Achieving Family-Integrated Care for Older Patients with Major Neurodegenerative and Mental Health Conditions: A Systematic Review of Intervention Characteristics and Outcomes
Abstract
1. Introduction
- -
- How do the studies describe the integration of family carers in health services delivery for community-dwelling and hospital-admitted OPNMHCs?
- -
- What is the evidence of impact that family-integrated care models produce on OPMHNCs’ health and wellbeing?
2. Materials and Methods
2.1. Review Design
2.2. Search Strategy
2.3. Inclusion and Exclusion Criteria
2.4. Quality Appraisal
2.5. Data Extraction and Analysis
Author (Year) and Country | Study Design | Study Settings | Study Participants | Integration of Family in Service Delivery | Outcomes | MMAT Scores | ||||
---|---|---|---|---|---|---|---|---|---|---|
Focus on Family-Integrated Care | Mechanisms into Family Integration | Level of Integration in Service Provision | Demographics and Health Problems Dealt with | Health and Wellbeing Outcomes | Satisfaction with Care Involving Family Carers | |||||
Fortinsky et al., (2020); USA [29] | Stratified randomization design; psychometric testing, telephonic interviews | Community settings, including in-home care for community-dwelling older adults | 576 members (participants included older adults aged over 65 with cognitive vulnerability, such as dementia, depression, and/or delirium) and 380 caregivers | To help shape the care model, provide personal experience and expertise, and refine the intervention |
| Screening and Clinical Assessment:
| Demographics:
| Statistically Significant Outcomes: A prior intervention that included home assessments and visits for older adults at high risk of hospitalization showed a 7–38% reduction in similar outcomes over a 1–2-year period Psychological Wellbeing Outcomes:
| Involves primary care providers and mental health specialists, Problem-Solving Therapy Successful Outcomes: Reduction in depressive symptoms and other health-related outcomes important to patients Patient Satisfaction: Study participants reported high levels of satisfaction with treatment provided by clinicians trained as depression care specialists | 5 |
Boltz et al., (2014); USA [30] | Comparative repeated measures design; psychometric testing (pen and paper questionnaire) | Three medical units of a community teaching hospital in the Northeast US | 97 dyads (patients and FCGs) |
|
| Screening:
Jointly developed bedside goals and care plans that support functional recovery and prevention of complications, updated daily with assigned nursing staff, FCG, and patient Treatment plan implementation: FCGs were involved in direct care activities, including cognitive stimulation, assistance with meals, bathing/showering, hygiene, and walking Rehabilitation: Emphasis on collaboration with other disciplines, including rehabilitation Tools used in service delivery: Discharge teaching and planning incorporating function-focused care dimensions in addition to management of the medical condition | Patient Characteristics:
Cognitive impairment: delirium, depression | Statistically Significant Outcomes:
There was no significant effect of the intervention on Tinetti Gait and Balance (F(1.4) = 1.9, p = 0.173) Psychological Wellbeing Outcomes:
|
| 2 |
Dening et al., (2019); UK [31] | User-centred design (UCD) methodology (5) | Dementia UK and De Montfort University in Leicester, UK | Stakeholder group sizes:
| To ensure that care planning reflects the practical and emotional needs of both patients and caregivers, aiming to reduce stress and improve outcomes | A user-centred design (UCD) methodology was employed to develop the ACP guide and template. This method involves active involvement of end users (families affected by dementia) during the analysis and design process Focus groups, electronic feedback, and iterative testing with families were part of the process to refine the ACP guide and template |
The study used a co-design approach under the UCD methodology, actively involving families in every step of creating the ACP tools Feedback was gathered iteratively from families, professionals, and stakeholders Screening/Clinical Assessment: focusing on identifying preferences and needs through structured discussions, but it did not involve clinical diagnostic tools. Treatment Plan Development:
Families participated in implementing the treatment plan by field-testing the ACP guide and providing feedback on its usability and relevance Tools used: Tools like structured communication protocols and the ACP guide/template were used to support integration | Demographics:
Indirect physical wellbeing outcomes were implied through improved caregiving coordination and communication | Statistically Significant Outcomes Positive health outcomes include improved communication, relationship maintenance, and reduced psychological stress. These contribute to the quality of life but are not described with statistical significance Psychological Wellbeing Outcomes: reduced anxiety and enhanced coping abilities for families and patients. ACP discussions help mitigate stress and improve emotional preparedness |
| 5 |
Gitlin et al. (2008); USA [32] | A prospective, two-group controlled pilot study | Home settings | 60 dyads (dementia patients and their caregivers) |
|
|
| Demographics:
| Statistically Significant Health Outcomes:
Depressed mood: there was no significant effect found for depressed mood; there was a slight decrease in the number of reported behaviours for TAP participants compared to controls (for whom the number of behaviours increased), but the difference did not reach statistical significance Psychological and Physical Wellbeing Outcomes: Tailored activities: activities tailored to the cognitive capacity and interests of dementia patients resulted in symptom reduction by enhancing role identity and helping dementia patients express themselves positively; life-long activities were modified to match patient abilities, minimizing frustration and fostering positive engagement |
| 2 |
Budgett et al., (2024); UK [33] | Randomized controlled trial (RCT) with qualitative content analysis | Urban and regional areas across England, including National Health Service (NHS) trust memory clinics, older adult mental health services, general practitioner practices | People Living with Dementia (PLWD): n = 302 Family carers: n = 302 | To explore priorities related to living well at home:
|
| Screening as Part of Clinical Assessment: Baseline assessments involved identifying the unmet needs of PLWD and carers, including cognitive, mood, and behavioural domains
