Mapping Collaboration and Coordination of Health and Care Services for Older People with Dementia: A Scoping Review

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Introduction
A commonly discussed issue, in countries around the world, is the fragmentation of health and care services for older people [1][2][3].To address this fragmentation, there is an urgent need to shift the focus from health and care systems designed around diseases and institutions towards systems and practices designed for people and communities to achieve health and well-being in accordance with personal preferences and local prerequisites [4].Tis shift in focus is acknowledged by the integrated care approach; "integrated services are health services that are managed and delivered so that people receive a continuum of health promotion, disease prevention, diagnosis, treatment, disease management, rehabilitation, and palliative care services, coordinated across the diferent levels and sites of care within and beyond the health sector, and according to their needs throughout the life course" [5].
Collaboration and coordination are aspects often addressed and raised as vital to achieve and provide continuity and integrated and seamless care.As pointed out by Te World Health Organisation (WHO) [5], collaboration entails activities that cuts across sectors, organisations, providing agencies, professional responsibilities, between providers and users, and other types of boundaries.Furthermore, coordination of care is described, by WHO, as "a proactive approach to bring together care professionals and providers to meet the needs of service users to ensure that they receive integrated, person-focused care across various settings" [5].Accordingly, collaboration and coordination of care can be regarded as related to the provision of services both within and across various agencies where the patients receive the continuum of health and care services according to their need.In WHO's framework on the integration of care of older people [6], it is highlighted that actions are needed to integrate and implement care for older people at multiple levels: on the system level (e.g., fnancing health and care services, available services, accountability systems, guidelines, and regulations), the service level (e.g., coordination of services delivered by interdisciplinary providers), and the personal level (e.g., patients' goals, providing service to maximise capacity, and functional abilities of the older person).Tereby, collaboration and coordination of health and care services can refer to services provided by diferent professionals with various disciplinary backgrounds, working either on the same or on diverse levels within the same or at diferent health or care agencies.
Dementia is an umbrella concept used for cognitive and behavioral symptoms associated with diferent progressive brain diseases afecting higher cognitive functions (such as Alzheimer's disease, vascular dementia, and Lewy body dementia).Later stages of a dementia disease are often associated with multiple and complex health and care needs [7].In the coming years, the number of people with dementia is expected to grow [6,8].Consequently, stress will be put on health, social care, and welfare systems regarding challenges in prioritising due to limited resources [9].Tat is, care agencies must know how to use resources in a fair, appropriate, and efective way and to do what is most relevant for catering to the person's health and care needs.Terefore, diferent care agencies, with various responsibilities, must collaborate and coordinate their services [10] to overcome the risk that people with dementia, and their carers, do not receive the formal support that they need or are entitled to [11].Considering the widespread consensus on the signifcance of collaboration and coordination in achieving integrated care, the aim of this scoping review was to map how diferent health and care agencies collaborate and coordinate services for older people with dementia.

