Care For Older People Research Articles

A typology of family caregiving for older immigrants: perspectives from care receivers and care providers

Purpose As populations are ageing and the global average life expectancy is rising, the provision of care for older people is an increasingly salient issue. This paper aims to focus on family-provided care for older immigrants, examining how older immigrants and care providers experience and construct family caregiving. Design/methodology/approach Based on interviews with care recipients, family care providers, municipal staff and representatives for migrant organisations in Sweden, this study presents a typology of family caregiving for older immigrants. Findings The authors found three caregiving types, namely, solely family-provided care and a combination of family care and public care (predominantly one or the other). The decision to select family-provided or publicly-funded care depends on personal and institutional factors. Originality/value The paper makes three empirical contributions to the literature on care provision for older immigrants. Firstly, this study provides insights into the structural and personal factors that shape care-giving arrangements for older immigrants. Secondly, this study examines the perspectives of care recipients and care providers on family-provided care. Care expectations differ between both groups and sometimes result in intergenerational disagreement. Thirdly, in terms of institutional support, this study finds that the Swedish state’s notion of individual needs does not match the needs of immigrant elderly and their caregivers. The paper places the care types in a broader discussion about eldercare provision in the Swedish welfare state, which has experienced a decline in publicly funded care services and an increase in family caregiving in the past 30 years. In addition, it addresses questions of dignified ageing from a minority perspective.

A new scale for older resident satisfaction with residential integrated care in China: Development and validation

The factors that affect resident satisfaction with emerging residential integrated care for older people in China have been unclear due to a lack of validated instruments. Based on psychometric assessment procedures, we developed a new scale for older resident satisfaction with residential integrated care (SORSRIC). The scale was developed using a two-step process and a sample of 16 Chinese institutions and 333 residents. Exploratory and confirmatory factor analysis was used to evaluate reliability and validity. Principal component analysis and maximum variance methods were used to orthogonally rotate the items to extract seven factors. These were: resident expectations, perceived quality (physical care), perceived quality (mental care), perceived value, resident satisfaction, resident complaints, and resident loyalty. The CR value of each dimension of the pre-tested, formal scale was greater than 0.80, and the AVE value was greater than 0.50. This 24-item instrument showed good reliability and structural validity and can be applied to improve the experience and outcomes for older people in residential care.

Safety and efficacy in the management of older patients with displaced intracapsular hip fractures

The management of the older person with a displaced intracapsular hip fracture is one of the most significant aspects of musculoskeletal trauma. These patients require prompt, integrated pathway delivered care. The care delivered outside of the operating theatre and that performed within, are intertwined. Traditionally, surgeons have focussed predominantly only on the operative elements. In modern trauma care for older people, this focus must broaden. We provide for the first time a comprehensive overview of all elements of care for this important patient group. This brings together pathway elements from the National Hip Fracture Database Key Performance Indicators and NICE guidance alongside a synthesis of all current research output for intracapsular hip fracture.

Promoting speaking-up behaviours among nurses working in the care for older people: A scoping review.

To explore interventions employed to foster speaking-up behaviours of registered nurses (RNs) working in the care of older people. Scoping review. The updated Joann Briggs Institute scoping review methodological guidelines were followed. CINAHL, PubMed, PsycINFO, and Scopus were searched. A total of 1691 titles and abstracts were screened, resulting in 11 articles that met the inclusion criteria. Analysis focused upon intervention types, methodologies, speaking up strategies, barriers and effectiveness. Education was the most used intervention. There is a lack of published research on successful interventions to promote speaking-up behaviours in the care of older people, particularly relating to poor care practices. Evidence of speaking-up interventions in the residential aged care setting is absent. This highlights the need to develop strategies to support the RN to lead and enable others to raise care concerns. Developing strategies that enable staff, care recipients and their families to speak up about care concerns is a vital future area for nursing practice development. Nursing leadership of such strategies is central to improving the quality of care for older people, particularly those living in residential aged care. Older people receiving care should feel respected and be treated humanely. Evidence suggests this is often not the case. This review found a paucity of interventions to promote speaking-up about poor care practices among RNs working in the care of older people. Future research needs to address this, to empower RNs and improve the care afforded to older people. The PRISMA-ScR (Tricco etal., Annals of Internal Medicine, 169, 467-473, 2018) were adhered to throughout this scoping review. No patient or public contribution in this review.

