How older people enact care involvement during transition from hospital to home:a systematic review and model

Background. Current models of patient-enacted involvement do not capture the nuanced dynamic and interactional nature of involvement in care. This is important for the development of flexible interventions that can support patients to ‘reach-in’ to complex healthcare systems. Objective. To develop a dynamic and interactional model of patient-enacted involvement in care. Search Strategy. Electronic search strategy run in five databases and adapted to run in an internet search engine supplemented with searching of reference lists and forward citations. Inclusion criteria: Qualitative empirical published reports of older people’s experiences of care transitions from hospital to home. Data extraction and synthesis: Reported findings meeting our definition of involvement in care initially coded into an existing framework. Progression from deductive to inductive coding lead to the development of a new framework and thereafter a model representing changing states of involvement. Main results. Patients and caregivers occupy and move through multiple states of involvement in response to perceived interactions with health care professionals as they attempt to resolve health and wellbeing related goals. ‘Non-involvement’, ‘informationacting’, ‘challenging and chasing’, and ‘autonomous-acting’ were the main states of involvement. Feeling uninvolved as a consequence of perceived exclusion, lead patients to act autonomously, creating the potential to cause harm. Discussion and conclusion. The model suggests that involvement is highly challenging for older people during care transitions. Going forward, interventions which seek to support