Understanding the dynamics of crisis situations in care for community-dwelling older individuals-a qualitative study

Crisis situations in care for community-dwelling older individuals, where the capacity of existing care arrangements at home is suddenly and unsustainably exceeded, can lead to adverse outcomes, such as hospitalisation, institutionalisation and death. Understanding how these crisis situations arise and take shape may contribute to their prevention and mitigation.

To investigate the dynamics through which crisis situations in care for community-dwelling older individuals develop and take shape, as reflected in the experiences of older individuals, informal caregivers and healthcare professionals.

This qualitative study consisted of 45 semi-structured interviews about experiences with crisis situations among older individuals, informal caregivers and healthcare professionals from diverse disciplines, with two additional focus groups involving general practitioners. Data were analysed using thematic analysis.

The analysis yielded two main themes: 'Tipping points' and 'Progressive instability in care systems'. The first theme captures how tipping points mark the moment when remaining at home becomes untenable because the situation is unsafe, undignified or because an acute event requires medical attention. The second theme shows that older individuals are part of care systems that can become progressively unstable through various processes.

Crisis situations in care for community-dwelling older individuals are systemic phenomena, developing through progressive instability in care systems and taking shape at tipping points, when these systems suddenly lose their balance. This systemic understanding of crisis dynamics may help healthcare professionals map key issues, recognise early instability and identify resilience, thereby supporting crisis prevention and management.