Self-care is one of the most important dimensions of the health and well-being of populations (1). Thus, collecting data that facilitate a functional diagnosis or a diagnosis of self-care dependence is essential in developing an individual care plan that, in the medium- and long-term, can translate into health gains (2–5).

There is a strong association between age and the increasing prevalence of chronic diseases (6), emphasizing the need to promote of self-care throughout life (7–9). However, the state of greater vulnerability, the occurrence of pathological processes and thus the decreases in a person’s functionality and independence hinders his or her ability to perform self-care, requiring adaptations on the part of the health sectors and at the social level (3, 4, 10). Thus, there is an emerging need to respond to an imbalance between the provision of care to dependent persons and their ability to care for themselves; thus, many older adults and their families turn to long-term care institutions to guarantee necessary care (5).

Long-term care should ensure that people have the opportunity to optimize their abilities throughout the life course while providing a supportive environment and all the care necessary to maintain and promote their functional abilities (11). This care should value individuals as unique beings, taking into account their needs, values and expectations to provide person-centered care (7, 11).

In this context, it is important to design and implement care models that respond to the needs of populations, respecting their particularities to promote quality of life, independence and empowerment of citizens for self-care, considering the physical, cognitive, emotional and social domains (12).

The literature seems to support the benefits that personalized long-term care models exert in the training of self-care, which contribute to greater independence and autonomy in people’s daily lives (13). Other benefits reported include a more positive perception of quality of life and functionality in people with multimorbidity and frailties (9, 14), a reduction of hospitalizations and readmission rates (15), a reduction of polypharmacy (4, 16) and increased patient satisfaction with the perception of quality of care and access to services (17). However, the absence of reviews that directly compare the main health findings of different models of person-centered care hinders the construction of knowledge about the advantages or disadvantages of self-care training. This systematic knowledge may be a relevant tool for designing and developing sustainable and effective integrated and people-centered health care that promotes the empowerment of self-care in long-term care. In addition, the evidence provided might contribute to enriching clinical practices and improving health governance in the context of healthy aging.

The present rapid review aims to assess the association between the implementation of person-centered care models that promote self-care training in long-term care and health-related outcomes, among adults with chronic illness.

The present rapid review was developed according to the Cochrane rapid review methodology’ (18) and registered in PROSPERO (International Prospective Register of Systematic Reviews) under the number CRD42023415151.

The present rapid review of the literature revealed that the main health-related outcomes resulting from the implementation of person-centered care models to promote empowerment for self-care in long-term care are multidimensional, with implications at the individual, institutional and societal levels. The results highlight the variety of interventions implemented, as well as the exploitation of a wide range of health outcomes, evaluated through different instruments.

At the individual level, the promotion of quality, psychological well-being, nutritional status and health perception of the participants, as well as the reduction of neuropsychiatric symptoms, are the main benefits of the implemented models. Although the literature supports the associations described (3, 9, 13, 35), the systematic analysis of the studies revealed inconsistent results among them. Although some articles supported a positive association between the interventions and the participants’ perception of quality of life, psychological well-being and general perception of health, others did not find scientific evidence that clearly supports these conclusions. The heterogeneous evaluation of these characteristics, namely regarding the variability of the instruments used, compromises the comparability of the results between the different studies and may partially justify the contradictory results. Additionally, the lack of specific and validated instruments to evaluate people with chronic diseases in need of long-term care may lead the studies to neglect specific dimensions of mental health, quality of life and well-being that are particularly relevant for people with chronic disease that may not be addressed by instruments aimed at the general population. The inverse association with neuropsychiatric symptoms reported in the study by Ballard et al. (27) was not confirmed by two other studies. However, these two studies focused essentially on two neuropsychiatric symptoms, unlike the previous study that reported data on a combination of 12 neuropsychiatric disorders. Characterizing neuropsychiatric symptoms is a challenge, and there is a pressing need to resort to instruments that assess a broader range of behavioral symptoms (36). This will help health professionals and researchers to detect, quantify, and monitor neuropsychiatric symptoms in a more integrated manner that is appropriate to the needs of each person (37).

Contrary to what has been described in the literature, improvements in the functionality and the physical capacity of participants did not reach statistical significance after the implementation of the interventions. Functioning is assumed to be a central variable in the aging process, a dynamic interaction between health states and contextual factors (environmental and personal) (38) that results in the dependence/independence of each individual (39). The absence of significant results in these dimensions may be due to the context of long-term care in which the interventions were implemented. Often, the request for long-term care is made by families when a patient has reached an advanced stage of functional dependence or when there is an imbalance between the care needs and the necessary and appropriate responsiveness in the family context (4, 40, 41). Thus, future studies should evaluate different levels of care, allowing for a stratified analysis of participants’ functionality by level of care.

