What Helps or Hinders Annual Wellness Visits for Detection and Management of Cognitive Impairment Among Older Adults? A Scoping Review Guided by the Consolidated Framework for Implementation Research

Topic: Risk, prevention and care in population studies

Among 19 included studies, most used quantitative designs and secondary data. Our CFIR-based synthesis revealed that AWV implementation is shaped by interdependent factors across five domains. Key facilitators included AWV adaptability, Electronic Health Record (EHR) integration, team-based workflows, policy alignment (e.g., Accountable Care Organization participation), and provider confidence. Barriers included vague Centers for Medicare and Medicaid Services (CMS) guidance, limited reimbursement, staffing shortages, workflow misalignment, and provider discomfort with cognitive screening. Implementation strategies were often poorly defined or inconsistently applied. Effective AWV delivery for older adults with cognitive impairment requires more than sound policy and intervention design; it demands organizational readiness, structured implementation, and engaged providers. Tailored training, leadership support, and integrated infrastructure are essential. These insights are relevant not only for U.S. Medicare but also for global efforts to integrate dementia-sensitive care into primary health systems. Our study has a few limitations that should be acknowledged. First, our scoping review synthesized findings predominantly from quantitative studies, with only two mixed-method studies and no studies using strictly qualitative methodologies. Second, few studies disaggregated findings by race, ethnicity, or geography, reducing our ability to assess equity-related outcomes. Moreover, few studies provided sufficient detail on the specific cognitive screening instruments used or on the scope and delivery of educational materials for patients and caregivers, limiting generalizability and implementation insights. Third, grey literature and non-peer-reviewed sources were not included. Fourth, although CFIR provided a comprehensive analytic structure, some studies did not explicitly fit in with our implementation frameworks, which required subjective mapping of findings to CFIR domains and may have introduced classification bias. Additionally, although our review did not quantitatively stratify findings by year, we observed that studies from more recent years were more likely to emphasize implementation facilitators (e.g., use of templates, workflow integration), whereas earlier studies often highlighted systemic barriers such as time constraints and provider unfamiliarity with AWV components. Finally, while our review focused specifically on AWV implementation in the

Key findings

• Among 19 included studies, most used quantitative designs and secondary data.
• Our CFIR-based synthesis revealed that AWV implementation is shaped by interdependent factors across five domains.
• Key facilitators included AWV adaptability, Electronic Health Record (EHR) integration, team-based workflows, policy alignment (e.g., Accountable Care Organization participation), and provider confidence.
• Barriers included vague Centers for Medicare and Medicaid Services (CMS) guidance, limited reimbursement, staffing shortages, workflow misalignment, and provider discomfort with cognitive screening.
• Implementation strategies were often poorly defined or inconsistently applied.

Why it matters

This scoping review examined factors helping or hindering Annual Wellness Visits for detection and management of cognitive impairment among older adults. It addresses detection and implementation in primary care, not treating, curing, or preventing Alzheimer's disease.

Study details

• Evidence strengthLow

Read the original

• DOI: 10.3390/nursrep15080295
• PubMed: 40863682
• Original source →

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@article{udoka2025-40863682,
  author  = {Udoka, Okpalauwaekwe and Hannah, Franks and Yong-Fang, Kuo and Raji Mukaila, A. and Elise, Passy and Huey-Ming, Tzeng},
  title   = {{What Helps or Hinders Annual Wellness Visits for Detection and Management of Cognitive Impairment Among Older Adults? A Scoping Review Guided by the Consolidated Framework for Implementation Research}},
  journal = {Nursing reports (Pavia, Italy)},
  year    = {2025},
  doi     = {10.3390/nursrep15080295},
  pmid    = {40863682},
  url     = {https://doi.org/10.3390/nursrep15080295}
}

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