Current state and future directions of health services and service management research on transitions in older age: a field-focused narrative review.

backgroundA thorough understanding of later-life transitions is key to designing and providing healthcare services that can help older adults and their carers navigate such times in life. Yet, to date, little is known about which types of transitions have drawn the attention of healthcare services scholars and how these transitions have been explored, made sense of and narrated over time. To fill this gap, we conducted a field-based narrative review seeking to critically summarise prior health services and service management research on transitions in late life and reconstruct the main narratives elaborated in this area.

methodsStudy retrieval entailed systematically searching the Web of Science database within pertinent journal categories to locate articles with a central focus on transition(s) characterising older age. Via citation mining, additional landmark papers were identified. The analysis and synthesis unveil how relevant research features (i.e. conceptualisations of transition adopted, study objectives, theoretical underpinnings, vocabularies, actors/places and methodological approaches) combine to give shape to distinct narratives about later-life transitions.

resultsWe find that the 335 included articles deal with four distinct conceptualisations of transition: in health states, across care settings/levels of care, relating to stressful/critical life events or end-of-life. Moreover, we identify two different, and partially contrasting, narratives. While the ‘healthcare consumption’ narrative primarily addresses health state and care transitions with a strong focus on cost containment, the ‘ageing experience’ narrative deals with the lived reality of a wide array of moments of transition, involving older adults immersed in a rich relational environment.

conclusionsOur review documents that the two narratives emphasise diverse views of ageing and of what the care system should do to accompany older adults through transitions. While emerging paradigms call for greater sensitivity to subjective stances, the challenges associated with reconciling individual and organisational demands appear evident. CLINICAL TRIAL NUMBER: Not applicable.