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Service Delivery Models to Maximize Quality of Life for Older People at the End of Life: A Rapid Review

Research output: Contribution to journalReview article

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Service Delivery Models to Maximize Quality of Life for Older People at the End of Life : A Rapid Review. / Evans, Catherine J; Ison, Lucy; Ellis-Smith, Clare; Nicholson, Caroline; Costa, Alessia; Oluyase, Adejoke O; Namisango, Eve; Bone, Anna E; Brighton, Lisa Jane; Yi, Deokhee; Combes, Sarah; Bajwah, Sabrina; Gao, Wei; Harding, Richard; Ong, Paul; Higginson, Irene J; Maddocks, Matthew.

In: Milbank Quarterly, Vol. 97, No. 1, 03.2019, p. 113-175.

Research output: Contribution to journalReview article

Harvard

Evans, CJ, Ison, L, Ellis-Smith, C, Nicholson, C, Costa, A, Oluyase, AO, Namisango, E, Bone, AE, Brighton, LJ, Yi, D, Combes, S, Bajwah, S, Gao, W, Harding, R, Ong, P, Higginson, IJ & Maddocks, M 2019, 'Service Delivery Models to Maximize Quality of Life for Older People at the End of Life: A Rapid Review', Milbank Quarterly, vol. 97, no. 1, pp. 113-175. https://doi.org/10.1111/1468-0009.12373

APA

Evans, C. J., Ison, L., Ellis-Smith, C., Nicholson, C., Costa, A., Oluyase, A. O., ... Maddocks, M. (2019). Service Delivery Models to Maximize Quality of Life for Older People at the End of Life: A Rapid Review. Milbank Quarterly, 97(1), 113-175. https://doi.org/10.1111/1468-0009.12373

Vancouver

Evans CJ, Ison L, Ellis-Smith C, Nicholson C, Costa A, Oluyase AO et al. Service Delivery Models to Maximize Quality of Life for Older People at the End of Life: A Rapid Review. Milbank Quarterly. 2019 Mar;97(1):113-175. https://doi.org/10.1111/1468-0009.12373

Author

Evans, Catherine J ; Ison, Lucy ; Ellis-Smith, Clare ; Nicholson, Caroline ; Costa, Alessia ; Oluyase, Adejoke O ; Namisango, Eve ; Bone, Anna E ; Brighton, Lisa Jane ; Yi, Deokhee ; Combes, Sarah ; Bajwah, Sabrina ; Gao, Wei ; Harding, Richard ; Ong, Paul ; Higginson, Irene J ; Maddocks, Matthew. / Service Delivery Models to Maximize Quality of Life for Older People at the End of Life : A Rapid Review. In: Milbank Quarterly. 2019 ; Vol. 97, No. 1. pp. 113-175.

