Continuity and sustainability of care in family medicine: Assessing its association with quality of life and health outcomes in older populations—A systematic review

Abstract

Background Continuity of care is a core principle of family medicine associated with improved outcomes. However, fragmentation challenges sustaining continuous relationships. This review aimed to provide timely and critical insights into the benefits of continuity and sustainability of care for older adults. Methods PubMed, EMBASE, CINAHL, Cochrane Library were systematically searched for studies on continuity/sustainability models in family medicine and effects on older adults. 14 studies met inclusion criteria for final synthesis. Quality was assessed using ROBINS-I. Outcomes were narratively and thematically synthesized. Results Greater continuity of care was consistently associated with reduced healthcare utilization including lower emergency department visits and hospitalizations. Continuity also correlated with improved chronic disease management, care coordination, patient-reported experiences, and quality of life. Patient-centered medical homes and care coordination models showed potential to strengthen continuity and sustainability. Thoughtful telehealth integration and technology tools augmented continuity. Conclusion Continuous healing relationships are vital for patient-centered care of older adults. While current fragmentation challenges sustainability, innovations in primary care teaming, coordination, telehealth, and health information technology can extend continuity’s benefits. Realizing improvements requires system-wide reorientation toward relationships and whole-person care.