‘Saying goodbye’. . . A systematic integrative review of palliative caregiving in intergenerational living contexts

Juhrmann, Madeleine and Vandersman, Priyanka and Damarell, Raechel and Sharaf, Ahmed Khamis and Martin, Jon San and Donkor, Andrew and Salifu, Yakubu (2025) ‘Saying goodbye’. . . A systematic integrative review of palliative caregiving in intergenerational living contexts. Palliative Medicine. pp. 1-19. ISSN 0269-2163

Abstract

Background: Intergenerational co-residence has historically been prevalent. Recent financial pressures, increasing caregiving responsibilities and ageing populations have led to a resurgence of this arrangement, particularly in end-of-life care. However, understanding of its influence on care quality across cultures remains limited. Aim: To explore how intergenerational co-residence affects emotional, practical, and cultural dimensions of palliative and end-of-life care across different settings, and to identify key themes shaping caregiving roles, decision-making, and support needs in these households. Design: Systematic integrative review and thematic synthesis based on Braun and Clarke's approach and using the Convoy Model as a theoretical framework. PROSPERO ID: CRD42023446688.Data sources: Six major databases were searched from inception to 22 May 2023 and updated to 8 June 2025. Eligible papers reported empirical studies on end-of-life care in intergenerational co-residence and were appraised using the Mixed Methods Appraisal Tool. Results: Three themes were constructed from seven studies from China, South Africa, Spain, Uganda, Turkey and the United States. These were: responding to an end-of-life diagnosis, with limited death literacy delaying care; identifying systems of support, where caregiving burdens often fell on women; and concluding the journey and saying goodbye. Conclusions: Intergenerational co-residence can foster support at the end of life, yet it may also reinforce gendered caregiving roles that disproportionately burden women. Effective integration of formal support services with family caregiving remains important in alleviating pressures and promoting equitable care models, highlighting the need for culturally sensitive interventions that address the diverse needs of families, while encouraging collaborative caregiving approaches.