Bibtex Download

@article{8cb72e02d67b4890ba186d9ac84464ec,
title = "Service Delivery Models to Maximize Quality of Life for Older People at the End of Life: A Rapid Review",
abstract = "Policy Points We identified two overarching classifications of integrated geriatric and palliative care to maximize older people's quality of life at the end of life. Both are oriented to person-centered care, but with differing emphasis on either function or symptoms and concerns. Policymakers should both improve access to palliative care beyond just the last months of life and increase geriatric care provision to maintain and optimize function. This would ensure that continuity and coordination for potentially complex care needs across the continuum of late life would be maintained, where the demarcation of boundaries between healthy aging and healthy dying become increasingly blurred. Our findings highlight the urgent need for health system change to improve end-of-life care as part of universal health coverage. The use of health services should be informed by the likelihood of benefits and intended outcomes rather than on prognosis.CONTEXT: In an era of unprecedented global aging, a key priority is to align health and social services for older populations in order to support the dual priorities of living well while adapting to a gradual decline in function. We aimed to provide a comprehensive synthesis of evidence regarding service delivery models that optimize the quality of life (QoL) for older people at the end of life across health, social, and welfare services worldwide.METHODS: We conducted a rapid scoping review of systematic reviews. We searched MEDLINE, CINAHL, EMBASE, and CDSR databases from 2000 to 2017 for reviews reporting the effectiveness of service models aimed at optimizing QoL for older people, more than 50{\%} of whom were older than 60 and in the last one or two years of life. We assessed the quality of these included reviews using AMSTAR and synthesized the findings narratively.RESULTS: Of the 2,238 reviews identified, we included 72, with 20 reporting meta-analysis. Although all the World Health Organization (WHO) regions were represented, most of the reviews reported data from the Americas (52 of 72), Europe (46 of 72), and/or the Western Pacific (28 of 72). We identified two overarching classifications of service models but with different target outcomes: Integrated Geriatric Care, emphasizing physical function, and Integrated Palliative Care, focusing mainly on symptoms and concerns. Areas of synergy across the overarching classifications included person-centered care, education, and a multiprofessional workforce. The reviews assessed 117 separate outcomes. A meta-analysis demonstrated effectiveness for both classifications on QoL, including symptoms such as pain, depression, and psychological well-being. Economic analysis and its implications were poorly considered.CONCLUSIONS: Despite their different target outcomes, those service models classified as Integrated Geriatric Care or Integrated Palliative Care were effective in improving QoL for older people nearing the end of life. Both approaches highlight the imperative for integrating services across the care continuum, with service involvement triggered by the patient's needs and likelihood of benefits. To inform the sustainability of health system change we encourage economic analyses that span health and social care and examine all sources of finance to understand contextual inequalities.",
keywords = "geriatrics, health services for the aged, palliative care, quality of life",
author = "Evans, {Catherine J} and Lucy Ison and Clare Ellis-Smith and Caroline Nicholson and Alessia Costa and Oluyase, {Adejoke O} and Eve Namisango and Bone, {Anna E} and Brighton, {Lisa Jane} and Deokhee Yi and Sarah Combes and Sabrina Bajwah and Wei Gao and Richard Harding and Paul Ong and Higginson, {Irene J} and Matthew Maddocks",
note = "{\circledC} 2019 The Authors The Milbank Quarterly published by Wiley Periodicals, Inc. on behalf of The Millbank Memorial Fund.",
year = "2019",
month = "3",
doi = "10.1111/1468-0009.12373",
language = "English",
volume = "97",
pages = "113--175",
journal = "Milbank Quarterly",
issn = "0887-378X",
publisher = "Wiley-Blackwell",
number = "1",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - Service Delivery Models to Maximize Quality of Life for Older People at the End of Life

T2 - A Rapid Review

AU - Evans, Catherine J

AU - Ison, Lucy

AU - Ellis-Smith, Clare

AU - Nicholson, Caroline

AU - Costa, Alessia

AU - Oluyase, Adejoke O

AU - Namisango, Eve

AU - Bone, Anna E

AU - Brighton, Lisa Jane

AU - Yi, Deokhee

AU - Combes, Sarah

AU - Bajwah, Sabrina

AU - Gao, Wei

AU - Harding, Richard

AU - Ong, Paul

AU - Higginson, Irene J

AU - Maddocks, Matthew

N1 - © 2019 The Authors The Milbank Quarterly published by Wiley Periodicals, Inc. on behalf of The Millbank Memorial Fund.

PY - 2019/3

Y1 - 2019/3

N2 - Policy Points We identified two overarching classifications of integrated geriatric and palliative care to maximize older people's quality of life at the end of life. Both are oriented to person-centered care, but with differing emphasis on either function or symptoms and concerns. Policymakers should both improve access to palliative care beyond just the last months of life and increase geriatric care provision to maintain and optimize function. This would ensure that continuity and coordination for potentially complex care needs across the continuum of late life would be maintained, where the demarcation of boundaries between healthy aging and healthy dying become increasingly blurred. Our findings highlight the urgent need for health system change to improve end-of-life care as part of universal health coverage. The use of health services should be informed by the likelihood of benefits and intended outcomes rather than on prognosis.CONTEXT: In an era of unprecedented global aging, a key priority is to align health and social services for older populations in order to support the dual priorities of living well while adapting to a gradual decline in function. We aimed to provide a comprehensive synthesis of evidence regarding service delivery models that optimize the quality of life (QoL) for older people at the end of life across health, social, and welfare services worldwide.METHODS: We conducted a rapid scoping review of systematic reviews. We searched MEDLINE, CINAHL, EMBASE, and CDSR databases from 2000 to 2017 for reviews reporting the effectiveness of service models aimed at optimizing QoL for older people, more than 50% of whom were older than 60 and in the last one or two years of life. We assessed the quality of these included reviews using AMSTAR and synthesized the findings narratively.RESULTS: Of the 2,238 reviews identified, we included 72, with 20 reporting meta-analysis. Although all the World Health Organization (WHO) regions were represented, most of the reviews reported data from the Americas (52 of 72), Europe (46 of 72), and/or the Western Pacific (28 of 72). We identified two overarching classifications of service models but with different target outcomes: Integrated Geriatric Care, emphasizing physical function, and Integrated Palliative Care, focusing mainly on symptoms and concerns. Areas of synergy across the overarching classifications included person-centered care, education, and a multiprofessional workforce. The reviews assessed 117 separate outcomes. A meta-analysis demonstrated effectiveness for both classifications on QoL, including symptoms such as pain, depression, and psychological well-being. Economic analysis and its implications were poorly considered.CONCLUSIONS: Despite their different target outcomes, those service models classified as Integrated Geriatric Care or Integrated Palliative Care were effective in improving QoL for older people nearing the end of life. Both approaches highlight the imperative for integrating services across the care continuum, with service involvement triggered by the patient's needs and likelihood of benefits. To inform the sustainability of health system change we encourage economic analyses that span health and social care and examine all sources of finance to understand contextual inequalities.