Previous Research on Collaboration and Coordination
regarding People with Dementia.Previous research on coordination of health and care services for older people with dementia has primarily been conducted from the perspective of case management, also referred to as care management [12,13].Case management is a complex intervention used to identify various needs and to provide or coordinate medical and community services [14,15].A commonality of case management is that one key person coordinates and monitors all support and services provided to the service user [16].Te impact of case management is diverse and varies according to previous research [10,17].Probably this is because case management is implemented diferently in various countries or contexts with diferent management systems, funding policies, and cultural variations governing the process [10,17].In addition to this, the clinical setting has consequences for how case management is implemented [13].For example, additional support such as cognitive stimulation, stress management, and psychological support might be provided at memory clinics but not provided at a primary care setting [13,14,18].
Tere are some previous reviews summarising the evidence on interventions aiming at coordinating health and care services for people with dementia [10,12], but most reviews on collaboration and coordination of health and care services do not single out a specifc target group.Røsvik and colleagues [12] mapped and examined research, in a scoping review, on how access to and use of formal community services could be improved through case management, monetary support, enhancing referral, and information sharing.In the process of coordinating health and care services for people with dementia, a variety of professions (e.g., social workers and nurses) or interprofessional teams are involved [10,14,15,19,20].Te disciplinary background of the professionals and their organisational afliations have also been described to have consequences for what is pointed out as important in the process of coordinating care for people with dementia.Furthermore, interprofessional teams working collaboratively could result in more efcient primary, secondary, and tertiary care for people with dementia [10].Information sharing between diferent agencies and diferent care providers with various disciplinary backgrounds has been identifed as vital when coordinating services for people with dementia to provide appropriate support, especially in terms of communication between diferent agencies and professionals [14,15,19].Less is known about the actual collaboration and coordination taking place between diferent agencies of professionals working together either at the same or at diverse levels in health, social care, and welfare system and what the consequences are for the individuals concerned and their signifcant others.
Even though there is a legal requirement in many countries for diferent care agencies and various professionals to collaborate and coordinate their services or activities [5], this does not seem to achieve the expected result-to create good, fair, accurate, and efective provision of care for older people [4,5].Terefore, more knowledge is needed on how diferent care agencies collaborate and coordinate health and care services for people with dementia.

Review Questions
Te aim of this scoping review was to map how diferent health and care agencies collaborate and coordinate services for older people with dementia.
RQ1: what characterises collaboration and coordination between diferent care agencies regarding people with dementia?RQ2: what are the outcomes reported following collaboration and coordination of health and care services for people with dementia?

Study Design.
A scoping review has been carried out following the methodology proposed by Joanna Briggs Institute (JBI) [21], reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) [21][22][23].A protocol presenting the design of this scoping review in more detail has previously been published [24].

Search
Strategy.An initial limited search [21] was conducted in PubMed and CINAHL to identify and determine search terms.Te fnal search for this scoping review was then conducted in PubMed, CINAHL, Embase, PsycInfo, Scopus, and Web of Science using the search terms reported in Appendix A. Te search terms and the combination of search terms were adjusted according to the instructions of each database.Te fnal search was conducted on the 6th of April 2022.
Neither a citation search nor a reference list search was conducted.Tis was agreed upon among all authors, since the number of articles included was judged to be extensive and sufcient to address the aim and the research questions of this scoping review.

Study Eligibility.
Te inclusion criteria in this scoping review were that the studies should be empirical (conducted with qualitative, quantitative, or mixed methodology) and published in peer-reviewed journals in the English language.Study protocols, reviews, letters to editors, opinions, doctoral dissertations, and conference abstracts have been excluded.A 10-year limit, considering the publication date of articles, has also been applied (i.e., 2012 and forward) to include contemporary research in this scoping review.

Search Outcome.
All potential studies were imported to an EndNote 20© library.EndNote 20© was utilised to identify and remove duplicates of articles.EndNote 20© was also employed to identify and exclude articles based on their publication years and type of publications (i.e., study protocols, reviews, letters to editors, opinions, doctoral dissertations, and conference abstracts).Inclusion of articles was then based on titles and abstract screening and full text reading (JH Ö and ÅLR).All included articles were then retrieved in full text and imported to an EndNote 20© library.A full text reading was conducted of all included articles at this stage to ensure that articles were relevant in accordance with the eligibility criteria of this scoping review (JH Ö and ÅLR).During the article selection process, disagreements in article inclusions were discussed among all authors until consensus was reached.Te study selection process is reported in a PRISMA fow diagram [25] (Figure 1).A list of articles excluded after full text reading can be obtained from the authors.

Data Extraction Process.
Data of relevance for this scoping review's aim and research questions were extracted from the included articles.A Microsoft Excel© spreadsheet was used for organising the extracted data, including the following parameters: (1) basic characteristics of the included studies (author(s), year of publication, country of origin, aims/purposes, and methodology/method); (2) different stakeholders represented/presented in the study (i.e., from which perspective is collaboration and coordination studied, who are participating in the study); (3) intervention or model of collaboration or coordination; and (4) outcome or key fndings of the intervention/model.

