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Common elements of service delivery models that optimise quality of life and health service use among older people with advanced progressive conditions: a tertiary systematic review

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Joanne Bayly, Anna E Bone, Clare Ellis-Smith, India Tunnard, Shuja Yaqub, Deokhee Yi, Kennedy B Nkhoma, Amelia Cook, Sarah Combes, Sabrina Bajwah, Richard Harding, Caroline Nicholson, Charles Normand, Shalini Ahuja, Pamela Turrillas, Yoshiyuki Kizawa, Tatsuya Morita, Nanako Nishiyama, Satoru Tsuneto, Paul Ong & 3 more Irene J Higginson, Catherine J Evans, Matthew Maddocks

Original languageEnglish
Article numbere048417
JournalBMJ Open
Issue number12
PublishedNov 2021

Bibliographical note

Funding Information: Funding This research was supported by the World Health Organization Centre for Health Development (WHO Kobe Centre – WKC: K19002), the Dunhill Medical Trust (grant number RPGF1906\177) and the National Institute of Health Research Applied Research Collaboration South London (NIHRARC South London NIHR200152) at King’s College Hospital NHS Foundation Trust. AB is supported by the Dunhill Medical Trust (number RPGF1906\177) and Cicely Saunders International. SC is funded by a Health Education England/NIHR Clinical Doctoral Research Fellowship (ICA-CDRF-2017-03-012) and CNi by a Health Education England/NIHR Senior Clinical Lectureship (ICA-SCL-2018-04-ST2-001). IH is an NIHR Senior Investigator Emeritus. CE is funded by a Health Education England/ NIHR Senior Clinical Lectureship (ICA-SCL-2015-01-001) and MM is funded by an NIHR Career Development Fellowship (CDF-2017-10-009). This publication presents independent research supported by the National Institute for Health Research (NIHR). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, NIHR or the Department of Health and Social Care. Publisher Copyright: ©

King's Authors


INTRODUCTION: Health and social care services worldwide need to support ageing populations to live well with advanced progressive conditions while adapting to functional decline and finitude. We aimed to identify and map common elements of effective geriatric and palliative care services and consider their scalability and generalisability to high, middle and low-income countries.

METHODS: Tertiary systematic review (Cochrane Database of Systematic Reviews, CINAHL, Embase, January 2000-October 2019) of studies in geriatric or palliative care that demonstrated improved quality of life and/or health service use outcomes among older people with advanced progressive conditions. Using frameworks for health system analysis, service elements were identified. We used a staged, iterative process to develop a 'common components' logic model and consulted experts in geriatric or palliative care from high, middle and low-income countries on its scalability.

RESULTS: 78 studies (59 geriatric and 19 palliative) spanning all WHO regions were included. Data were available from 17 739 participants. Nearly half the studies recruited patients with heart failure (n=36) and one-third recruited patients with mixed diagnoses (n=26). Common service elements (≥80% of studies) included collaborative working, ongoing assessment, active patient participation, patient/family education and patient self-management. Effective services incorporated patient engagement, patient goal-driven care and the centrality of patient needs. Stakeholders (n=20) emphasised that wider implementation of such services would require access to skilled, multidisciplinary teams with sufficient resource to meet patients' needs. Identified barriers to scalability included the political and societal will to invest in and prioritise palliative and geriatric care for older people, alongside geographical and socioeconomic factors.

CONCLUSION: Our logic model combines elements of effective services to achieve optimal quality of life and health service use among older people with advanced progressive conditions. The model transcends current best practice in geriatric and palliative care and applies across the care continuum, from prevention of functional decline to end-of-life care.


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