Integrated Care for Older Patients: Geriatrics

Sofia Duque (), Lorena Villa-García (), Armagan Albayrak (), Tischa Cammen () and Marco Inzitari ()
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Sofia Duque: Hospital CUF Descobertas
Lorena Villa-García: Parc Sanitari Pere Virgili and Vall d’Hebron Institute of Research
Armagan Albayrak: Delft University of Technology
Tischa Cammen: Delft University of Technology
Marco Inzitari: Parc Sanitari Pere Virgili Hospital and Vall d’Hebron Institute of Research

Chapter 53 in Handbook of Integrated Care, 2025, pp 1011-1035 from Springer

Abstract: Abstract Integrated care models for older adults are key to addressing their complex, often coexisting, health, and social needs. In this chapter, we explore their main characteristics and the challenges associated with geriatric care, such as multimorbidity, declining intrinsic capacity, frailty, geriatric syndromes, fragmentation of care, and the role of place of living and informal caregiving. Through examples of successful models, we present strategies that have been shown to reduce service use, improve well-being, and increase older adults and caregiver satisfaction. In addition, evidence is provided on supportive resources and strategies, such as care transitions, intermediate care, home hospitalization, preventive care, and social prescribing. The need to evaluate the impact of these models through patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) is emphasized, and qualitative research is presented. Technology has an essential role in facilitating integrated care, although there are still challenges to its adoption. The importance of user-centered design and human factors is highlighted. Finally, the need to improve in training professionals to provide sustainable and effective integrated care for the older person is emphasized.

Date: 2025
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DOI: 10.1007/978-3-031-96286-8_40

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