Barriers in Health and Social Care Access and Systems Navigation among Older Adults without Advocates: A Scoping Literature Review and Framework Synthesis

Informal caregivers are relied on to supplement formal systems. Sociodemographic shifts have driven concerns regarding the outcomes of older adults who are unable to rely on informal support, or older adults without advocates (OAWAs). This scoping review aimed to identify barriers and facilitators of health and social care access and systems navigation for OAWAs. We searched for peer-reviewed quantitative, qualitative, and mixed studies published from 2005 onwards in the following electronic databases: CINAHL Complete, ASSIA, PubMed, Scopus, Web of Science, and PsycINFO. The review adhered to methodological recommendations from the JBI and Arksey and O'Malley's (2005) framework. Primary and secondary peer-reviewed empirical research studies conducted within Canada, the United States, Australia and New Zealand, Western Europe, and the United Kingdom and describing barriers/facilitators of access and navigation for OAWAs were included. Evidence was synthesized using a framework synthesis approach guided by Levesque's (2013) access framework. Studies with evidence-informed reference to barriers and facilitators of access and navigation for OAWAs were included. Searches yielded 775 unique articles, of which 13 met inclusion criteria. Notable barriers included system fragmentation, incompatible provider approaches, and service medicalization and privatization. Engaging OAWAs as decision-making partners, flexible delivery mechanisms, navigation support, and adequate clinical documentation were among factors facilitating access. Findings underscore the importance of care models and practices that consider the unique circumstances of OAWAs. Current service delivery approaches will be incompatible with the future care needs of this growing population. Tailored interventions may ensure their needs do not go unaddressed and negatively affect their wellbeing and formal system capacity.