| Demographics: Participants: People Living with Dementia (PLWD): n = 302 Family carers: n = 302 Age: PLWD: mean age = 79.9 years Carers: mean age = 63.4 years Gender: PLWD: Male = 44%, Female = 56% Carers: Male = 29.8%, Female = 70.2% Ethnicity: Majority White (88.1%), with smaller representations from Mixed (1.3%), Asian (5.6%), and Black (3.6%) communities. Dementia Diagnoses: Alzheimer’s disease = 46.0% Vascular dementia = 12.6% Lewy body dementia = 3.3% Frontotemporal dementia = 2.6% Other = 27.8% Unspecified = 7.6% Health Problems Addressed: Mood: Reducing anxiety/worry and improving interest/initiative in activities for better mental stimulation Behaviour: Increasing positive interactions and reducing or coping with repetitive or unsafe behaviours Self-Care: Goals included managing pain, improving mobility, and addressing resistance or distress during personal care Cognition: Improving memory, managing repetitive questions, and coping with concentration or orientation problems Physical Health: Managing limited walking ability and promoting activities like leaving the house twice a week Improving fluid intake and appetite to address weight loss or other nutritional concerns | Statistically Significant Outcomes: Improvement in Mood: Goals in this domain focused on improving the PLWD’s interest, initiative, and engagement in activities to improve mood One goal aimed for a PLWD to ‘leave the house without anxiety symptoms lasting longer than 3 min, twice a week or more’ Positive Behaviour Changes: Increasing positive social interactions with others was a key goal, such as ‘having social contact with family or friends (other than the primary carer) once a week for at least 15 min’ Self-Care and Mobility: A goal for self-care included ‘reducing distress during personal care sessions’ and improving physical health, such as ‘getting out of the house at least two times a week’ Psychological Wellbeing Outcomes: Goals related to reducing anxiety, such as ‘PLWD can leave the house without anxiety symptoms lasting longer than 3 min,’ showed significant psychological benefits Goals also targeted reducing frequency or intensity of low mood and engaging PLWD in stimulating activities Physical and psychological outcomes were linked, e.g., improving mobility to participate in activities contributed to psychological wellbeing | Satisfaction with Interventions:
| 5 |
Gitlin et al., (2001); USA [34] | Randomized, controlled trial | Home settings | 171 family caregivers of dementia patients | To provide caregivers with practical skills and mechanisms to exert control over difficult situations, targeting caregiver upset and self-efficacy |
|
| Demographics:
| Statistically Significant Outcomes: Regarding outcomes related to dementia patients, there was a statistically significant effect in one of the three outcomes studied; caregivers in the experimental group reported less decline in IADL dependence in the person with dementia compared to the control group caregivers (p = 0.03) Non-Statistically Significant Outcomes:
|
| 2 |
Kelley et al. (2019); UK [35] | Qualitative ethnographic design. Data collection methods included participant observations, informal conversations, and in-depth semi-structured interviews | Two carers of older people acute hospital wards in two cities in the north of England Specific settings: An 18-bedded rehabilitation ward A 24-bedded general hospital ward | n = 12 people with dementia were purposefully sampled; relatives and friends included 8 daughters, 2 husbands, 2 sons, 2 granddaughters, 1 wife, and 1 friend; hospital staff: n = 23, including doctors, nurses, healthcare assistants, and therapists (e.g., physiotherapists and occupational therapists) | To explore the involvement of families in the hospital care of people living with dementia | Patient-Oriented Research: Observational ethnographic approach involving participant observations, informal conversations, and semi-structured interviews Direct Family Engagement: Families provided critical input on patient care routines, preferences, and communication methods
| Screening: Families were indirectly involved in screening and assessments by providing background knowledge and observations on the patient’s condition Example: Families could hold crucial information for interpreting the needs of people living with dementia, families’ input in hospital records highlighted potential health deviations Treatment Plan Development: Family contributions included sharing patient preferences and routines, which informed treatment adjustments Information from families could help maintain connections to usual routines by informing personalisation of care routines Treatment Plan Implementation: Families were actively involved in care delivery, especially for activities like feeding, dressing, and encouraging participation in therapy tasks Example: some families directly helped administer medications when staff struggled Rehabilitation: Families played a role in rehabilitation by engaging patients in familiar routines or activities that supported recovery, such as playing games or continuing hobbies like photography Tools Used:
| Demographics:
| Positive Health Outcomes: Families’ knowledge could also help staff engage people living with dementia in activities such as assessments and therapy tasks, leading to better participation and outcomes Families recognized signs that their relative was more unwell or in need, even when the person had significant communication difficulties Non-Statistically Significant Outcomes: Negative Health Impacts: Prolonged disruptions to familiar routines and levels of functioning could exacerbate confusion and cause the person to lose, through lack of practice, connections to valuable abilities Irreversible functional decline could lead to increased care post-discharge, including residential care, causing further disconnections from previous life Psychological Wellbeing Outcomes: Positive Psychological Outcomes: Families’ involvement often created a sense of comfort for people living with dementia, lessening the unfamiliarity of ward environments and routines Maintaining family connections during hospitalization was a key concern for people living with dementia, many of whom attached great value to these relationships and the opportunities visiting times offered to maintain them People who were distressed or anxious had a particularly high need for connection with others. Family involvement helped alleviate fear and distress Negative Psychological Outcomes: A lack of interaction and stimulating features in hospital environments could lead to feelings of disorientation, distress, and confusion A lack of staff presence or time to interact was linked to an increased risk of agitation and falls | Satisfaction of Family Members Improved Satisfaction: Families spoke positively about being able to contribute to care by providing personal items or helping with daily tasks like feeding and dressing, which allowed them to feel involved and reassured about the quality of care Families appreciated staff efforts to include them in conversations about care routines and discharge planning Dissatisfaction: Families sometimes expressed frustration with restricted visiting hours and the lack of clear guidelines about how they could contribute to care
