Literature Collection

National and international aged care frameworks recommend family-integrated care to enhance care quality and outcomes, supported by evidence demonstrating improvements in patient and clinician experiences. Yet uncertainty remains about how to integrate family carers effectively in diverse healthcare models and settings for neurodegenerative and mental health conditions. A systematic integrative review was conducted to answer two research questions: how do the studies describe the integration of family carers in health services design and delivery for older patients with neurodegenerative and mental health conditions? And what is the evidence for family-integrated care models impacting the health and wellbeing of these older patients? Structured and iterative searches of five databases (CINAHL, Medline (Ovid), Web of Science, PsycINFO, and ProQuest) and the Google Scholar search engine identified 2271 records. A Covidence screening process resulted in 14 studies for review, comprising randomised controlled trials, mixed methods studies, qualitative studies, and quasi-experimental designs. The following four themes emerged from the evidence synthesis: (1) family participation in service delivery, (2) health and wellbeing outcomes, (3) satisfaction with care, and (4) service dynamics in enabling family-integrated care successfully. This review highlights that while family-integrated care models contribute to positive health and wellbeing outcomes for older patients with neurodegenerative and mental health conditions, challenges remain for implementation due to the extent and variability in integration strategies, a lack of rigorous evaluation, and an absence of standardised frameworks.

BACKGROUND: The clinical profiles of youth presenting to early intervention mental health services are heterogeneous, with various sub-groups proposed and little information about the longitudinal stability of profiles, especially those associated with bipolarity. METHODS: 802 youth aged 12-25-years (Mean = 18.26; 66 % females) accessing primary-care based mental health clinics were assessed at baseline and 417 were re-assessed after 12-months. An exploratory factor analysis of 62 items from six validated rating scales of the severity of mental and physical ill-health was conducted. Seven factors (anxiety, sleep, depression, restlessness, distress, activation, somatic complaints) were derived and modelled using latent profile analysis. Associations between profile membership, clinical outcomes and functioning were examined. Conditional probabilities of shifting to a different profile longitudinally were computed. RESULTS: Three profiles were revealed which were psychometrically invariant across baseline and follow-up: (1) 'High distress with high activation' (32 % baseline, 25 % follow-up); (2) 'High distress without activation' (31 % baseline, 26 % follow-up); and (3) 'Moderate distress' (37 % baseline, 33 % follow-up). A fourth profile, 'Low distress' (16 %), emerged at follow-up. Profiles did not differ by age at baseline or sex. 'High distress with high activation' was more likely to be impaired longitudinally, and to meet criteria for a full-threshold mental disorder at follow-up. About 39 % of youth retained the same profile longitudinally, while 16 % shifted to lower distress, and 13 % shifted to higher distress. CONCLUSION: These findings suggest that activation is a marker of poorer clinical and functional outcomes in youth presenting for mental health care.