Examining the Concept of Healthcare Trajectories in Older Adults With Major Neurocognitive Disorder Using the ‘6W’ Multidimensional Model of Care Trajectories: A Mixed Methods Systematic Review Protocol

Abstract

Introduction: The use of healthcare services by older adults with major neurocognitive disorder (MNCD) varies significantly throughout the disease process. The evaluation of healthcare trajectories, defined as the pattern of care use over time, allows for a better understanding of how people move through the healthcare system and facilitates the identification of potentially modifiable risk factors for suboptimal care trajectories. Objectives: The objectives of the review are to: 1) critically appraise and synthesize evidence on how healthcare trajectories of older adults with MNCD are measured and defined, using the ‘6W’ multidimensional model of care trajectories, and 2) examine how socioeconomic factors are considered in studies reporting on healthcare trajectories. Inclusion criteria: This review will consider community-dwelling older adults diagnosed with MNCD. The quantitative component will include studies reporting on healthcare trajectories, including at least 2 different care services and at least 3 time-points. The qualitative component will include studies reporting on healthcare trajectories from the perspective of patients or their informal caregivers. Methods: This review will follow the Joanna Briggs Institute mixed methods review approach. We will search EMBASE, MEDLINE, CINAHL, PsycINFO, and the Web of Science Core Collection for English or French articles. Independent reviewers will identify articles for inclusion, extract data, and assess quality. A convergent integrated approach to synthesis and integration will be used. Discussion and conclusion: The results will help anticipate patients’ needs, improve patient care, service planning and coordination, and understand inequities in MNCD care.

Trajectories of care of community-dwelling people living with dementia: a multidimensional state sequence analysis

“…These results contribute to an emerging literature on ToCs for persons living with dementia [ 12 ]. Nevertheless, comparing our results with existing studies is challenging.…”

“…Some studies have advanced our knowledge of ToCs in people living with dementia [ 12 ]. For example, a study conducted in the United States by Rahman et al [ 13 ] aimed to describe survival and ToCs among individuals from rural and urban areas.…”

“…Amongst others, they observed higher rates of health service use, long-term care placement, and mortality among individuals living with dementia compared with individuals without the condition [ 14 ]. Building on these previous studies and to bridge remaining knowledge gaps, we sought to examine multidimensional ToCs (according to the healthcare settings and the professionals consulted) while accounting for population heterogeneity [ 12 ].…”

“…SSA is an innovative statistical method that enables the visualization of complex longitudinal patterns [ 15 ]. Its use in healthcare research has recently increased, and to our knowledge, this is the first study to apply SSA to examine ToC in people living with dementia [ 12 ]. We operationalized the “6W” multidimensional model of ToCs in six dimensions: patients, with their individual and clinical attributes ( who ), in responding to their illness condition and care needs ( why ) will seek healthcare services from different categories of care providers ( which ) in care units and settings ( where ) where they will receive tests and treatments ( what ) at specific times ( when ) [ 11 ].…”