Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
Continuing Care Branch, Alberta Health, Edmonton, Alberta, Canada.
Gerontologist. 2023 Aug 24;63(7):1211-1227. doi: 10.1093/geront/gnac091.
Older adults (≥65 years) are living longer with complex health needs and wish to remain at home as their care needs change. We aimed to determine which factors influence older persons' transitions from home living to facility-based care (FBC) settings such as long-term care facilities or assisted living.
Through a scoping review of 7 databases, we considered all academic literature examining factors influencing transitions from home living to FBC. Only English articles were reviewed. Based on the Meleis' Health Transition (MHT) model, we categorized findings into: (a) transition conditions; (b) patterns of response; and (c) health services and interventions.
We included 204 unique studies. Age, cognitive/functional impairments, and caregiver burden were the most consistent risk factors for older persons' transitions to FBC. Caregiver burden was the only consistent risk factor in both quantitative and qualitative literature. Other factors around health service use or nonmedical factors were examined in a small number of studies, or demonstrated mixed or nonsignificant results. Key research gaps relate to transitions to intermediate levels of FBC, research in public health systems, and research employing qualitative and interventional methods.
We expanded the MHT model to capture informal caregivers and their critical role in transitions from home to FBC settings. More research is needed to address practical needs of clients and caregivers while at home, and self-directed care funding models could be expanded. Theory-driven interventional research focusing on caregivers and successful hospital discharge is critically needed.
老年人（≥65 岁）的寿命越来越长，同时健康需求也更加复杂，他们希望在自己的照顾需求发生变化时能够继续留在家里。我们旨在确定哪些因素会影响老年人从家庭生活过渡到机构护理（FBC）环境，如长期护理设施或辅助生活设施。
通过对 7 个数据库的范围审查，我们考虑了所有研究因素影响从家庭生活过渡到 FBC 的学术文献。仅审查了英文文章。基于 Meleis 的健康过渡（MHT）模型，我们将研究结果分为：（a）过渡条件；（b）应对模式；和（c）卫生服务和干预措施。
我们纳入了 204 项独特的研究。年龄、认知/功能障碍和照顾者负担是老年人过渡到 FBC 的最一致的危险因素。在定量和定性文献中，照顾者负担是唯一一致的危险因素。其他与卫生服务使用或非医疗因素有关的因素在少数研究中进行了研究，或显示出混合或无显著结果。主要的研究空白涉及到 FBC 的中级过渡、公共卫生系统的研究以及采用定性和干预方法的研究。
我们扩展了 MHT 模型，以涵盖非正式照顾者及其在从家庭到 FBC 环境过渡中的关键作用。需要更多的研究来满足客户和照顾者在家时的实际需求，并扩大自我管理护理的资金模式。需要有理论驱动的干预性研究，重点关注照顾者和成功的出院。
