What matters to people aged 80 and over regarding ambulatory care? A systematic review and meta-synthesis of qualitative studies

Abstract

The growing percentage of the population aged 80 and over is challenging for healthcare systems, as frailty and other complex health issues are common in this age group. In order to provide patient-centered ambulatory healthcare, their preferences and expectations need to be explored. Therefore, the aim of this study was to systematically search for and synthesize qualitative evidence on how people aged 80 and over believe ambulatory healthcare (medical and nursing care) should be delivered to them. Medline, PsycINFO, CINAHL, Web of Science Core Collection and Google Scholar were searched for full research reports of qualitative studies focusing on the preferences, wishes, needs, expectations and experiences of people aged 80 and over regarding ambulatory medical and nursing care. The results were screened by two independent reviewers using a two-step approach. The included studies were meta-synthesized using Thomas and Harden’s ‘thematic synthesis’ approach in order to gain a new, second-order interpretation of the findings of the primary studies. In the intermediate synthesis step, 14 aspects of healthcare structures and care relationships were identified as relevant. Based on these, three underlying wishes were found: feeling safe, feeling like a meaningful human being, and maintaining control and independence. The results of this review are in line with other research, such as reviews focusing on the preferences of the younger age group (65–80). However, the importance of aspects of care relationships as an integral part of favorable ambulatory healthcare and the wish to be strengthened as a meaningful human being are emphasized more strongly.

Outreach dental care programme for older adults using long‐term care services in Hong Kong: A qualitative study

“…21 The older adults' emotional and social needs should be taken into account while providing outreach dental care. 22 This study also revealed that different outreach dental teams uate training in various specialities, on the treatment decisions for complex endodontic cases reported that procedural predictability, technical difficulty, risk of damage to the tooth and patient preference were the most important factors affecting clinical decisionmaking. 23 The authors suggested that evidence-based treatment guidelines and dental curricula should be reviewed to enhance interclinician agreement in clinical decision-making.…”

“…A network of cooperating healthcare providers, including dental professionals, and social support structures should be built to design patient‐centred care for older adults 21 . The older adults' emotional and social needs should be taken into account while providing outreach dental care 22 …”

Providing ambulatory healthcare for people aged 80 and over: Views and perspectives of physicians and dentists from a qualitative survey

“…The final survey contained nine closed items on sociodemographic and practice aspects. The eight open items asked for 1) characterization and challenges of working with patients aged 80 and over, 2) what constitutes good healthcare in older age from the healthcare providers’ perspective, 3) influential factors (barriers and facilitators) of treating older patients as intended, 4) conceptions on ensuring that patients feel safe, feel like meaningful human beings and maintain control and independence (older people’s core motives identified in [ 20 ]), and 5) proposals to improve or design future healthcare in old age. The complete survey is provided in the online S1 Appendix .…”

“…For example, it was found that nurses holding negative attitudes towards older people were stereotyping their patients, finding them incapable of decision-making and perceiving them as a burden [18,19]. This conflicts with older people's core motives in healthcare, these being 1) to feel safe, 2) to feel like a meaningful human being, and 3) to maintain control and independence [20]. Therefore, understanding healthcare providers' perceptions and their interactions is crucial for delivering appropriate healthcare to older Supplemental file S2 Appendix contains the full codebook that was developed and used for data analysis.…”

Co-creation of a Patient-Reported Outcome Measure for Older People Living with Frailty Receiving Acute Care (PROM-OPAC)

“…A PROM for this population and setting should measure the outcomes which users consider important. Recent qualitative research has consistently confirmed the holistic nature of acute healthcare outcome goals for older people living with frailty (7)(8)(9). Research to operationalize these goals toward measurement classified outcomes as "autonomy" (information, security, and control) and "function" (physical, psychosocial, and symptom relief) (10).…”