Redesigning care for older people to preserve physical and mental capacity: WHO guidelines on community-level interventions in integrated care

Thiyagarajan, Jotheeswaran Amuthavalli; Carvalho, Islène Araujo de; Peña-Rosas, Juan Pablo; Chadha, Shelly; Mariotti, Silvio Paolo; Dua, Tarun; Albanese, Emiliano; Bruyère, Olivier; Cesari, Matteo; Dangour, Alan D.; Dias, Amit; Guerra, Mariella; Keeffe, Jill; Kerse, Ngaire; Khan, Qurat ul Ain; Liu, Chiung Ju; Murthy, Gudlavalleti V S; Ndegwa, Serah N.; Reginster, Jean Yves; Robledo, L. M.; Tremblay, Kelly L.; Woo, Jean; Prince, Martin; Beard, John

doi:10.1371/journal.pmed.1002948

Cited by 62 publications

(39 citation statements)

References 16 publications

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“…Our findings resonate with ideas around needing more tailored interventions for people with frailty 76 and respiratory disease, 77 thinking creatively about engagement with exercise-based interventions, 78 and taking integrated approaches to support the maintenance of physical and mental capacities in an aging population. 79 Recent examples within wider respiratory care include interdisciplinary models of primary care for people with COPD, 80 integrated respiratory and palliative care services for chronic breathlessness, 81 and rehabilitation for people with both respiratory and heart disease. 82 As research specifically with people with COPD and frailty increases, 50,54 this type of complex interventional work will be a priority.…”

Section: Discussionmentioning

confidence: 99%

<p>Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review</p>

Brighton

Evans

Man

et al. 2020

COPD

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Background: People living with both chronic obstructive pulmonary disease (COPD) and frailty have high potential to benefit from exercise-based interventions, including pulmonary rehabilitation, but face challenges completing them. Research to understand ways to optimise exercise-based interventions in this group is lacking. We aimed to understand how exercisebased interventions might improve outcomes for people living with both COPD and frailty. Methods: This realist review used database searches and handsearching until October 2019 to identify articles of relevance to exercise-based interventions for people living with COPD and frailty. A scoping search explored what is important about the context of living with COPD and frailty, and what mechanisms might be important in how exercise-based interventions result in their intended outcomes. Through discussion with stakeholders, the review scope was refined to areas deemed pertinent to improving care. We retained articles within this refined scope and identified additional articles through targeted handsearching. Data were extracted and synthesised in a narrative, prioritised by relevance and rigour. Results: Of 344 records identified, 35 were included in the review and 20 informed the final synthesis. Important contextual factors to consider included: negative beliefs about themselves and exercise-based interventions; heterogenous presentation and comorbidities; decreased reserves and multidimensional loss; and experiencing unpredictable health and disruptions. In these circumstances, mechanisms that may help maximise outcomes from exercise-based interventions included: trusting relationships; creating a shared understanding of needs; having the capacity to address multidimensional concerns; being able to individualise approaches to needs and priorities; and flexible approaches to intervention delivery. Mixed-methods research and explicit theorising were often absent. Conclusion: Building trusting relationships, understanding priorities, using individualised and multidisciplinary approaches, and flexible service delivery can improve the value of exercise-based interventions for people living with both COPD and frailty. Development and evaluation of new and adapted interventions should consider these principles.

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Section: Discussionmentioning

confidence: 99%

<p>Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review</p>

Brighton

Evans

Man

et al. 2020

COPD

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“…Through this, recommendations were published on community-level interventions to manage declines in intrinsic capacity (ie. the composite of all the physical and mental capacities of an individual) of older people [14]. To achieve personcentred care in practice requires a community aged care workforce that can identify and respond to the health and care needs of all people with diverse characteristics, including older people [15].…”

Section: Introductionmentioning

confidence: 99%

The inter-relationship of diversity principles for the enhanced participation of older people in their care: a qualitative study

