How is complexity measured and detected among community dwelling older people aged 65 years and over? A scoping review

Abstract

Aim: To identify and explore tools that measured and detected complexity of care among community dwelling people aged 65 years and older.

Data sources: Databases were searched for articles published up to 23 September 2022 including CINAHL, EMBASE and MEDLINE, Cochrane database for trials and grey literature.

Methods: A scoping review was conducted and reported in accordance with the PRISMA guidelines. Eligible articles included those with participants aged over 65 years, living in the community and studies that included care complexity detection or assessment and how this related to care delivered. Covidence was used to screen titles, abstracts and full-text articles.

Results: Eighteen full texts were reviewed; four studies were included in the final review. All selected studies included people aged over 65 years living in the community. A high level of reliability for the items included in the interventions was found. The selected studies included tools for assessing older person's needs with nurses involved in the assessment.

Conclusion: The review identified four tools for measuring complexity in community dwelling older people. Two tools have the capacity to objectively measure complexity due to the holistic nature of items included and appear easy to use to support clinical judgement decisions.

Impact: The review places a spotlight on the concept of complexity and highlights the lack of definition of care complexity. The synthesized result highlights the need to explore detection of care complexity of older people further and consider ways of supporting clinical judgement and decision making of community nurses. The use of a validated tool may enhance clinical judgement regarding care complexity and may lead to a more consistent and timely approach to care.

Patient or public contribution: During the development phase, the study was presented to a consumer group from the researcher's workplace.

Prospero registration: CRD42022299336.

Keywords: adult nursing; ageing; assessment; clinical decision making; clinical judgement; community care; district nursing; gerontology; older people.