AB - Policy Points We identified two overarching classifications of integrated geriatric and palliative care to maximize older people's quality of life at the end of life. Both are oriented to person-centered care, but with differing emphasis on either function or symptoms and concerns. Policymakers should both improve access to palliative care beyond just the last months of life and increase geriatric care provision to maintain and optimize function. This would ensure that continuity and coordination for potentially complex care needs across the continuum of late life would be maintained, where the demarcation of boundaries between healthy aging and healthy dying become increasingly blurred. Our findings highlight the urgent need for health system change to improve end-of-life care as part of universal health coverage. The use of health services should be informed by the likelihood of benefits and intended outcomes rather than on prognosis.CONTEXT: In an era of unprecedented global aging, a key priority is to align health and social services for older populations in order to support the dual priorities of living well while adapting to a gradual decline in function. We aimed to provide a comprehensive synthesis of evidence regarding service delivery models that optimize the quality of life (QoL) for older people at the end of life across health, social, and welfare services worldwide.METHODS: We conducted a rapid scoping review of systematic reviews. We searched MEDLINE, CINAHL, EMBASE, and CDSR databases from 2000 to 2017 for reviews reporting the effectiveness of service models aimed at optimizing QoL for older people, more than 50% of whom were older than 60 and in the last one or two years of life. We assessed the quality of these included reviews using AMSTAR and synthesized the findings narratively.RESULTS: Of the 2,238 reviews identified, we included 72, with 20 reporting meta-analysis. Although all the World Health Organization (WHO) regions were represented, most of the reviews reported data from the Americas (52 of 72), Europe (46 of 72), and/or the Western Pacific (28 of 72). We identified two overarching classifications of service models but with different target outcomes: Integrated Geriatric Care, emphasizing physical function, and Integrated Palliative Care, focusing mainly on symptoms and concerns. Areas of synergy across the overarching classifications included person-centered care, education, and a multiprofessional workforce. The reviews assessed 117 separate outcomes. A meta-analysis demonstrated effectiveness for both classifications on QoL, including symptoms such as pain, depression, and psychological well-being. Economic analysis and its implications were poorly considered.CONCLUSIONS: Despite their different target outcomes, those service models classified as Integrated Geriatric Care or Integrated Palliative Care were effective in improving QoL for older people nearing the end of life. Both approaches highlight the imperative for integrating services across the care continuum, with service involvement triggered by the patient's needs and likelihood of benefits. To inform the sustainability of health system change we encourage economic analyses that span health and social care and examine all sources of finance to understand contextual inequalities.

KW - geriatrics

KW - health services for the aged

KW - palliative care

KW - quality of life

UR - http://www.scopus.com/inward/record.url?scp=85063252902&partnerID=8YFLogxK

U2 - 10.1111/1468-0009.12373

DO - 10.1111/1468-0009.12373

M3 - Review article

C2 - 30883956

VL - 97

SP - 113

EP - 175

JO - Milbank Quarterly

JF - Milbank Quarterly

SN - 0887-378X

IS - 1

ER -

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