| 5 |
Black et al., (2013); USA [36] | Cross-sectional | Urban, Maryland | Community-residing people with dementia (PWD): n = 254 Informal caregivers: n = 246 | The study emphasizes the importance of family members and friends in the care of community-residing individuals with dementia | Integration was achieved through various caregiver tasks, including assisting with ADLs, managing safety and behavioural symptoms, coordinating services, facilitating health care visits, and advocating for the individual with dementia |
| Demographics: community-residing persons with dementia (PWD): n = 254; informal caregivers: n = 246 Health Issues Dealt With: dementia | Statistically Significant Outcomes:
Cognitive function and unmet needs: unmet needs in PWD were significantly greater among those with higher cognitive function | Unmet needs in caregivers: over 85% of caregivers had unmet needs for referrals to community resources and caregiver education on topics such as how dementia affects individuals and their loved ones, availability of community-based services, caregiver skills Mental health domain: 45% of caregivers had unmet needs in the mental health domain, with most requiring emotional support or respite care | 2 |
Carnevale et al., (2002); USA [37] | Repeated measures randomized design with three groups (control, education only, education plus behaviour management) | Community settings in northeastern New Jersey | Persons with brain injury with their caregiver: n = 27 each | To address unmet caregiver needs and manage caregiver burden associated with TBI-related neurobehavioral challenges | Community-delivered behaviour management program (NSBM) with educational and interventional modules |
| Demographics:
| Statistically Significant Outcomes:
|
| 2 |
Woods et al., (2016); United Kingdom [38] | Pragmatic multi-centre randomised controlled trial | Community settings, primarily in urban and regional areas | Total days that completed the study: 350 | To assess the effectiveness and cost-effectiveness of joint reminiscence groups | Patient-oriented research involving joint reminiscence groups for people with dementia and their carers | Screening or Assessment: Families were involved as informants in the clinical assessment of participants’ eligibility (e.g., DSM-IV criteria for dementia) Treatment Plan Development: Each session blended work in large and small groups, and a range of activities including art, cooking, physical re-enactment of memories, singing and oral reminiscence Treatment Plan Implementation: Carers participated directly in delivering the intervention by engaging in group sessions with their family members Carers were guided to value their contribution by allowing the person with dementia to actively participate Tools Used: Clifton Assessment Procedures for the Elderly (used in clinical screening for dementia)
| Demographics: Of the people with dementia, 242 (50%) were female, 447 (95%) were of white ethnicity, 337 (72%) were married, and mean age was 77.5 (SD 7.3) The carers comprised 325 (67%) females, 448 (96%) of white ethnicity, 345 (74%) were caring for their spouse, and mean age was 69.7 (SD 11.6) Health Problems Dealt With: Focused on mild to moderate dementia diagnosed using DSM-IV criteria | Statistically Significant Outcomes: Increased anxiety in carers at the ten-month endpoint was statistically significant Carers of people with dementia allocated to the reminiscence intervention had significantly increased anxiety on the General Health Questionnaire-28 sub-scale at the ten-month endpoint (mean difference 1.25, F = 8.28, p = 0.04) Non-Statistically Significant Outcomes: No significant differences in primary outcomes (e.g., quality of life for the person with dementia, carer mental health) between intervention and control groups The intention to treat analyses indicated there were no differences in outcome between the intervention and control conditions on primary outcomes at the ten-month endpoint (self-reported QoL-AD mean difference 0.07, F = 0.48, p = 0.53) No significant differences in secondary outcomes like daily living activities, depression, or relationship quality There were no significant differences in secondary outcome measures, at either ten or three-month endpoints Psychological Wellbeing Outcomes Limited psychological benefits for carers Carers showed increased stress related to caregiving associated with more sessions attended Some benefits for people with dementia who attended sessions Compliance analyses suggested improved autobiographical memory, quality of life, and relationship quality for people with dementia attending more reminiscence sessions | Satisfaction of Family Members: Of 215 participants responding to a feedback survey at the end of the weekly groups, all but 3 said that they would recommend the program to a friend Families reported enjoyment despite lack of clinical improvement
| 2 |
Schoenmakers et al., (2010); Belgium [39] | Randomized controlled trial (RCT), quasi design; interviews; psychometric testing | Community-dwelling elder in a mixed rural-city area of Leuven, Belgium | Initial screening: 346 Included in the trial: 62 Follow-up interviews after six months: 52 Follow-up interviews after twelve months: 46 | Intervention of a care counsellor, coordinating home care in a non-hierarchical and quasi-unstructured way for one year, will alleviate carers’ feelings of depression |
| Screening: Tools used: Mini Mental State Examination (MMSE), Zarit Burden Inventory, Ways of Coping Checklist, Stai-instrument for anxiety Treatment Plan Development:
|
| Statistically Significant Outcomes: Depression: one year after the start of the intervention, the odds ratio for depression in the treatment group versus the control group was 0.16 (95% CI 0.03–0.86); sequential analysis showed no significant change in the odds ratio for depression when considering gender and relationship status Psychological Wellbeing Outcomes for Patients:
|
| 2 |
Manning et al., (2020); USA [40] | Experimental study; interview; psychometric test | NA | 105 people with dementia and their caregivers | To address the increased morbidity and poorer health among caregivers and to mitigate negative biopsychosocial impacts and prevent institutional placements | Care coordination involves education, support, guidance, and access to resources | Treatment plan development: Families received guidance and support but not specifically involved in co-designing services | Demographics: participants included 105 people with dementia, of whom 54.3% were women; 67.3% of the caregivers were women Health Problems Dealt With: Dementia | Statistically Significant Outcomes:
|
| 2 |
Lennaerts et al., (2017); Netherlands [41] | Mixed methods study, including:
