Palliative needs and models for care home residents with multiple long-term conditions: systematic review and narrative synthesis

Introduction Care homes play a significant role in caring for older adults at the end of their lives. Residents often have multiple long-term conditions (MLTC), complex care needs, and unpredictable health trajectories. This makes the delivery of effective palliative care difficult and may leave residents’ needs inadequately addressed.

Methods This systematic review aimed to narratively synthesise evidence on the palliative care needs of care home residents with MLTC, and the care models available to meet these needs. Two review protocols were registered with PROSPERO (CRD42024512220/CRD42024510220), and five databases searched to identify relevant studies (MEDLINE, Embase, Scopus, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL)). Retrieved articles were merged and independently double-screened. Included articles were evaluated for quality and risk of bias.

Results 18 studies met the inclusion criteria. The main findings were categorised into four groups: (1) complex and unpredictable health trajectories; (2) residents’ significant physical, functional and emotional needs; (3) inadequate and inequitable access to palliative care; and (4) a limited number of existing and proposed models of care.

Conclusion Residents in care homes with MLTC have complex palliative care needs. A limited number of palliative care models exist; however, access is currently insufficient and inequitable and their evidence base requires expansion.