Family involvement in care transitions of older adults: What do we know and where do we go from here?

Family members have historically been and will continue to be, now and into the future, involved in the health and care of older adults (Institute of Medicine, 2008; B. C. Spillman & K. J. Black, 2005). Family involvement is a global phenomenon occurring across all socioeconomic levels, within all race and ethnic groups, and in developed and developing countries (American Association of Retired Persons, National Alliance on Caregiving, & United Nations Program on Ageing, 2008; United Nations, 2007). This chapter examines what is known about family involvement in care transitional processes from which new directions for research and intervention design are articulated. Specifi cally, by drawing on diverse bodies of research, we examine what is known about the prevalence and relevance of family involvement in care transitions, the specifi c roles that may be assumed by families in different types of transitions, and the impact of care transitions on family members. Two overlapping and interrelated care transitions that families experience are examined: assisting older adults in transitioning from one care setting to another or between health professionals, and assisting older adults as they transition in a downward trajectory from one level of care needs to another. We identify core competencies and the specifi c knowledge and skills families may need to make informed decisions about and participate more fully and effectivelyin varied care transition experiences. As family involvement in care transitions refl ects complex, dynamic processes that have a temporal dimension, we discuss the unique methodological challenges that warrant careful consideration and innovation in future research investigations.