| Hospitals General practices Nursing homes Focused coverage via ParkinsonNet in urban and regional settings | 5–15 patients with advanced Parkinson’s disease and their family caregivers, bereaved family caregivers, and 10 professionals from various disciplines | To explore patients’ unmet needs and involvement in care provision | Patient-oriented research using interviews and questionnaires | Screening Involvement: Patients will be included based on an affirmative answer from the attending physician on the so-called ‘surprise question’ Family caregivers will also complete questionnaires like the Zarit Burden Interview (ZBI) to assess caregiver burden Assessment Tools: Zarit Burden Interview (ZBI): used for assessing caregiver burden Edmonton Symptom Assessment Scale (ESAS-PD): used for patient symptoms but involved family caregivers for corroboration Treatment Plan Development:
Caregivers supported patients during interviews and provided information about their needs | 1. Demographics: The study collected comprehensive socio-demographic data for all participants, ensuring diversity in experiences. Participants included patients, family caregivers, and bereaved caregivers, primarily from the Netherlands Participants include 5–15 patients with advanced Parkinson’s disease and their family caregivers, bereaved family caregivers, and 10 professionals from various disciplines 2. Health Problems Addressed: Parkinson’s disease, targeting symptoms, such as motor difficulties, cognitive impairments, psychological symptoms (e.g., depression, hallucinations), and caregiver burden 3. Physical Wellbeing Outcomes: Outcomes were evaluated using validated tools like ESAS-PD and FACT-G to assess physical symptoms and functional wellbeing, alongside quality-of-life questionnaires tailored to Parkinson’s disease | Positive Health Outcomes:
| Caregiver Satisfaction: Caregivers expressed a lack of satisfaction due to poor coordination of palliative care services | 4 |
Livingston et al., (2020); UK [42] | Randomized controlled trial (RCT). It is a parallel-group, single-blind superiority trial | The study was conducted across four sites in the UK: A large city mental health trust A semi-rural area trust A tertiary neurological clinic for rare and young-onset dementia A mental health trust with specialist nurse services (admiral nurses) | Total participants: 260 family carers Intervention group: 173 carers Control group: 87 carers (treatment as usual) Participants were self-identified family carers of individuals diagnosed with dementia | To evaluate the effectiveness of the START (STrAtegies for RelaTives) intervention over six years, aiming to alleviate their anxiety and depressive symptoms | The START multicomponent intervention for family carers is individually delivered by supervised psychology graduates (with a first degree in psychology and no clinical training) and was tested by our research team in a randomised controlled trial (RCT) Therapists worked with carers to identify individual difficulties and implement strategies including behavioural management, communication strategies, identifying and changing unhelpful thoughts, positive reframing, accessing support, future planning, and increasing pleasant events | Screening: We collected carer and patient sociodemographic details at baseline and measured dementia severity using the Clinical Dementia Rating We also administered the Neuropsychiatric Inventory (NPI), as neuropsychiatric symptoms have been shown to be associated with carer psychological morbidity and the Zarit Burden Interview Treatment Plan Development: Each session included a relaxation exercise, and we asked carers to put into practice the individualized strategies and relaxation between sessions. The final session was used to agree on a plan of what to do in the future based upon what that carer had felt worked Patients in both groups received TAU (treatment as usual) and the use of services in both groups has been described in detail Treatment Plan Implementation: Therapists worked with carers to implement strategies including behavioural management, communication strategies, and positive reframing Tools Used: Screening tools: Clinical Dementia Rating, Neuropsychiatric Inventory (NPI), Zarit Burden Interview, Hospital Anxiety and Depression Scale (HADS) | Demographics: We recruited 260 participants to study Carers were mostly spouses/partners (109; 42%) or children (113; 44%) Health Problems Dealt With: Focus on dementia’s impact, including carers’ mental health challenges such as anxiety and depression Physical Wellbeing Outcomes: Time spent at home (median time until death or admission to care): START group = 42.2 months vs. TAU group = 39.0 months, though not statistically significant There were no significant group differences in patient-related physical health outcomes, such as time to care home admission or death rates | Statistically Significant Health Outcomes: Analysis of HADS-T, adjusting for centre, baseline score, time, and factors related to outcome (carer age and gender, NPI, Zarit) over the 6-year period, showed an average improvement in HADS-T of 2.00 points compared with TAU (95% CI −3.38 to −0.63; p = 0.005) Fully adjusted models for HADS-D and HADS-A continuous scores indicated significant beneficial intervention effects over 6 years, with average decreases of −1.06 (95% CI −1.78 to −0.35) for depression and −0.97 (95% CI −1.78 to −0.15) for anxiety Non-Statistically Significant Health Outcomes: Reduction in HADS-anxiety cases, however, was not significant (OR = 0.50, 95% CI: 0.24–1.07, p = 0.07) Time until care home admission or death showed no significant between-group differences (Intensity Ratio 0.88, 95% CI 0.58–1.35) Psychological Wellbeing Outcomes: The START intervention reduced depressive and anxiety symptoms of family carers of relatives with dementia at home over 2 years and was cost-effective In the intervention group, carers were five times less likely to have clinically significant depression on a validated rating scale Specific Observations: Improvements in anxiety and depression scores for family carers as measured by HADS (Hospital Anxiety and Depression Scale) Sustained improvements over six years in depression and anxiety outcomes for family carers | Carers reported satisfaction with the intervention, emphasizing its role in providing practical coping mechanisms and improved quality of life | 2 |
3. Results
3.1. The Study Characteristics
3.2. An Overview of the Fourteen Included Studies Is Provided in Table 3
3.3. Identified Themes
3.3.1. Family Participation in Service Delivery
3.3.2. Patient Health and Wellbeing Outcomes
3.3.3. Satisfaction with Care Involving Family Members
3.3.4. Service Dynamics in Enabling Family-Integrated Care to Be Successful
4. Discussion and Conclusions
Implications for Policy and Clinical Practice
- Frameworks must mandate a collaborative approach that treats family carers as essential partners in care. This includes structured processes for their involvement in goal setting, care planning, and decision making, moving beyond peripheral tasks.