Critical Appraisal.
All included articles were critically appraised ( ÅLR) and then verifed (AN and JH Ö), using the Research Pyramid Model, which allows articles with diferent study designs to be critically appraised [26].Te Research Pyramid Model is illustrated as a pyramid, where descriptive research forms the base of the pyramid, and the three sides represent experimental research, outcome research, and qualitative research.Each side and the base are divided into four levels used to appraise the evidence.Evidence grading, according to the JBI recommendations for scoping reviews, could either be based on the title, abstract, or full text of included studies [21].Te grading of the evidence has been based on the included articles' abstracts and is presented both in text and tabular form in the Findings section.

Data Analysis and Synthesis.
A descriptive and inductive content analysis [27] was performed.Tis analytical approach was chosen because scoping reviews typically do not synthesise the results of the articles included [21].Te extracted data in the spreadsheet were coded independently by all authors.In this coding procedure, extracted data were labelled with a shorter sentence or a single word with the intention of shortening the extraction but keeping the principal content of these kinds of extraction.All codes of the extracted data were then discussed by all authors together.Tese codes were then compiled into categories of relevance for what characterises collaboration and coordination of health and care services for older people with dementia.Eight categories emerged and could be identifed in the analysis.Discussions among all authors have occurred continuously throughout the analytical process.Tis procedure was chosen to ensure rigidness in the analysis, and that the fndings emerged from the included articles and not a single author's preunderstanding of the studied topic at hand.

Ethical Considerations
Scoping review does not require approval from a human research ethics authority as it does not involve human participants.

Findings
In this section, we will present the characteristics of the included studies, the grading of the evidence, and what characterises collaboration and coordination for people with dementia.Based on the content analysis, we identifed eight categories of what characterise collaboration and coordination for older people with dementia.Tese categories are presented in Section 5.3.

Characteristics of the Included Articles.
In this scoping review, 59 articles were included.Of these articles, 27 had qualitative design, 20 quantitative design, and 12 mixed method design.Te qualitative data were collected using interviews (21), focus group interviews (10), or observations (4).Seven (7) of the quantitative studies were randomised controlled trials.Twenty-seven of the articles included persons with dementia as participants (among these, eight studies included dyads).Health or social care professionals were participating in thirtyseven of the included articles.More characteristics and the main fndings of the included articles are presented in Table 1.
Most of the articles included were conducted by researchers located in Western countries (27 in Europe and 23 in North America), with additional studies conducted in Asia (4) and Oceania (3).Additionally, a few articles were co-authored by researchers from Asia and Europe (1) and Oceania, North America, and Europe (1).

Grading of the
Evidence.About half of the included studies (n � 29) were categorised according to the Research Pyramid Model [26] as qualitative research (27 qualitative methods and two with a mixed method design), all at level 3 (group qualitative studies with less rigor).Tirteen (13) articles were categorised as outcome research, with ten (10) at level 3 (case-control studies, preexisting group comparisons) and three (3) at level 4 (one-group pre-post studies).Ten (10)  , and two on level 2, suggesting that the evidence for the articles included must be deemed as moderate (see Table 2).

Characteristics of Collaboration and Coordination for
People with Dementia.Various characteristics of collaboration and coordination of health and care services for older people with dementia were identifed through the inductive and descriptive content analysis.Tese are presented in Table 3.

Structural and Organisational Barriers Hindering
Collaboration and Coordination.Consistency and stability over time were identifed as central aspects when coordinating health and care services for people with dementia [28].Tere are several structural barriers presented in the included articles such as lack of structured documentation [29], lack of shared information-technology platforms between various organisations or agencies [29,30], lack of clarity [31], difculties in coordinating multiple schedules, inadequate infrastructural support, and insufcient communication among team members [32,33].Stafs' lack of skills, training, and limited time for refection or feedback were also raised as structural barriers [31].
Tere are also organisational barriers described in the included articles, hindering collaboration and coordination of health and care services for older people with dementia.Tese include lack of sustainable funding and consistency [30,[33][34][35], lack of fnancial compensations for collaborative practices, lack of designated time [36,37], restrictive commissioning frameworks, constraints in resources [32], competing priorities in everyday work [33], competition among various care agencies [34], a centralised care system [38], and blurry boundaries of responsibility in-between diferent organisations or agencies [39,40].Other organisational barriers consist of infexible structures and services [36], limited availability of care places [39], and lack of service integration [41].One article [42] showed that the organisational features did not afect care giver burden.

