care have been developed to
support them, however there is mixed evidence on their value and they include multiple overlapping
components. We aimed to synthesise the ...
The number of older people living with complex health conditions is increasing, with the majority of
these managed in primary and community settings. Many models of care have been developed to
support them, however there is mixed evidence on their value and they include multiple overlapping
components. We aimed to synthesise the evidence to learn what works for managing complex
conditions in older people in primary and community care. We carried out a state-of-the-art review
of systematic reviews. We searched three databases (Jan 2009-Jul 2019) for models of primary and
community care for long-term conditions, frailty, multimorbidity and complex neurological
conditions common to older people such as dementia. We narratively synthesised review findings to
summarise the evidence for each model type and identify components which influenced
effectiveness. Out of 2129 unique titles and abstracts, 178 full texts were reviewed and 54
systematic reviews were included. We found that models of care were more likely to improve
depressive symptoms and mental health outcomes than physical health or service use outcomes.
Interventions including self-management, patient education, assessment with follow-up care
procedures, and structured care processes or pathways had greater evidence of effectiveness. The
level of healthcare service integration appeared to be more important than inclusion of specific
professional types within a team. However, more experienced and qualified nurses were associated
with better outcomes. These conclusions are limited by the overlap between reviews, reliance on
vote counting within some included reviews, and the quality of study reports. In conclusion, primary
and community care interventions for complex conditions in older people should include: (i) clear
intervention targets; (ii) explicit theoretical underpinnings; and (iii) elements of self-management
and patient education, structured collaboration between healthcare professionals and professional
support. Further work needs to determine the optimal intensity, length, team composition and role
of technology in interventions.
