Performance Indicators for the Assessment of Aging-In-Place Reform Policies: A Scoping Review and Evidence Map

Objectives: Many countries have reformed their long-term care system to promote aging-in-place. Currently, there is no framework for evaluating these reforms. This review aimed to identify performance indicators used for aging-in-place reform evaluation.

Design: A scoping review and evidence map of literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist.

Setting and participants: Long-term care reforms aimed at aging-in-place.

Methods: The databases Medline, Embase, and Academic Search Premier were searched. Three independent reviewers screened the articles. Pairs of data collectors extracted the data, with conflicts determined by agreement or by a third reviewer. Performance indicators were classified into the Donabedian framework as structure, process, or outcome.

Results: We retained 58 articles. From the included articles, 28 discussed structure indicators, comprising of 71 indicators in the domains expenditures, care availability, and workforce; 36 articles included process indicators comprising 80 indicators about care utilization, service quality, and service satisfaction; and 20 articles reported on outcome indicators comprising 34 indicators about health status and informal caregiving.

Conclusion and implications: Most articles focused on the performance domains care expenditures and care utilization, whereas measuring effects on older adults and society was less common. A framework assessing system and services delivery indicators and the effects on those aging-in-place with actionable performance indicators is recommended.