Care Coordinator as a Function for Enhancing Collaboration and Coordination.
Many articles took their point of departure in a key person [43,44], often referred to as a care coordinator, case manager, care manager, social worker, or admiral nurse (i.e., registered nurses who are specialised in dementia care), that served an important function for enhanced collaboration and coordination of services.Several tasks for the care coordinators were mentioned in the articles, such as making various organisations' responsibilities explicit, referring the person with dementia to the right care provider, giving recommendations on how to proceed, support in contacts, and creating a structure or a timeline for when certain tasks should be carried out or when support should be implemented [37,45].Furthermore, as part of their function, care coordinators advocate the necessity of services [46] and provide emotional support to the person with dementia [47,48].
When services were provided by diferent organisations or care agencies, the care coordinator's function was to link the person with dementia, in relation to their care needs, to relevant care providers [37,49,50].On the contrary, imbedded, or integrated care coordinators within an organisation or a care agency were described to work intensively with the same patient over time, in close collaboration with other health care professionals at the same agency [40,50].
In some articles, care coordinators with medical knowledge, working in a health care organisation, were addressing medical needs, while care coordinators within community services were responsible for catering to social care needs [51][52][53][54][55][56].Care coordinators representing a medical discipline were presented as having additional working tasks, which might be prioritised over work related to coordination of care [50].

Assessments and Planning to Provide Services in Relation to their Care Needs (Current).
Various assessments and interventions were prominent components of collaboration and coordination of health and care services for older people with dementia described in the articles.A structured assessment was depicted as important to ensure that care needs were not missed when coordinating services [52].Computer-based systems [57] and standardised protocols provide a clear division of responsibility among all professionals [53,54,58] to address both medical and nonmedical needs [53].Standardised protocols were also used to ensure an equal distribution of services, to support the care coordinator in prioritising various patients [37], and to facilitate for care coordinators to be proactive in their work rather than acting on crises as the disease trajectory progresses [59].
Since dementia is a progressive condition, the assessment of the person's needs of care must be continuously updated, discussed, and reported back to the patient and their signifcant others to ensure that relevant support is still provided [49,53,54,[60][61][62].Telephone [53,54,63] or e-mail contacts [53,54] were described as being used to regularly follow up the patient's disease trajectory.Changes in health and care needs for people with dementia often occur swiftly, which is why there might be limited possibilities to plan services or support in advance [64].At an early phase of the disease, coordination of diferent services might be easier than at later stages when the patient's condition has worsened [65].Tere are examples of a delayed implementation of services with the consequence of having a crisis-driven process rather than a need-driven process [36,44].Health & Social Care in the Community

Interprofessional Collaboration to Address Multiple
Health and Care Needs.Many articles took their point of departure in interprofessional collaboration and coordination of services for people with dementia [35,39,41,66].Diverse concepts were used among the included articles to refer to this such as multiprofessional, multidisciplinary, interdisciplinary, and interprofessional teams.Interprofessional teams were portrayed as a prerequisite for collaboration in dementia care [35,39,67] and for providing person-centred care [33,68].It was depicted that interprofessional teams provide a broader understanding of the patient's situation or condition for physicians [63,66] or for care coordinators [51] that works as a support in decision making of how to proceed with a person's care needs.Various professional disciplines participate in interprofessional collaboration to provide services [66], bringing their professional competency to the team [67,69,70].Diferent professionals representing various disciplines might have diferent understandings or assessments of a person's health and care needs (and responsibilities), as well as diferent ideas of how to proceed [71].
Tere are some hierarchies presented in the included articles associated with interprofessional collaboration among health professionals [65,72].For example, the main responsibility for a given care recipient is usually held by a general practitioner who sometimes cannot prioritise participating in interprofessional work, which is why the necessary mandate to make decisions may be missing [65,69,73].Professionals partaking in interprofessional collaboration may be located at various agencies or within the same organisation or care agency [36].Furthermore, team members tend to appreciate being part of an interprofessional team when coordinating care for people with dementia [51].Still, little is known about interagency coordination in dementia care [74].
Case conferences, as part of interprofessional collaboration, facilitate the coordination of health and care services for people with dementia.At case conferences, key responsible professionals meet to discuss patients' needs, but also to share information about patients [75].At these meetings, team members discuss, plan, and make collective assessments on the needs of people with dementia and on how and when to proceed [73].

