Fragmentation and integration in long-term care for older adults living with dementia in mainland China: a polycentric governance framework synthesis

Objectives To examine how long-term care for older adults living with dementia is organised across family, community, institutional, and cross-level settings in mainland China; identify where fragmentation occurs; and examine mechanisms relevant to integration. Methods We conducted a systematic review with a theory-informed framework synthesis. CNKI and the Web of Science Core Collection were searched for empirical studies published from 2006 to 2026. Eligible reports were independently screened, appraised with design-appropriate tools, and synthesised across care domains, with polycentric governance used as a sensitising framework. Results The review included 340 reports representing 321 underlying studies or projects. Within individual care domains, families carried most day-to-day care and coordination responsibilities, community services had uneven capacity for sustained support and linkage, and institutional expansion was not consistently matched by dementia-specific staffing, competence, or organisational support. Directly documented fragmentation concerned referral and transition, information continuity, and the transfer or sharing of responsibility, while financing and eligibility interfaces were less directly studied. Directly evaluated interventions were concentrated in caregiver support and selected setting-based programmes, while more direct integration evidence concerned continued cross-setting support, defined coordination roles, referral and feedback, and multidisciplinary or community-linked collaboration. System-level integration was seldom directly evaluated. Conclusion Long-term dementia care in mainland China comprises multiple service components, but their connections remain uneven. The findings identify cross-setting coordination, information continuity, follow-up and clearer responsibility as priorities for development and evaluation, while financing and eligibility require further investigation.