Integration of Older Adult Service Systems for Families with Dementia in Central America: A social network approach

Abstract

It is estimated that the global incidence of dementia will double by 2050 and that the majority of people with dementia will be living in developing countries. Developing countries are under-researched; data from Central America is scarce. A lack of coordination between service providers and across settings results in fragmented health care systems [6]. Therefore, organisation of older adult service systems, dementia specific services, and exchange between organizations, is needed [7]. Research on the key indicators of integrated care at the macro, or system level is scarce [8].

From a global health perspective, this study explores the interorganisational ties of service providers for older adults, and families with dementia. The target population of this study was providers of services for older adults and families with dementia in Guatemala, El Salvador, Honduras, Costa Rica and Panama. Sixty-eight (68) semi-structured interviews of representatives of: government, public, private, non-profit organizations, hospitals, care homes, universities, and families with dementia, were completed. The types of ties, strength of ties, and types of exchange were assessed together with the analysis of 4 network properties: density, centrality, E-I index, and QAP correlation.

This study provides primary data on: integration levels of older adult service systems based on Leutz’s levels of integration (1999); insight into services provided; and structures of five developing countries’ older adult service systems. 304 ties, between 167 organizations were explored. Findings portray a quid pro quo culture of exchange between organizations with underlying strong, collaborative ties. Families are excluded in the exchanges, and consistently unaware of services especially those specifically for dementia.

In general, system density and centrality measures were low, correlation among networks was not significant, indicating fragmentation and low integration. Yet the systems also included multiple high indicators of linkage development, such as exchange of resources and information, external ties, and an overall sense of collaboration.

In conclusion, SNA provides an effective methodology for evaluating integration levels of care service systems in developing countries through understanding who the actors are and the relationships between them. The findings of this study influence policies on partnership working and suggest new inter-organizational practices leading to increased system integration and consequently increased provision/receipt of services for families with dementia.