Communication as a Means of Sharing Information and Building
Relationships.Communication was identifed as being relevant for the collaboration and coordination of health and care services for older people with dementia.An aspect pointed out as of importance was information sharing between various organisations or care agencies [39,51] to ensure that relevant support was administered by staf with the right competencies [39,62], that knowledge about the patient was shared among all involved professionals [59], and that they work towards the same preferred (by the patient) outcome [51,75].One study also identifed the importance of communication by using a mobile application for information sharing (about medication, contacts with health care professionals, or changes in the person's health condition) among signifcant others [76].
Another aspect relating to communication was the importance of building relationships such as creating an alliance with the person with dementia when coordinating services [36,77], to signal an interest in the family's individual circumstances [48].When interacting with the person concerned, health and care professionals should ensure that a relationship is developed to facilitate participation in the process of coordinating care [77] and to ensure person-centred care [60,67,72].If the person living with dementia experiences an encounter with the professional or the use of a service negatively, further requests for support or the person's compliance with care plans could be afected negatively [44].Te use of visual prompts, but also reduction of external stimuli, was described as important to facilitate communication [59].Facilitation of communication between lay persons and professionals might also be needed since professionals often use complex terms in their communication [78].

Knowledge to Navigate a Complex Health and Care
System.When people with dementia or their signifcant others need support, they must navigate in a complex health and care system [43], often with limited knowledge and information about the system [47].Professionals experience that when people with dementia or their signifcant others request support, they often do not know what to apply for or what services are available [44].In relation to this, guidance and advice may be given by professionals with knowledge about the system on how to proceed [62,79,80] and how to support decision making among people with dementia [38].Knowledge about the health and care system seems to some extent to be of greater importance than professional training (such as being a trained social worker or nurse) [59].Still, the professional competencies associated with various disciplines have consequences as medical health care professionals and social workers address diferent forms of needs (i.e., medical, or social care needs) among people with dementia [51].

Categories Structural and organisational barriers hindering collaboration and coordination
Care coordinator as a function for enhancing collaboration and coordination Assessments and planning to provide services in relation to their care needs (current) Interprofessional collaboration to address multiple health and care needs Communication as a means of sharing information and building relationships Knowledge to navigate a complex health and care system Knowledge and competencies about dementia Personalisation of care, empowerment, and acknowledging agency

Knowledge and Competencies about Dementia.
Knowledge and competencies related to dementia diseases and how to approach people with dementia, among both professionals and caregivers, were highlighted as important for the collaboration and coordination of health and care services for people with dementia.Special competencies and skills of professionals have been found to be important [55,60] and necessary for providing accurate care and support [31,48].For example, specialist clinics were described as a resource to increase competencies among nonspecialised clinics or practitioners by giving assistance in the care of patients with dementia [30,81] or consultations for general practitioners from dementia specialists (such as geriatricians) [65].Furthermore, nurses with specialist training in dementia, in identifying behavioral and psychological symptoms, increase the chance of use of dementia medications [57].Other competencies depicted as being of importance were interpersonal skills when interacting with people with dementia and advocating that they accept relevant services [72].Tese interactional skills also pertain to understanding the diagnosis, as well as how to adjust interaction in accordance with the person's needs [37,72].
Te dissemination of knowledge and skills based on the caregiver's preferences and choices has been identifed as an important aspect of establishing regular and lasting contact between informal caregivers and professionals [45,46,58].Training of informal caregivers [49] on how to manage dementia symptoms [62,78] and how to manage stress and self-care strategies [78] was also presented as key in the included articles.Te caregivers of the person with dementia could also be thought competencies such as coping skills, communication skills, behavioral management techniques, and problem-solving techniques [45,47,58].Training informal caregivers the skills [73] of how to manage the care of, interact with, and understand people with dementia, reduces perceived caregiver burden [63,82], depression [78,82], and visits to the emergency department [82].On the other hand, an increased understanding of dementia diseases and their consequences among informal caregivers may also increase perceived caregiver burden [83].