- To prevent burnout and enhance carer efficacy, services must provide formal training and ongoing support. As shown in several reviewed interventions [32,39], providing carers with specific skills in behavioural management, communication, and navigating the health system leads to better outcomes for both the carer and the patient.
- Policymakers should consider developing comprehensive training programs and increasing financial and respite support for family carers. Healthcare organisations must allocate dedicated staff time and resources to facilitate meaningful partnerships between families and professionals, which are critical for effective collaboration.
- Future models should standardise the inclusion of family carers while allowing for flexibility in the implementation to meet the diverse and complex needs of individual OPNMHCs and their families. Adopting such a structured yet person-centred approach can significantly enhance outcomes for OPNMHCs and reduce the burden often experienced by those providing care.
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Hou, Y.; Dan, X.; Babbar, M.; Wei, Y.; Hasselbalch, S.G.; Croteau, D.L.; Bohr, V.A. Ageing as a risk factor for neurodegenerative disease. Nat. Rev. Neurol. 2019, 15, 565–581. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. International Classification of Diseases, Eleventh Revision (ICD-11). Available online: https://icd.who.int/browse/2025-01/mms/en (accessed on 13 May 2025).
- Giri, P.M.; Banerjee, A.; Ghosal, A.; Layek, B. Neuroinflammation in neurodegenerative disorders: Current knowledge and therapeutic implications. Int. J. Mol. Sci. 2024, 25, 3995. [Google Scholar] [CrossRef]
- Clinical Practice Guidelines and Principles of Care for People with Dementia; Guideline Adaptation Committee: Sydney, Australia. 2016. Available online: https://cdpc.sydney.edu.au/wp-content/uploads/2019/06/CDPC-Dementia-Guidelines_WEB.pdf (accessed on 13 May 2025).
- Sherman, D.W.; Alfano, A.R.; Alfonso, F.; Duque, C.R.; Eiroa, D.; Marrero, Y.; Muñecas, T.; Radcliffe-Henry, E.; Rodriguez, A.; Sommer, C.L. A systematic review of the relationship between social isolation and physical health in adults. Healthcare 2024, 12, 1135. [Google Scholar] [CrossRef]
- World Health Organization. Primary Health Care. Available online: https://www.who.int/health-topics/primary-health-care (accessed on 13 May 2025).
- Carers Australia. Who Is a Carer? Available online: http://carersaustralia.com.au/about-carers/who-is-a-carer/ (accessed on 13 May 2025).
- Levoy, K.; Rivera, E.; McHugh, M.; Hanlon, A.; Hirschman, K.B.; Naylor, M.D. Caregiver engagement enhances outcomes among randomized control trials of transitional care interventions. Med. Care 2022, 60, 519–529. [Google Scholar] [CrossRef] [PubMed]
- Boltz, M.; Chippendale, T.; Resnick, B.; Galvin, J.E. Anxiety in family caregivers of hospitalized persons with dementia. Alzheimer Dis. Assoc. Disord. 2015, 29, 236–241. [Google Scholar] [CrossRef] [PubMed]
- Surr, C.A.; Griffiths, A.W.; Kelley, R. Implementing Dementia Care Mapping as a practice development tool in dementia care services: A systematic review. Clin. Interv. Aging 2018, 13, 165–177. [Google Scholar] [CrossRef]
- U.S. Department of Veterans Affairs. Caregivers: REACH VA Program. Available online: https://www.research.va.gov/topics/caregivers.cfm (accessed on 13 May 2025).
- Waddington, C.; Van Veenendaal, N.R.; O’Brien, K.; Patel, N. Family integrated care: Supporting parents as primary caregivers in the neonatal intensive care unit. Pediatr. Investig. 2021, 5, 148–154. [Google Scholar] [CrossRef]
- MacDonald, S.; Grand, N.; Caspar, N. Clinical features and multidisciplinary approaches to dementia care. J. Multidiscip. Healthc. 2011, 4, 125–147. [Google Scholar] [CrossRef]
- World Health Organization. Global Strategy and Action Plan on Ageing and Health. Available online: https://iris.who.int/bitstream/handle/10665/329960/9789241513500-eng.pdf (accessed on 13 May 2025).
- Aged Care Quality and Safety Commission. Partnerships in Care: Fact Sheet for Family and Friends of Those in Residential Aged Care. Available online: https://www.agedcarequality.gov.au/sites/default/files/media/partnerships-in-care-fact-sheet.pdf (accessed on 13 May 2025).