Developing a multidisciplinary medication review and deprescribing intervention in primary care for older people living with frailty

Abstract Introduction Reducing overprescribing in primary care through targeted structured medication reviews (SMRs) is a national priority. Shared decision-making and a multidisciplinary team (MDT) approach to SMR are recommended for successful deprescribing (stop/reduce inappropriate medications) among older people, specifically those with frailty. Aim To develop a multidisciplinary medication review and deprescribing intervention in primary care for older people with frailty. Methods The intervention development involved two stages and was informed by the Medical Research Council framework for complex intervention. Stage one involved intervention planning and included: 1) a realist review of 28 articles that identified 35 context-mechanism-outcome (CMO) configurations for successful MDT medication review and deprescribing in primary care[1] and 2) a qualitative study with 26 primary care healthcare professionals (HCPs) including GPs, pharmacists, and advanced clinical practitioners, and 13 older people with polypharmacy and their informal carers recruited from two general practices within Wessex. Using the person-based approach, drawing on the COM-B model for behaviour change, and a normalisation process theory lens, the findings of these two studies informed the development of intervention’s guiding principles. Stage two involved intervention development based on six co-design online workshops with key stakeholders (n=25), including primary care HCPs recruited from across the South region, patient and carer representatives, and the research management team. The intervention guiding principles were presented in these workshops and possible intervention content, format and delivery were proposed, discussed and refined through an iterative process. Workshop data were analysed drawing on a rapid analysis method and a final version of the intervention was agreed. Results The final version of the complex intervention consisted of five main components based on findings from stages one and two: 1) Proactive identification of patients with frailty and polypharmacy for targeted SMR using the electronic frailty index embedded in primary care health systems and the UK national polypharmacy prescribing comparators, 2) HCPs preparation to conduct SMR through targeted education on deprescribing and identifying and prioritising high-risk medications for deprescribing using evidence-based deprescribing tool(s), 3) Preparing and educating patients and carers about the purpose of SMR and reasons for potentially stopping or changing medications (patient leaflet sent prior to SMR), 4) Conducting a person-centred SMR that includes in-person, phone or virtual appointments tailored to patient and carer needs and preferences, involving other MDT members based on their expertise, documenting and sharing any agreed changes with patients and other staff members, and 5) Tailored follow-up plans that allow continuity of care and management and include highlighting specific signs and symptoms for patients and carers to monitor following medication changes, and arranging further contact through text, phone or in-person follow-up appointment. Conclusion The use of multiple research methods has led to the development of a complex MDT medication review and deprescribing intervention for older people with frailty and drawing on behaviour and implementation theories could potentially maximise the intervention’s feasibility, acceptability and successful implementation. A mixed-method study in primary care is currently underway to test the feasibility and acceptability of intervention implementation, in preparation for a full trial.

Can Socially Assistive Robots Be Accepted by Older People Living Alone in the Community?: Empirical Findings from a Social Work Project in China

ABSTRACT A pilot study was undertaken between March 2019 and September 2021, loaning socially assistive robots (SARs) for a 7-day trial to older people living alone in China. Quantitative assessments of participants’ acceptance of technology and loneliness were conducted before and after the intervention, supplemented with qualitative interviews. Unexpectedly, participants’ intention to use SARs decreased significantly, largely due to emotional anxiety. Meanwhile, participants’ level of loneliness remained unchanged. Follow-up interviews revealed anxious emotion, hesitant attitudes, unreal social presence, usability difficulties as contributing factors. The study provides social workers with valuable insights into introducing SARs into community care of older people.

Predictive capacity of the Integrated Care for Older People (ICOPE) screening tool for intrinsic capacity impairments: results from the INSPIRE-T cohort.

The Integrated Care for Older People (ICOPE) approach was developed by the World Health Organization (WHO) aiming to shift the traditional focus of care based on diseases to a function- and person-centered approach, focused on maintaining and monitoring intrinsic capacity (IC). This study aimed to investigate the ability of the ICOPE screening tool to identify older people with clinically meaningful impairments in IC domains. This cross-sectional analysis included 603 older adults, participants (mean age 74.7 [SD 8.8] years, women 59.0%) of the INSPIRE Translational (INSPIRE-T) cohort. Responses at screening were compared to results of the subsequent in-depth assessment (i.e., Mini Mental State Examination, Mini Nutritional Assessment, Short Physical Performance Battery, Patient Health Questionnaire-9, and clinical investigation of vision problems) to determine its predictive capacity for impairments at the IC domains (i.e., cognition, psychological, sensory (vision), vitality, and locomotion). The ICOPE screening items provided very high sensitivity for identifying abnormality in vision (97.2%), and varied from 42.0% to 69.6% for the other domains. High specificity (>70%) was observed for all the IC domains, except for vision (2.7%). The ICOPE screening tool can be a useful instrument enabling the identification of older people with impairments in IC domains, but studies with different populations are needed. It should be considered as a low-cost and simple screening tool in clinical care.

Improving Care for People Aging with HIV: A Collaborative Quality Improvement Approach.