Personalisation of Care, Empowerment, and Acknowledging Agency.
Te aspects of enhancing participation in the decision-making processes and acknowledging the agency of persons with dementia were discussed in the articles included [47,71].In these articles, empowerment, inclusion, and participation in the process of coordinating care were described as goals [38,47,79], but none of the articles presented these as achieved outcomes.Acknowledging agency was also performed by advocacy [79] and by supporters/advisors through the mechanism of supported decision making [38].
Te disease trajectory may have implications for the person's involvement in the process of coordinating services [54].Younger patients, and those who reported memory difculties themselves, exhibited a higher level of engagement in coordinating their care.Nevertheless, for people with dementia to remain motivated to receive or accept support, it is crucial for the time between the decision to implement care and the actual implementation to be as short as possible to minimise the risk of them later declining support [28].
Signifcant others often advocate for support, frequently at an earlier stage of the disease trajectory than the person with dementia [44].However, in the process of receiving formal support, signifcant others may experience a fear of losing control when allowing strangers into their personal space [44].Te role of the family has been emphasised [84], and family case conferences provide an opportunity for signifcant others to infuence the organisation of care and share their understanding of the person with dementia.Tis understanding can then be taken into consideration when coordinating services [75].
Non-clinical community care coordinators engage in advocacy on behalf of or together with the person with dementia to access support or to address various difculties encountered when using health and care services [79,85].Furthermore, care coordinators working from an ofce located at, for example, the Alzheimer's associations, were presented as accessible and easily reachable for people with dementia and their signifcant others.For care coordinators, splitting their time between an Alzheimer's association and a clinic made it possible to engage with those receiving services and also interact with professionals responsible for providing or organising health or care services, thereby advocating on behalf of the person with dementia [62,66,86].