- Gwaza, E.; Msiska, G. Family involvement in caring for inpatients in acute care hospital settings: A systematic review of literature. SAGE Open Nurs. 2022, 8, 23779608221089541. [Google Scholar] [CrossRef]
- Rodakowski, J.; Rocco, P.B.; Ortiz, M.; Folb, B.; Schulz, R.; Morton, S.C.; Leathers, S.C.; Hu, L.; James, A.E., III. Caregiver integration during discharge planning for older adults to reduce resource use: A meta-analysis. J. Am. Geriatr. Soc. 2017, 65, 1748–1755. [Google Scholar] [CrossRef]
- Manias, E.; Bucknall, T.; Hughes, C.; Jorm, C.; Woodward-Kron, R. Family involvement in managing medications of older patients across transitions of care: A systematic review. BMC Geriatr. 2019, 19, 95. [Google Scholar] [CrossRef] [PubMed]
- Liu, W.; Qin, R.; Zhang, X.; Li, G.; Qiu, Y.; Huang, K.; Li, X.; Chen, L.; Xiao, J. Effectiveness of integrated care for older adults-based interventions on depressive symptoms: A systematic review and meta-analysis. J. Clin. Nurs. 2024, 33, 3737–3751. [Google Scholar] [CrossRef] [PubMed]
- Wei, A.; Bell, J.; Locke, J.; Roach, A.; Rogers, A.; Plys, E.; Zaguri-Greener, D.; Zisberg, A.; Lopez, R.P. Family involvement in the care of nursing home residents with dementia: A scoping review. J. Appl. Gerontol. 2024, 43, 1772–1784. [Google Scholar] [CrossRef] [PubMed]
- Phillips, R.; Durkin, M.; Engward, H.; Cable, G.; Iancu, M. The impact of caring for family members with mental illnesses on the caregiver: A scoping review. Health Promot. Int. 2022, 38, daac049. [Google Scholar] [CrossRef]
- Schardt, C.; Adams, M.B.; Owens, T.; Keitz, S.; Fontelo, P. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med. Inform. Decis. Mak. 2007, 7, 16. [Google Scholar] [CrossRef]
- Cooper, H.M. Scientific Guidelines for Conducting Integrative Research Reviews. Rev. Educ. Res. 1982, 52, 291. [Google Scholar] [CrossRef]
- Whittemore, R.; Knafl, K. The integrative review: Updated methodology. J. Adv. Nurs. 2005, 52, 546–553. [Google Scholar] [CrossRef]
- Hong, Q.N.; Fàbregues, S.; Bartlett, G.; Boardman, F.; Cargo, M.; Dagenais, P.; Gagnon, M.; Griffiths, F.; Nicolau, B.; O’Cathain, A.; et al. The Mixed Methods Appraisal Tool (MMAT) version 2018. Educ. Inf. 2018, 34, 285–291. [Google Scholar] [CrossRef]
- Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Shamseer, L.; Tetzlaff, J.M.; Akl, E.A.; Brennan, S.E.; et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021, 372, n71. [Google Scholar] [CrossRef]
- Blackberry, I.; Rasekaba, T.; Morgan, D.; Royals, K.; Greenhill, J.; Perkins, D.; O’Connell, M.; Hamiduzzaman, M.; Winbolt, M.; Robinson, A.l.; et al. Virtual dementia-friendly communities (verily connect) stepped-wedge cluster-randomised controlled trial: Improving Dementia Caregiver Wellbeing in Rural Australia. Geriatrics 2023, 8, 5. [Google Scholar] [CrossRef]
- Braun, V.; Clarke, V. Thematic analysis. In APA Handbook of Research Methods for Psychology, Vol. 2: Research Designs: Quantitative, Qualitative, Neuropsychological, and Biological; Cooper, H., Camic, P.M., Long, D., Panter, A.T., Rindskopf, D., Sher, K.J., Eds.; American Psychological Association: Washington, DC, USA, 2012; pp. 57–71. [Google Scholar] [CrossRef]
- Fortinsky, R.H.; Kuchel, G.A.; Steffens, D.C.; Grady, J.; Smith, M.; Robison, J.T. Clinical trial testing in-home multidisciplinary care management for older adults with cognitive vulnerability: Rationale and study design. Contemp. Clin. Trials 2020, 92, 105992. [Google Scholar] [CrossRef] [PubMed]
- Boltz, M.; Resnick, B.; Chippendale, T.; Galvin, J. Testing a family-centered intervention to promote functional and cognitive recovery in hospitalized older adults. J. Am. Geriatr. Soc. 2014, 62, 2398–2407. [Google Scholar] [CrossRef]
- Dening, K.H.; Castle, E.; Scates, C.; De Vries, K. Advance care plans in dementia: User-centred design. BMJ Support. Palliat. Care 2019, 10, e38. [Google Scholar] [CrossRef] [PubMed]
