From Nursing Homes to Geriatric Psychiatry: Contextual Factors Associated With the Admission of People With Dementia and Behaviour That Challenges—An Integrative Review

Aim To systematically identify the contextual factors leading to (re)admission to psychiatry of people with dementia and behaviour that challenges living in nursing homes. Behaviour that challenges is understood as a social construct that reflects individual and environmental factors and their interaction. Design The 5‐step Whittemore & Knafl method was followed for this integrative review. Data Sources The databases MEDLINE, CINAHL, Cochrane Library, GeroLit and PsychINFO and the study registers ISRCTN, PROSPERO and DRKS were searched. Hand search and citation tracking were used. Methods Inclusion and exclusion criteria were applied. Two independent reviewers assessed the quality of the studies via the Mixed Method Appraisal Tool and Joanna Briggs Institute's instruments. Data synthesis and integration were based on The Convergent Integrated Approach for Mixed Methods Systematic Reviews and the thematic analysis of Braun and Clarke. Results 1161 articles were identified, 8 articles/studies were retained. The contextual factors could be specified as ‘crisis determining factors’ (main theme). Three sub‐themes were identified: multifactoriality and ‐dimensionality of dementia and behaviour that challenges; structural and systemic barriers and lack of effective interprofessional and patient‐centred collaboration. Conclusion Dementia crises often lead to hospitalisation. A key crisis‐determining factor is interprofessional collaboration. High‐quality studies on this topic are lacking. The existing results originate mainly from Europe and should be interpreted with caution in view of contextual and methodological limitations. Policymakers should promote cross‐sector care models, the deployment of psychiatric crisis teams, Advance Care Planning and digital communication tools. Reporting Method We based our reporting on the PRISMA 2020 statement. Patient or Public Contribution No patient or public contribution. Trial Registration PROSPERO 2022 CRD42022367169; https://www.crd.york.ac.uk/prospero/display_record.php?