• Mariam Kirvalidze, Anne-Marie Boström, Ann Liljas, Megan Doheny, Anne Hendry, Brendan McCormack, Laura Fratiglioni, Sulin Ali, Zahra Ebrahimi, Sölve Elmståhl, Maria Eriksdotter, Pascal Gläske, Lena-Karin Gustafsson, Åsa Hedberg Rundgren, Helena Hvitfeldt, Carin Lennartsson, Lena Marmstål Hammar, Gunnar H Nilsson, Peter Nilsson, Joakim Öhlén, Anna Sandgren, Annika Söderman, Karl Swedberg, Nicoline Vackerberg, Davide Liborio Vetrano, Helle Wijk, Janne Agerholm, and Amaia Calderón-Larrañaga.
• Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden.
• J. Intern. Med. 2024 Jun 1; 295 (6): 804824804-824.

AbstractOlder adults have multiple medical and social care needs, requiring a shift toward an integrated person-centered model of care. Our objective was to describe and summarize Swedish experiences of integrated person-centered care by reviewing studies published between 2000 and 2023, and to identify the main challenges and scientific gaps through expert discussions. Seventy-three publications were identified by searching MEDLINE and contacting experts. Interventions were categorized using two World Health Organization frameworks: (1) Integrated Care for Older People (ICOPE), and (2) Integrated People-Centered Health Services (IPCHS). The included 73 publications were derived from 31 unique and heterogeneous interventions pertaining mainly to the micro- and meso-levels. Among publications measuring mortality, 15% were effective. Subjective health outcomes showed improvement in 24% of publications, morbidity outcomes in 42%, disability outcomes in 48%, and service utilization outcomes in 58%. Workshop discussions in Stockholm (Sweden), March 2023, were recorded, transcribed, and summarized. Experts emphasized: (1) lack of rigorous evaluation methods, (2) need for participatory designs, (3) scarcity of macro-level interventions, and (4) importance of transitioning from person- to people-centered integrated care. These challenges could explain the unexpected weak beneficial effects of the interventions on health outcomes, whereas service utilization outcomes were more positively impacted. Finally, we derived a list of recommendations, including the need to engage care organizations in interventions from their inception and to leverage researchers' scientific expertise. Although this review provides a comprehensive snapshot of interventions in the context of Sweden, the findings offer transferable perspectives on the real-world challenges encountered in this field.© 2024 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.

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