- Gitlin, L.N.; Winter, L.; Burke, J.; Chernett, N.; Dennis, M.P.; Hauck, W.W. Tailored activities to manage neuropsychiatric behaviors in persons with dementia and reduce caregiver burden: A randomized pilot study. Am. J. Geriatr. Psychiatry 2008, 16, 229–239. [Google Scholar] [CrossRef] [PubMed]
- Budgett, J.; Sommerlad, A.; Kupeli, N.; Zabihi, S.; Rockwood, K.; Cooper, C. Personalized goals of people living with dementia and family carers: A content analysis of goals set within an individually tailored psychosocial intervention trial. Alzheimers Dement. Transl. Res. Clin. Interv. 2024, 10, e12493. [Google Scholar] [CrossRef]
- Gitlin, L.N.; Corcoran, M.; Winter, L.; Boyce, A.; Hauck, W.W. A randomized, controlled trial of a home environmental intervention. Gerontologist 2001, 41, 4–14. [Google Scholar] [CrossRef]
- Kelley, R.; Godfrey, M.; Young, J. The impacts of family involvement on general hospital care experiences for people living with dementia: An ethnographic study. Int. J. Nurs. Stud. 2019, 96, 72–81. [Google Scholar] [CrossRef]
- Black, B.S.; Johnston, D.; Rabins, P.V.; Morrison, A.; Lyketsos, C.; Samus, Q.M. Unmet needs of community-residing persons with dementia and their informal caregivers: Findings from the maximizing independence at home study. J. Am. Geriatr. Soc. 2013, 61, 2087–2095. [Google Scholar] [CrossRef]
- Carnevale, G.J.; Anselmi, V.; Busichio, K.; Millis, S.R. Changes in ratings of caregiver burden following a community-based behavior management program for persons with traumatic brain injury. J. Head Trauma Rehabil. 2002, 17, 83–95. [Google Scholar] [CrossRef]
- Woods, R.T.; Orrell, M.; Bruce, E.; Edwards, R.T.; Hoare, Z.; Hounsome, B.; Keady, J.; Moniz-Cook, E.; Orgeta, V.; Rees, J.; et al. REMCARE: Pragmatic multi-centre randomised trial of reminiscence groups for people with dementia and their family carers: Effectiveness and economic analysis. PLoS ONE 2016, 11, e0152843. [Google Scholar] [CrossRef]
- Schoenmakers, B.; Buntinx, F.; Delepeleire, J. Supporting family carers of community-dwelling elder with cognitive decline: A randomized controlled trial. Int. J. Fam. Med. 2010, 2010, 184152. [Google Scholar] [CrossRef] [PubMed]
- Manning, C.A.; Boyd, E.; Fields, S.; Sperling, S.A.; Tsang, S. A novel care model for dementia: Improving caregiver burden and depression. Alzheimers Dement. 2020, 16, e044033. [Google Scholar] [CrossRef]
- Lennaerts, H.; Groot, M.; Steppe, M.; Van Der Steen, J.T.; Van Den Brand, M.; Van Amelsvoort, D.; Vissers, K.; Munneke, M.; Bloem, B.R. Palliative care for patients with Parkinson’s disease: Study protocol for a mixed methods study. BMC Palliat. Care 2017, 16, 61. [Google Scholar] [CrossRef]
- Livingston, G.; Barber, J.; Rapaport, P.; Knapp, M.; Griffin, M.; Romeo, R.; King, D.; Livingston, D.; Lewis-Holmes, E.; Mummery, C.; et al. START (STrAtegies for RelaTives) study: A pragmatic randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manual-based coping strategy programme in promoting the mental health of carers of people with dementia. Health Technol. Assess. 2014, 18, 1–242. [Google Scholar] [CrossRef] [PubMed]
- Menear, M.; Girard, A.; Dugas, M.; Gervais, M.; Gilbert, M.; Gagnon, M. Personalized care planning and shared decision making in collaborative care programs for depression and anxiety disorders: A systematic review. PLoS ONE 2022, 17, e0268649. [Google Scholar] [CrossRef]
- Ring, M.; Kaarakainen, M.; Laulainen, S.; Rissanen, S. Family carers as service producers—Insights into psychological contracts. Educ. Gerontol. 2025, 51, 488–500. [Google Scholar] [CrossRef]
- Reinhard, S.C.; Given, B.; Petlick, N.H.; Bemis, A. Supporting family caregivers in providing care. In Patient Safety and Quality: An Evidence-Based Handbook for Nurses; Hughes, R.G., Ed.; Agency for Healthcare Research and Quality: Rockville, MD, USA, 2008; Chapter 14. Available online: https://www.ncbi.nlm.nih.gov/books/NBK2665/ (accessed on 13 May 2025).
