IntroductionHealth 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.MethodsTertiary 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.Results78 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.ConclusionOur 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.PROSPERO registration numberCRD42020150252.
receiving an oral treatment whereas only 33.5% would agree if the treatment was endovenous. In general, younger patients (<50 years old) feel more comfortable with virtual visits than older ones (>70 y) (77.4% vs 62%, p¼0.07). Only 20% of patients older than 50 believe that they can handle new technologies as opposed to 58.5% of younger ones (p¼0.001). 60.4% of the younger patients would like to have different technological tools to contact their oncologist whereas most patients (47.6%) older than 70 prefer only phone calls (p¼0.001). Regardless of the type of visit (treatment or follow-up) patients felt comfortable with virtual attendance (58.7% and 65.6% respectively, p¼0.2).Conclusions: As a whole, patients surveyed believed that telehealth could have a role following the COVID-19 pandemic. However, telemedicine is not applicable in all cases. Visits to older patients, to inform about radiological results and to patients recieving treatment should be assessed case by case.
is currently a 4th year medical student of King's College London, London, United Kingdom of a 6-year program. Hannah Suh is currently a 4thyear medical student of King's College London, London, United Kingdom of a 6-year program. Hozafa Ali is currently a 4th year medical student of King's College London, London, United Kingdom of a 6-year program.
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