Health and care services for older immigrants: a systematic scoping review
We carried out a systematic scoping review of research on older immigrants, family caregivers, and healthcare personnel’s’ experiences with and perspectives on health and care services as well as research on adapted interventions for older immigrants in the health and care services.
Older immigrants do not necessarily have the same needs and preferences for health and care services as the majority population. There is an indication that there may be a need to adapt these services to a diverse population to ensure an equitable service for all.
We carried out a systematic scoping review of research on older immigrants, family caregivers, and healthcare personnels’ experiences with and perspectives on health and care services as well as research on adapted interventions for older immigrants in the health and care services.
We mapped and described existing research. We identified 24 studies from the Nordic countries, 36 from other European countries and 27 from Canada, Australia, and New Zealand. We assessed the methodological limitations of the Nordic studies, and these are presented in more detail than for the remaining studies.
The main findings from the Nordic studies are:
- 22 of 24 studies had a qualitative design
- Six studies were about experiences with adapted interventions for older immigrants
- A large proportion of the studies were about experiences with healthcare services in general and experiences with dementia and dementia care
- In the studies that specified setting, the most frequent setting was nursing homes
- Most of the studies dealt with people originating from European or Asian countries
Among the Nordic studies, there seem to be a lack of studies on the effect of interventions, users’ experiences with such interventions, and studies about intermediate care, acute care services, general practitioners, mental health services, physiotherapists, and care allowances.
At the start of 2022, 15.1% of the Norwegian population were immigrants. Just over 11.0% of immigrants in Norway are aged 60 or over, which equals seven per cent of all seniors in the country. Older immigrants in Norway come from 197 different countries. We lack knowledge about many groups of older immigrants in Norway, but what we do know from Statistics Norway's survey of living conditions among immigrants is that they generally report poorer self-reported physical and mental health than the general population. It was also reported that the increase in chronic diseases with age and reduced functional capacity is greater among immigrants than in the general population. Reviews of immigrants' use of municipal health and care services also shows that older immigrants use the services to a lesser extent than the rest of the population.
Cultural and social factors influence health behavior and patients' opportunity, desire, and ability to access and use health and care services. Older immigrants do not necessarily have the same needs and preferences for health and care services as the majority population. There is a great need to adapt the services to a complex and heterogeneous population to ensure an equitable service for all.
This review’s objective is to map available research on older immigrants, family caregivers and healthcare personnel’s’ experiences with and perspectives of health and care services for older immigrants, as well as interventions to better adapt health and care services for older immigrants.
We carried out a systematic scoping review. We included quantitative and qualitative primary studies from Europe, Canada, Australia, and New Zealand published in the last ten years in English or a Scandinavian language. We searched Medline, Central, PsycINFO, CINAHL, Google and Scandinavian library catalogues in October 2022. Two researchers independently assessed relevant full texts and the risk of systematic bias or methodological limitations of the included studies using checklists appropriate to the study designs. One researcher extracted data and results from the included studies, another checked for completeness and correctness. We then sorted and compiled data in text and created tables and figures where relevant from the included studies.
We identified 24 studies from the Nordic countries, 36 studies from other European countries and 27 studies from Canada, Australia, and New Zealand.
Among the Nordic studies, 22 of 24 studies had a qualitative design. We found that most of the Nordic studies were about people with origins in European or Asian countries.
Themes from the Nordic studies exploring elderly immigrants and their family caregivers were perceptions of healthcare services in general and of nursing homes and dementia and dementia care specifically. Experiences of barriers and facilitators to seeking to services were also common themes. In addition, the studies were about family caregivers’ care contributions and presence, experience of obligation and moral dilemmas related to caring for the elderly. Themes from the Nordic studies regarding healthcare personnel were perspectives on how the services are adapted to older immigrants and their strategies for overcoming cultural and language barriers. Perspectives on the use of multicultural and multilingual healthcare personnel in services for older immigrants were also discussed.
Six Nordic studies described adapted interventions for older immigrants. Five of these were about culturally adapted nursing homes, and one was about a care model where arrangements were made to meet individual and cultural needs. Four of these studies reported healthcare personnel's experiences, one reported healthcare personnel and family caregivers’ experiences and one reported only family caregivers’ experiences. We did not identify any studies that examined the effect of adapted interventions for older immigrants or studies that explored older immigrants´ own experiences with such interventions.
Of the studies we identified from other European countries, more than half were from Great Britain. Most of the studies were qualitative and dealt with experiences with and perspectives of services. Only a few dealt with specific interventions to adapt services to older immigrants. Where diagnosis was specified, dementia was the most common followed by cardiovascular disease. Most of the studies dealt with healthcare services in general. When the setting was specified, nursing homes and home care were most frequent.
Among the studies with data collection in Europe, Turkey and Morocco were the most common countries of immigrant origin. China was the most common country of immigrant origin in studies set in Canada, New Zealand, and Australia.
As this is a systematic scoping review, we did not perform in depth analysis or assess our confidence in the findings across the included studies. We present a higher level, condensed summary of the literature based on the studies' main findings, without text extracts, quotations or coding of themes across the studies. This means that we cannot present the nuances within and depth of the study's results as in a qualitative evidence synthesis. Therefore, this scoping review only provides a description of the existing research in the field and identifies knowledge gaps.
We prepared and carried out an extensive search in databases and gray literature as well as reference lists of the included studies. We may have missed some relevant studies. The broad research objective meant that it was difficult to narrow the search. We had to use a search filter for study design and prepare a less sensitive search string for the population than normal.
Our findings show that this is a field where qualitative research is prominent. One of the knowledge gaps we identified in this scoping review was the lack of research into the effect of interventions. We identified a few studies about experiences with adapted interventions, but none dealt with the experiences of the immigrants themselves. This means that we have limited knowledge target population satisfaction. It would therefore be challenging for decision-makers to make evidence-based decisions on which concrete programs or interventions are best adapted to older immigrants.
We identified few studies about home services. According to the Stay safe at home re-form (Bo trygt hjemme-reformen) which is the catalyst for this scoping review, it would have been interesting to take a closer look at what makes older immigrants satisfied with the home services and what mechanisms make them use them. Further research into how older immigrants experience the services and how they can be adapted in a good way is necessary. Better involvement by and care of family caregivers are also areas in which it is important to do further research. The same applies to other settings where we did not identify research, such as GPs, health centers and municipal acute in-patient units, services in mental health, physiotherapists and use of care allowances.
It appears that the existing research on municipal health and care services for elderly immigrants mainly has a qualitative design and deals with different groups' experiences with these services; mainly experiences with services in general and services related to dementia or nursing homes. Several studies also deal with perceptions of health and illness and culturally conditioned perceptions of receiving public care versus family care. It appears that the research largely concerns immigrants with origins in European and Asian countries.
Our results show that there is a lack of research in several settings. The results also indicate that there is a lack of research on adapted interventions in the health and care services and interventions/programs to reduce barriers to access and use of services. There is a particular need for research that examines the effect of such interventions/programs, as well as research into how these are experienced by the users and their relatives. To adapt these services to older immigrants, it may be appropriate for the health and care services to carry out studies to evaluate the interventions/programs they are implementing.