Ogrin

Meyer

Appannah

et al. 2020

Int J Equity Health

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Background: The health and aged care workforce must understand and support the diverse needs of older people to enhance their care experience. We previously identified five principles of diversity training for this workforce: awareness of unconscious bias and prejudice; promotion of inclusion; access and equity; appropriate engagement; and intersectionality. This study aims to explore how these principles are considered from the perspectives of older Australians. Methods: Older people (≥65 years) receiving home care and nursing services based in Victoria, Australia were invited to participate in a home-based semi-structured interview about their experience of, or with, diversity. Interviews were thematically analysed using a priori categories based on our previous work on principles of diversity training, and themes were interpreted and expanded upon based on the participants' experiences and understanding of diversity concepts and their care needs.Results: Fifteen older people (seven female, eight male), mean age 76 years (range 71-85 years), were interviewed. Five themes were drawn from the data. It was found that human connection through building (1) trust and rapport was highly valued as an approach by older people, crucial as a first step to understanding what is important to the older person. Identifying with (2) intersectionality, that is, the different intersecting aspects of who they are and their experiences was understood by the participants as an important framework to meet their needs. The participants were aware of (3) unconscious bias and prejudice by health professionals and its impact on their care. Participants also noted that (4) promotion of inclusion through language was important to for a positive relationship with the healthcare worker. The participants understood that to facilitate human connection, these four principles of human interaction were critical, underpinned by (5) access and equity of the system. A model articulating these relationships was developed. Conclusion: Health and aged care training should incorporate the five diversity principles to support older people to participate in their own care.

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“…Aging and multimorbidity have shifted patients’ health care needs. Most elderly people desire longer consultations with a focus on counselling and guidance in order to maintain high quality of life despite chronic illness [ 1 , 2 ]. Hence, tasks such as counselling have become more prominent in the daily activities of general practitioners (GP).…”

Section: Introductionmentioning

confidence: 99%

Patients’ experiences with the advanced practice nurse role in Swiss family practices: a qualitative study

Schönenberger

Sottas²,

Merlo

et al. 2020

BMC Nurs

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Background Considering shortages of general practitioners (GP) and strategies for improving the quality of health care provision, many countries have implemented interprofessional care models with advanced practice nurses (APN). International evidence suggests that APN care results in high patient satisfaction. In Switzerland, the role is still new, and the patient perspective has not yet been researched. Our aim was therefore to explore patients’ experiences with the APN role in Swiss family practices. Methods We conducted 22 semi-structured interviews in four different family practices with patients aged 18 to 97 suffering from minor acute to multiple chronic diseases, and who had at least one consultation with an APN. All interviews were audiotaped, transcribed verbatim, and analysed using qualitative content analysis. Results The analysis resulted in five themes: Despite the unfamiliarity, all patients were willing to be consulted by an APN because it was recommended by their GP (1); after several encounters, most participants perceived differences between the APN and the GP consultation in terms of the length and style of the consultations as well as the complexity of their tasks (2); the interviewees emphasised coaching, guidance, care coordination, and GP-assisting tasks as APN core competencies and attributed the characteristics empathetic, trustworthy, and competent to the APN role (3); most patients especially valued home visits and the holistic approach of the APNs, but they also noticed that in certain cases GP supervision was required (4); and due to the close collaboration between the APN and the GP, patients felt safe, well cared for and experienced improvements in physical and psychological well-being as well as in daily activities (5). Conclusion Our results suggested that patients value the APNs’ competencies, despite their initial lack of role knowledge. Trust in the GP seemed to be the most important factor for patients’ receptiveness toward the APN role. Overall, patients perceived an added value due to the enlargement of the scope of practice offered by APNs. The patient perspective might provide valuable insights for further APN role implementation in Swiss family practices.

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Redesigning care for older people to preserve physical and mental capacity: WHO guidelines on community-level interventions in integrated care

Abstract: Islene Araujo de Carvalho and coauthors discuss the WHO guidelines on integrated care for older people.

Cited by 62 publications

References 16 publications

<p>Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review</p>

<p>Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review</p>

The inter-relationship of diversity principles for the enhanced participation of older people in their care: a qualitative study

Patients’ experiences with the advanced practice nurse role in Swiss family practices: a qualitative study

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