- Aung, T.N.N.; Aung, M.N.; Moolphate, S.; Koyanagi, Y.; Supakankunti, S.; Yuasa, M. Caregiver burden and associated factors for the respite care needs among the family caregivers of community dwelling senior citizens in Chiang Mai, Northern Thailand. Int. J. Environ. Res. Public Health 2021, 18, 5873. [Google Scholar] [CrossRef]
- Malmir, S.; Navipour, H.; Negarandeh, R. Exploring challenges among Iranian family caregivers of seniors with multiple chronic conditions: A qualitative research study. BMC Geriatr. 2022, 22, 270. [Google Scholar] [CrossRef]
- Rahmani, F.; Roshangar, F.; Gholizadeh, L.; Asghari, E. Caregiver burden and the associated factors in the family caregivers of patients with schizophrenia. Nurs. Open 2022, 9, 1995–2002. [Google Scholar] [CrossRef]
- Wolff, J.L.; Freedman, V.A.; Mulcahy, J.F.; Kasper, J.D. Family caregivers’ experiences with health care workers in the care of older adults with activity limitations. JAMA Netw. Open 2020, 3, e1919866. [Google Scholar] [CrossRef]
- Hazzan, A.A.; Dauenhauer, J.; Follansbee, P.; Hazzan, J.O.; Allen, K.; Omobepade, I. Family caregiver quality of life and the care provided to older people living with dementia: Qualitative analyses of caregiver interviews. BMC Geriatr. 2022, 22, 86. [Google Scholar] [CrossRef]
Step | Search Term | Results |
---|---|---|
1. | (“old n2 (‘senior citizen’ OR ‘elderly’ OR ‘older people’ OR ‘aged people’ OR ‘older patient’ OR ‘elderly patient’)”) | 79,074 |
2. | (mh( aged+)) | 980,690 |
3. | S1 OR S2 | 1,005,800 |
4. | (‘neurodegenerative disease’ OR ‘neurodegenerative disorder’ OR ‘neurodegenerative condition’ OR ‘Alzheimer’ OR ‘dementia’ OR ‘Parkinson’ or ‘Parkinson’s disease’ or ‘Parkinsons disease’ OR ‘mental health condition’ OR ‘depression’ OR ‘anxiety’ OR ‘anxiety disorder’ or ‘major depressive disorder’ or MDD or ‘mental illness’ or ‘mental health’ or ‘mental wellbeing’ or ‘mental health disorder’ or ‘mental disorder’) | 149,012 |
5. | S3 AND S4 | 181,853 |
6. | (‘family member’ OR ‘family-centered’ OR ‘family’ OR ‘spouse’ OR ‘brother’ OR ‘sister’ OR ‘son’ OR ‘daughter’ OR ‘relatives’ OR ‘friends’) | 648,367 |
7. | (‘participation’ OR particip* OR ‘involvement’ OR involv* OR ‘engagement’ OR engag* OR ‘partnership’ OR ‘integration’ OR ‘support’) | 1,605,722 |
8. | S6 AND S7 | 264,612 |
9. | S5 AND S8 | 1131 |
10. | ‘primary care’ OR ‘primary health care’ OR ‘general practitioner’ OR ‘general practice’ OR ‘family medicine’ OR ‘ambulatory care’ OR ‘outpatient care’ OR ‘outpatient department’ OR ‘community care’ OR ‘community health’ OR rehabilitation clinic OR ‘home care’ OR ‘visiting nursing service’ OR ‘homebound patient’ OR ‘independent living’ OR gp OR gps OR ambulatory* OR outpatient* OR ‘in-patient’ OR ‘hospital admitted’ OR ‘intensive care unit’ OR ICU OR ‘emergency department’ OR ED OR ‘general wards’ OR ‘aged care home’ OR communit* OR ‘home nursing’ OR neighbo* OR ‘nursing service’ OR ‘allied health service’ | 100,824 |
11. | S9 AND S10 | 819 |
12. | Language: English | 812 |
13. | Time restrictions (from 2001 onwards) | 782 |
Criteria | Inclusion | Exclusion |
---|---|---|
Population | Older patients (≥65 years) had at least one diagnosed neurodegenerative and mental health condition (i.e., Alzheimer’s, dementia, Parkinson’s disease, depression, and anxiety) Experience and perspectives of family members of community-dwelling and/or hospital-admitted OPNMHCs Healthcare professional experience and perspectives | OPNMHCs with Huntington’s disease, Lewy body diseases, spinal muscular atrophy, bipolar or psychotic disorders, or with acute, non-progressive neurological illness (e.g., stroke) |
Intervention | Family-integrated health service delivery to community-dwelling and hospital-admitted OPNMHCs Family-integrated care models, management approaches, or interventions that focused on screening, treatment, or rehabilitation for OPNMHCs | Studies that did not involve family members in the interventions Interventions for family members of OPNMHCs Interventions are designed to improve management of OPNMHC behaviours and access to services |
Outcomes | Experiences and views of family-integrated health service delivery, reported from the perspectives of the OPNMHCs, their family carers, and healthcare professionals. | |
Study design | Quantitative, qualitative, and mixed methods studies (e.g., randomised control trials (RCTs), pre–post-test, longitudinal, quasi-experimental, cross-sectional, and case-control research designs) | Literature reviews Retrospective analysis of data Research commentary on the acceptability and feasibility of family-integrated care |
Types of publication | Peer-reviewed published articles | Commentaries, book chapters, editorials, clinical guidelines, or recommendations |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Jindal, S.; Hamiduzzaman, M.; Gaffney, H.; Siddiquee, N.; McLaren, H. Achieving Family-Integrated Care for Older Patients with Major Neurodegenerative and Mental Health Conditions: A Systematic Review of Intervention Characteristics and Outcomes. Int. J. Environ. Res. Public Health 2025, 22, 1096. https://doi.org/10.3390/ijerph22071096
Jindal S, Hamiduzzaman M, Gaffney H, Siddiquee N, McLaren H. Achieving Family-Integrated Care for Older Patients with Major Neurodegenerative and Mental Health Conditions: A Systematic Review of Intervention Characteristics and Outcomes. International Journal of Environmental Research and Public Health. 2025; 22(7):1096. https://doi.org/10.3390/ijerph22071096
Chicago/Turabian StyleJindal, Shruti, Mohammad Hamiduzzaman, Harry Gaffney, Noore Siddiquee, and Helen McLaren. 2025. "Achieving Family-Integrated Care for Older Patients with Major Neurodegenerative and Mental Health Conditions: A Systematic Review of Intervention Characteristics and Outcomes" International Journal of Environmental Research and Public Health 22, no. 7: 1096. https://doi.org/10.3390/ijerph22071096
APA StyleJindal, S., Hamiduzzaman, M., Gaffney, H., Siddiquee, N., & McLaren, H. (2025). Achieving Family-Integrated Care for Older Patients with Major Neurodegenerative and Mental Health Conditions: A Systematic Review of Intervention Characteristics and Outcomes. International Journal of Environmental Research and Public Health, 22(7), 1096. https://doi.org/10.3390/ijerph22071096