All studies implemented a structured, supervised, individualized and personalized intervention program according to the needs of each person and his or her circumstances. Previous literature supports that the involvement of patients with chronic disease in interventions that promote self-care facilitates the concrete perception of their preferences and abilities (42, 43), motivating them to promote and participate in their self-care (3, 10, 13, 44). Although only one study (28) reported benefits of implementing patient-centered care for the promotion of self-care, the other study that also analyzed this variable concluded that there was a slight, but not significant, benefit to the implementation of policies and environments that supported person-centered approaches to dementia care (32). The difficulty in finding significant results regarding the implementation of person-centered care models may be due to a long-standing problem faced by care services regarding the lack of an adequate and properly paid workforce, which would ensure the implementation of quality person-centered care (4, 45–47).

The interventions developed favored a significant increase in the proportion of positive interactions between the team of health professionals and patients with chronic disease (27), as well as in the number of consultations with nurses and primary care physicians (28). These findings emphasized the previously reported importance of the benefit conferred by social interaction and pleasurable activities in empowerment for self-care (48). This greater social interaction may also be beneficial for health professionals, as the results reveal a decrease in risk factors for work-related burnout. Thus, it is important to optimize care and interventions to improve care, promote interdisciplinarity and reduce the burden of the health team to promote the health and well-being of both patients and health professionals (49, 50).

Although only one study reported a significant decrease in total health and social care costs compared to usual care, the remaining studies that evaluated this dimension concluded that the implementation of interventions did not exacerbate the costs associated with providing care. This is a relevant indicator to consider in the design of health policies since these results seem to suggest that strategies to promote empowerment for self-care (51–53) show health gains without added costs to the health and social systems. Similarly, the absence of significant differences in mortality is interpreted as a positive finding, not compromising the implementation of the intervention. Finally, the implementation of care models to promote self-care seems to have a positive impact on caregivers, contributing to improving their self-efficacy and competence without increasing their perceived burden. In fact, family-centered intervention programs are beneficial for increasing the confidence, knowledge and skills of family caregivers of chronically ill patients (54, 55). The inclusion of informal caregivers in care provision is particularly important, as they are often challenged by a lack of information sharing, frequent role confusion and disorganized care planning (56, 57).

To the best of our knowledge, this is the first review that aims to analyze the health-related outcomes of randomized trials that evaluate the effect of different models of care centered on people with chronic disease, performed in long-term care, with the objective of promoting empowerment for self-care. However, some limitations must be discussed. The period from 2017 to 2022 used for literature search, was selected in response to the need to access the most up-to-date information on the topic being researched. Although some relevant papers published before 2017 may have been excluded from the current analysis, previous literature suggests that the conclusions of most systematic reviews might be valid for approximately 5 years (21). Thus, it has been advocated that systematic literature reviews should take into account evidence from the last 5 years (20), which should reflect the state of current knowledge on the field. Additionally, there was considerable heterogeneity among the studies, particularly regarding the specific characteristics of the selected samples, the care model implemented, the variety of scales used and the diversity of health outcomes evaluated. However, the selected databases, the search strategy and the inclusion criteria were carefully structured and supported by the literature and research experiences to capture the largest number and diversity of studies to meet the objectives of this rapid review of the literature.

A comprehensive mapping the health-related outcomes of person-centered care models to promote empowerment for self-care is presented in Figure 2, to synthetize our main conclusions. The absence of statistically significant associations for a large proportion of health outcomes emphasizes the need to develop robust experimental studies conducted in different countries and cultures, using internationally accepted and validated scales for chronic patients to assess health gains at short-, medium- and long-term. Such may contribute to identifying at-risk groups, empower the chronically ill to assume self-care, and promote the main facilitators for self-care. Also, the inclusion of the views and experiences of health professionals and the analysis of health outcomes by level of care may enhance the promotion of health and well-being among health professionals, while adapting the interventions to meet the needs of patients. Finally, the design and implementation of integrated care models in the community that promote the integration of variables that evaluate the interpersonal relationships between chronically ill patients, their peers, family members and caregivers, as well as the cooperation of health and social services will contribute to the integration of policies focused on the needs and experiences of citizens. Also, comparisons between countries will enhance the capture of broader experiences, diverse and representative, allowing comparisons and providing quality support to all stakeholders, taking into account different realities, needs and cultural origins.

FC and AJ reviewed the literature and identified the studies. FC and EA selected the studies and were responsible for the data extraction. FC drafted the manuscript. AJ, HO, and LP collaborated in the analysis and interpretation of the data and critically reviewed the manuscript. CF and EA designed the study, analyzed and interpreted the data, and critically reviewed the article for important intellectual content. All authors contributed to the article and approved the submitted version.

This research was funded by the European Regional Development Fund (ERDF) through the Program Interreg VA España-Portugal (POCTEP) 2014–2020, International Institute for Research and Innovation in Aging–Capitaliza, “0786_CAP4ie_4_P”. This work was funded by national funds through the Foundation for Science and Technology, under the project UIDP/04923/2020.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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