Discussion
In this scoping review, we have mapped research about how diferent care agencies collaborate and coordinate health and care services for older people with dementia.Most of the articles included in this scoping review were conducted in either Europe or North America.Our grading of the evidence [26] suggests that available research about the topic at hand is moderate.Hence, there is a need for more extensive research with more robust research methodologies in countries with various health, social care, and welfare systems to further our understanding of collaboration and coordination of health and care services for people with dementia.
In the present scoping review, we identifed that the care coordinator exercises a function for enhancing coordination of health and care services, but also in relation to facilitate collaboration among various professionals and lay persons when care services are implemented.Te function of working as a care coordinator is administered by a key person such as nurses, social workers, or admiral nurses.What is expected of this function difers depending on several factors such as professional training (diferent skills or what is deemed as important to address) and where the care coordinator is working (e.g., within a team or an agency, between diferent agencies or authorities, or in an organisation representing civil society).In previous research, the care coordinator has frequently been described to be a case manager, with the main responsibility of coordinating health Health & Social Care in the Community and care services for people with dementia [7,87].Furthermore, the work conducted by case managers difers in implementation due to several factors, such as variations in legislative frameworks governing the process, funding policies, or cultural variations [10,15,17].Tis warrants further research, both to understand what is expected of a professional care coordinator working with people with dementia and to explore how various structural factors infuence their work and responsibilities.
Interprofessional collaboration is highlighted in our fndings as being important for the collaboration and coordination of health and care services for people with dementia.Nonetheless, research on how to achieve constructive collaboration and how to organise this work is scarcely addressed.Previously, several studies on interprofessional collaboration and coordination of health and care services have primarily focused on barriers [1,2,12,88,89], but how to handle these barriers remains to be addressed [83].Barriers were also a prominent feature in the articles included, such as lack of communication or understanding of various team members' competences.Further research is needed to study how these identifed barriers could be reduced.One approach to overcome some of these structural barriers could be to study how professionals with specifc knowledge about dementia could be utilised as a resource for other professionals.Additionally, exploring the use of structured assessments of care needs [90] in the context of collaborating and coordinating health and care services for people with dementia may prove valuable.
Our fndings suggest that people with dementia and their signifcant others need support to navigate the health, social care, and welfare system, as it is often complex in its nature.Furthermore, what support is available and suitable for addressing the health and care needs of the person with dementia and their signifcant other might be unknown or difcult for them to understand.Dementia is a syndrome associated with, for example, cognitive declines and communication problems [6].It might, therefore, be difcult for an older person with dementia to know what support or services to request in accordance with their needs [91].Hence, it falls upon professionals to promote involvement in the decision-making process by providing relevant information in an accessible manner and visualising what support is available and how it could be implemented [92].Tis has been briefy mentioned in our fndings because little is known about how to organise the provision of such information.Tis is something that merits further research.However, a characteristic presented in our results is the assessment and planning of services that follow a predetermined structure to ensure that care needs are not missed or overlooked.Tis might be one way to achieve personalisation of care, as care needs are continuously monitored and assessed throughout the disease trajectory.Nonetheless, fexibility and responsiveness are important in relation to guidelines or predetermined structures to ensure personalisation of care and to prevent integrated care from being provided as a "tick box culture" [90].
Our fndings also relate to various professionals with diferent disciplinary training who are relevant for coordinating care and supporting collaboration between diferent care agencies.Diferent professionals have diferent perspectives and understandings of the characteristics of collaboration and coordination of health and care services for older people with dementia.Many of the included articles take a professional perspective.Terefore, there is a need for further studies that address the collaboration and coordination of services provided by various agencies from the perspective of the person concerned (i.e., the person with dementia).Our fndings suggest that various professionals, depending on their afliations, locations, or professional training, have diferent starting points in how they approach collaboration and coordination.Since diferent professionals represent diferent authorities or care agencies, there is a need for them to convene in various contexts to discuss how to proceed with a person with dementia.Furthermore, the term "location" also pertains to the physical location of the care coordinators' ofces.For example, a care coordinator working from a local civil society organisation could reduce the barrier for people with dementia or their signifcant others to request or apply for formal support.Our fndings suggest that civil society is an emerging stakeholder, facilitating participation for people with dementia in the decision-making process and empowering them as a group that seeks agency by being present in situations where health and care services are coordinated among professional stakeholders.Tis also underscores the importance of considering local communities to provide integrated care [4].
Personalisation of care, participation in decision making about future services, and empowerment were presented as characteristics in our fndings.However, instead of being achieved, these processes were shown as something sought after when coordinating care for people with dementia.In dementia studies, a citizenship perspective has been developed and advocated for in research and practice to explore how empowerment can occur and support people with dementia in using their remaining capabilities to participate in decisions regarding future health and care services [91,93,94].A citizenship perspective entails the empowerment of people with dementia, emphasising the individual's possibility to be independent, set their own goals, and have control over their own life [95].Further research is needed to investigate how a citizenship perspective could be applied in the process of collaborating and coordinating health and care services for people with dementia, to align with an integrated care approach.
6.1.Implications for Practice.Te fndings suggest that the physical location of the care coordinator may reduce barriers for people with dementia when requesting or applying for support.Additionally, a care coordinator's professional background has implications for the health or care needs they address and how they prioritise various tasks in their daily work.Tis has implications for both policy and practice, as it might be essential to engage diferent care coordinators with diverse competencies to address both medical and social care needs, given that people with dementia often experience multiple and complex health and 20 Health & Social Care in the Community care needs.Te signifcance of establishing a relationship with the person with dementia and their signifcant others was emphasised in the fndings.Communication is crucial for building this relationship.It is also relevant to explain and visualise the services available for the person with dementia to meet their health and care needs and to determine when these services are suitable to implement in their disease trajectory.Given the information asymmetry that exists between professionals and lay person, addressing this gap in knowledge about services is necessary.Furthermore, the fndings suggest that specifc knowledge and competencies about dementia are needed among both professionals and signifcant others to support and empower people with dementia in everyday life situations.Terefore, it is important to provide relevant educational eforts and skills training for professionals working in dementia care, as well as for signifcant others of people with dementia.

