Communication complexity in care for older people with multiple needs: a Malaysian multiple case study

Purpose This study aims to explore the experience of communication complexity of older people with multiple needs, family caregivers and healthcare professionals in integrated care settings in Malaysia and develops the Integrated Communication Complexity Framework (ICCF) to explain communication as the mechanism connecting disease complexity and system complexity. Design/methodology/approach The study used a qualitative multiple case study design. It involved 60 purposefully selected participants from five stakeholder groups (older adults, family caregivers, doctors, nurses and community/NGO workers) and three care settings (hospital, primary care clinic and community centre). Data were collected via semi-structured interviews and were analysed using Braun and Clarke’s six-phase thematic analysis, with the help of NVivo. Findings Four interrelated themes were identified: breakdown in communication across care transitions; family caregivers as informal communication coordinators; fragmentation of communication across providers; and sensory impairment as a catalyst of complexity. These findings form the basis of the ICCF that places communication as the connecting mechanism between disease complexity, system complexity and integrated care. Practical implications Findings support strategies at the level of practice including teach-back techniques, sensory-aware communication practices, formal recognition of caregivers as communication partners and improved information-sharing across hospitals, primary care and community services. Originality/value The paper offers a novel empirically based framework integrating complex adaptive systems theory, person-centred integrated care and comprehensive geriatric assessment, extending integrated care scholarship from an under-represented Southeast Asian context.