Caring for the whole: the five R’s of working with complexity in older age

Purpose This study aims to develop a practice-oriented conceptual framework for working with complexity in the care of older people with multiple, interacting needs. This study responds to the limitations of single-condition, standardised models of care by treating complexity not as a deficiency to be eliminated but as a defining, workable feature of later life. Design/methodology/approach This paper is a conceptual contribution developed through an integrative review, a method designed to combine diverse theoretical and empirical literature to generate new conceptual understanding. Five bodies of scholarship – multimorbidity and frailty, complexity science, person- and relationship-centred care, the ethics of care and inequalities and intersectionality – were purposively identified and thematically synthesised to surface recurring principles of effective practice. Findings Complexity in later life is emergent and relational: the combined effect of physical, cognitive, mental and social factors is frequently greater than the sum of the parts, as the paradigmatic case of deafblindness demonstrates. Five interdependent principles recur across otherwise disparate literature. This study consolidates them into the “Five R’s” of complexity-informed care: Recognise, Relate, Reconfigure, Respond and Redistribute. Practical implications The framework offers practitioners, managers and commissioners a shared vocabulary and a set of orienting questions for holistic assessment, care coordination, adaptive practice and equitable service design. It foregrounds relational continuity, boundary-spanning coordination, tolerance of uncertainty and explicit attention to inequality and the agency of older people and their carers. Originality/value This study connects complexity theory with relationship-centred and equity-focused traditions of care that are seldom held in a single view, translating abstract concepts into a usable, teachable framework with explicit implications for everyday practice.