Abstract
BackgroundIntegrated care is recognised as an important enabler to healthy ageing, yet few countries have managed to sustainably deliver integrated care for older people. We aimed to gather global consensus on the key actions required to realign health and long-term systems and integrate services to implement the World Health Organization (WHO) Integrated Care for Older People (ICOPE) approach.MethodsA two-round eDelphi study, including a global consultation meeting, was undertaken to identify, refine and generate consensus on the actions required across high-, middle- and low-income countries to implement the WHO ICOPE approach. In round 1, a framework of 31 actions, empirically derived from previous WHO evidence reviews was presented to panellists to judge the relative importance of each action (numeric rating scale; range:1–9) and provide free-text comments concerning the scope of the actions. These outcomes were discussed and debated at the global consultation meeting. In round 2, a revised framework of 19 actions was presented to panellists to measure their extent of agreement and identify ‘essential’ actions (five-point Likert scale; range: strongly agree to strongly disagree). A threshold of ≥80% for agree/strongly agree was set a priori for consensus.ResultsAfter round 1 (n = 80 panellists), median scores across 31 actions ranged from 6 to 9. Based on pre-defined category thresholds for median scores, panellists considered 28 actions (90·3%) as ‘important’ and three (9·7%) as ‘uncertain’. Fifteen additional actions were suggested for inclusion based on free-text comments, creating 46 for consideration at the global consultation meeting. In round 2 (n = 84 panellists), agreement (agree or strongly agree) ranged from 84·6–97·6%, suggesting consensus. Fourteen (73·7%) actions were rated as essential.ConclusionFourteen essential actions and five important actions are necessary at system (macro; n = 10) and service (meso; n = 9) levels to implement community-based integrated care for older people.
Highlights
The global population is ageing more rapidly than ever before–from 2015 to 2050, the proportion of the global population aged 60 years and over will nearly double [1]
A two-round eDelphi study, including a global consultation meeting, was undertaken to identify, refine and generate consensus on the actions required across high, middle- and lowincome countries to implement the World Health Organization (WHO) Integrated Care for Older People (ICOPE) approach
Fourteen essential actions and five important actions are necessary at system and service levels to implement community-based integrated care for older people
Summary
The global population is ageing more rapidly than ever before–from 2015 to 2050, the proportion of the global population aged 60 years and over will nearly double [1]. Many other major social changes are occurring alongside population ageing, for example urbanization and globalization have been accompanied by increased migration, in which younger generations migrate to areas of growth, while older people are left in poorer rural areas without family structures and social safety. These issues create new and complex challenges for health and long-term care systems. We aimed to gather global consensus on the key actions required to realign health and long-term systems and integrate services to implement the World Health Organization (WHO) Integrated Care for Older People (ICOPE) approach
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