Rural age‐friendly ecosystems for older adults: An international scoping review with recommendations to support age‐friendly communities

Abstract

Background and Aims: The population of older adults in rural areas is rising, and they experience higher rates of poverty and chronic illness, have poorer health behaviors, and experience different challenges than those in urban areas. This scoping review seeks to (1) map the state of the science of age-friendly systems in rural areas regarding structural characteristics, processes for delivering age-friendly practices, and outcomes of age-friendly systems, (2) analyze strengths, weakness, opportunities, and threats of age-friendly system implementation, and (3) make person, practice, and policy-level recommendations to support active aging and development of age-friendly communities.Methods: An international scoping review was conducted of articles that used agefriendly framing, had a sample age of 45 years of age or older, self-identified as rural, and reported empiric data. Searches were conducted in PubMed, CINAHL, AgeLine,

Characterizing changes to older adults' care transition patterns from hospital to home care in the initial year of COVID‐19

“…To understand whether the pandemic exacerbated vulnerabilities in certain subgroups, we conducted multiple logistic regression models regressing 30-day ED visit or rehospitalization (outcome measure) on the variable of interest (phase of pandemic), and interaction terms of the two examining whether the outcome worsened for certain vulnerable subgroups, adjusted for other covariates based on our clinical expertise and prior work in the field. [11][12][13][14][15][16][17] The subgroups of particular interest included African-American patients, patients with dementia, and those with poor activities of daily living (ADL) function. We also compared patients with a COVID diagnosis (or COVID-like symptoms) to those without on the number of days between hospital discharge and the first HH visit.…”

“…To examine changes in HH services across the pre‐ and post‐pandemic phases, we retrospectively reviewed days between hospital or SNF discharge and first HH visit, the percentage requiring a conversation with a physician for medication issues (OASIS item), and 30‐day ED visit or rehospitalization using run charts. To understand whether the pandemic exacerbated vulnerabilities in certain subgroups, we conducted multiple logistic regression models regressing 30‐day ED visit or rehospitalization (outcome measure) on the variable of interest (phase of pandemic), and interaction terms of the two examining whether the outcome worsened for certain vulnerable subgroups, adjusted for other covariates based on our clinical expertise and prior work in the field 11–17 . The subgroups of particular interest included African‐American patients, patients with dementia, and those with poor activities of daily living (ADL) function.…”

Facilitators and Barriers to Implementing the 4Ms Framework of Age-Friendly Health Systems: A Scoping Review

“…The Institute for Healthcare Improvement’s (IHI) 4Ms Framework of Age-Friendly Health Systems includes four components: (1) knowing “What Matters” to each person; (2) preventing, identifying, treating, and managing “mentation” issues; (3) supporting “mobility” needs; and (4) necessary “medication” [ 1 , 2 ]. Despite the benefits of age-friendly health systems on older adults’ health outcomes, there is limited evidence on improving health-system-level and community-level metrics to support the implementation and sustainability of age-friendly health systems [ 3 ]. A recent interview study [ 4 ] explored the insights of adopting the 4Ms Framework in three health systems that were early adopters of the Framework and found that the common barriers to implementing the IHI’s 4Ms Framework included disengaged physicians, siloed implementation efforts (which led to problems with collaborations and scaling), and challenges in implementing “What Matters” in a meaningful way during clinical encounters [ 4 ].…”

“…To our knowledge, no scoping review studies have examined the facilitators and barriers when implementing the IHI’s 4Ms Framework. In light of the existing knowledge gaps [ 3 , 4 ], the Alzheimer’s Association (AA) recommended the adoption of the IHI’s 4Ms Framework of Age-Friendly Health Systems; however, health systems and clinics need evidence on how the implementation of the IHI’s 4Ms Framework has better supported the health and well-being of people aged 65 years and older by providing older-adult-friendly clinical encounters (e.g., offering Medicare beneficiaries free annual wellness visits to access preventive services in ways that make sense to older adults) [ 5 , 6 , 7 ].…”

“…To our knowledge, no scoping review studies have examined the facilitators and barriers when implementing the IHI's 4Ms Framework. In light of the existing knowledge gaps [3,4], the Alzheimer's Association (AA) recommended the adoption of the IHI's 4Ms…”