Developing a model of short-term integrated palliative and supportive care for frail older people in community settings: perspectives of older people, carers and other key stakeholders.

Anna E Bone,Catherine J Evans,Juliet Wright,Irene J Higginson,Myfanwy Morgan,Matthew Maddocks,Shamim Taherzadeh,Clare Ellis-Smith,Katherine E Sleeman

doi:10.1093/ageing/afw124

Abstract

Backgroundunderstanding how best to provide palliative care for frail older people with non-malignant conditions is an international priority. We aimed to develop a community-based episodic model of short-term integrated palliative and supportive care (SIPS) based on the views of service users and other key stakeholders in the United Kingdom.Methodtransparent expert consultations with health professionals, voluntary sector and carer representatives including a consensus survey; and focus groups with older people and carers were used to generate recommendations for the SIPS model. Discussions focused on three key components of the model: potential benefit of SIPS, timing of delivery and processes of integrated working between specialist palliative care and generalist practitioners. Content and descriptive analysis was employed and findings were integrated across the data sources.Findingswe conducted two expert consultations (n = 63), a consensus survey (n = 42) and three focus groups (n = 17). Potential benefits of SIPS included holistic assessment, opportunity for end of life discussion, symptom management and carer reassurance. Older people and carers advocated early access to SIPS, while other stakeholders proposed delivery based on complex symptom burden. A priority for integrated working was the assignment of a key worker to co-ordinate care, but the assignment criteria remain uncertain.Interpretationkey stakeholders agree that a model of SIPS for frail older people with non-malignant conditions has potential benefits within community settings, but differ in opinion on the optimal timing and indications for this service. Our findings highlight the importance of consulting all key stakeholders in model development prior to feasibility evaluation.

Highlights

The ageing population and associated rise in long-term conditions present challenges to established models of care for older people [1, 2]
We proposed a model of short-term integrated palliative and supportive care (SIPS) for frail older people aged 75 years or over with non-malignant conditions living at home or in a care home
We integrated the views of older people, carers and other key stakeholders to develop a model of short-term integrated palliative and supportive care (SIPS) for frail older people with non-malignant conditions living in the community (Figure 2)

Summary

Introduction

The ageing population and associated rise in long-term conditions present challenges to established models of care for older people [1, 2]. People are living longer and increasingly with multi-morbidity and frailty. Frailty is defined as the accumulation of deficits and diminishing reserves [3]. This increases vulnerability to a seemingly minor stressor event leading to a marked deterioration in well-being and poor outcomes [3, 4]. The frailty state is characterised by an illness trajectory of prolonged dwindling with intermittent episodes of decline [5]. Frail older people commonly experience high physical and psychological symptom burden, which is frequently under-reported and under-treated [6]

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