Strengths and Limitations.
Tis scoping review has several strengths but also some limitations.A comprehensive literature search revealed many potential articles to include in the present scoping review.To reduce subjective bias in the article selection process, two researchers independently conducted the selection of articles, which was validated through consultation with the third researcher.Terefore, the approach to including studies for this scoping review was systematic.However, the concept used to inform the search, especially "collaboration" and "coordination," is often ambiguous with various interpretations.In the process of including articles, an inclusive approach has been applied regarding the terms "collaboration" and "coordination" (see the published study protocol for a more detailed explanation of the concepts used [24]).Consequently, in the articles included, various understandings and perspectives related to these terms are presented.Some of these articles also ofer more context and insight into these terms, which is why they are more extensively presented in our fndings.Furthermore, the focus of this scoping review was on empirical literature, and as a result, grey literature was excluded.Consequently, it is possible that not all studies that could have provided additional insights on the topic at hand were identifed.Additionally, no reference search or citation search was conducted, despite being planned in the study protocol for this scoping review [24].Tis should be taken into consideration, as relevant literature may have been missed.
Te analytical process was a collaborative efort, undertaken by all three authors working closely together.Tis collaborative approach was chosen to prevent any skewed or biased result, which might occur if dependent on any of the researchers' prior understandings, and to promote alternative interpretations of the included articles.
A critical appraisal of the evidence was performed based on the Research Pyramid [26] on the included articles' abstracts.During the analytical process, several weaknesses in the abstracts were identifed, including vague descriptions of methodology and lack of clarity regarding the number of participants, data collection methods, and analytical processes.As a result, the critical appraisal may have been negatively infuenced by shortcomings in the reporting of the design of the included studies in the abstracts.
Finally, the articles included in this scoping review were authored by researchers from various countries, each with its own legislative contexts infuencing the practice of collaboration and coordination of health and care services for people with dementia.While this scoping review provides information about the authors' afliations, the analysis presented here has not considered the legislative context in which the diferent studies were conducted.In previous research, it has been noted that the legislative context is often absent or inadequately described, which makes it challenging to apply the results of a study to other settings [10,17,88,[96][97][98].In future reviews, the analysis of articles could be included based on or analysed with regard to their legislative context.

Conclusion
In conclusion, in the qualitative part of this study, we were able to elaborate on the characteristics that have been presented in previously conducted research about collaboration and coordination of health and care services for older people with dementia.Engaging care coordinators with diverse competencies to address both medical and social care needs is essential, especially since people with dementia often experience multiple and complex health and care needs.It is also important to explain and visualise available services to the person with dementia and when these services are suitable for implementation.Specifc knowledge about dementia among professionals and signifcant others is necessary to empower people with dementia in everyday life situations.Trough the identifcation of characteristics described in previous research, we can now better understand how integrated care can be coordinated with the goal of creating the best possible conditions for the persons concerned, including their signifcant others, and for the professionals.Improved collaboration and coordination not only lead to better and integrated care for the patients but also contribute to more sustainable and robust health and care agencies, thereby strengthening the healthcare system.

Table 1 :
Characteristics and main fndings of the included articles.

Table 2 :
Levels of evidence for included articles.

Table 3 :
Presentation of the identifed categories.