Nearly 60% of people with HIV in New York State are over 50 years of age. After town halls and a statewide survey of long-term survivors, older people living with HIV, and their providers, the Quality of Care Program of the AIDS Institute in the New York State Department of Health developed a statewide quality improvement project that aimed to improve screening for functional impairments among people aging with HIV. Thirteen sites reported outcomes of a pilot project using a modification of the World Health Organization's Integrated Care of Older People (ICOPE) intrinsic capacity screen in small scale, short cycle tests of change. A total of 1,629 people were found to be eligible for screening, and of these, 638 people were screened. Both clinical and non-clinical sites were able to identify significant areas of need. Positive screens ranged from a low of 17% for the identification of hearing issues to 49% for vision concerns. Only 11% of people with memory or nutritional concerns were referred for services; hearing loss was the domain with the largest number of referrals, at 27%. Although in many cases, when referrals were not made, patients/clients were already under care for the identified functional deficit, in other cases no services were available for referral or patients/clients declined to use the offered service. Sites also responded to the findings of the screen by initiating process changes, and many reported continuing to screen for functional impairments after the close of the pilot. The modified ICOPE screen is still in use in sites throughout the state. This pilot demonstrated that a collaboration between people with lived HIV experience, the New York State Department of Health, clinicians, and service providers could result in improved quality of care for people aging with HIV.

Effectiveness of integrated person-centered interventions for older people's care: Review of Swedish experiences and experts' perspective.

Older adults have multiple medical and social care needs, requiring a shift toward an integrated person-centered model of care. Our objective was to describe and summarize Swedish experiences of integrated person-centered care by reviewing studies published between 2000 and 2023, and to identify the main challenges and scientific gaps through expert discussions. Seventy-three publications were identified by searching MEDLINE and contacting experts. Interventions were categorized using two World Health Organization frameworks: (1) Integrated Care for Older People (ICOPE), and (2) Integrated People-Centered Health Services (IPCHS). The included 73 publications were derived from 31 unique and heterogeneous interventions pertaining mainly to the micro- and meso-levels. Among publications measuring mortality, 15% were effective. Subjective health outcomes showed improvement in 24% of publications, morbidity outcomes in 42%, disability outcomes in 48%, and service utilization outcomes in 58%. Workshop discussions in Stockholm (Sweden), March 2023, were recorded, transcribed, and summarized. Experts emphasized: (1) lack of rigorous evaluation methods, (2) need for participatory designs, (3) scarcity of macro-level interventions, and (4) importance of transitioning from person- to people-centered integrated care. These challenges could explain the unexpected weak beneficial effects of the interventions on health outcomes, whereas service utilization outcomes were more positively impacted. Finally, we derived a list of recommendations, including the need to engage care organizations in interventions from their inception and to leverage researchers' scientific expertise. Although this review provides a comprehensive snapshot of interventions in the context of Sweden, the findings offer transferable perspectives on the real-world challenges encountered in this field.

Nursing students' reactions to a graphic novel: A multi-national descriptive qualitative study

BackgroundUndergraduate nursing programme teaching and learning methods and content must evolve to meet the changing evidence base, healthcare context and needs of new generations of nurses. Art-based and narrative methods have been employed to help student nurses explore complex issues, including patient experiences of health and illness, person-centred care and social determinants of health. One creative visual teaching tool is the graphic novel. However, little is known about student perceptions of graphic novels and how they facilitate student nurses' reflection, engagement and learning. Gaining such an understanding may be of especial value for teaching Generation Z students who are used to interacting with complex visual imgery and prefer alternatives to text-heavy documents. ObjectiveThe objective was to explore student nurses responses to Vivian, and graphic novels in general, as teaching resources in undergraduate nursing curricula in England, Sweden, and Aotearoa New Zealand. DesignA social constructionist critical framework informing a descriptive qualitative study. Setting and participantsUndergraduate nursing students in Sweden, England, and Aotearoa New Zealand. MethodsData were collected using focus groups and semi-structured interviews. Braun & Clark's method for thematic analysis was used to analyse the data. ResultsThree themes were developed: 1) reflections on clinical practice, including reflections on palliative care, holistic care for older people and communication between patients and staff; 2) graphic novels' usefulness as a teaching resource, in which students regarded them as an alternative way to learn; and 3) Vivian as a form of the graphic novel. ConclusionThe graphic novel Vivian helped nursing students engage in critical reflection and with challenging theoretical concepts. It, and graphic novels in general offer an alternative to print-based texts, which may heighten their appeal to Generation Z learners.

Wound care in older people: overcoming the challenges of assessment and management.

Age-related skin changes lead to increased susceptibility to skin damage and delayed wound healing, which is exacerbated by comorbidities such as cardiovascular disease and diabetes mellitus. In some cases, wound healing is not achievable or realistic and this needs to be reflected in the wound management plan. To improve outcomes and experience in older people presenting with wounds it is important to select wound management products that protect the wound bed and surrounding skin, minimise trauma, reduce symptoms and/or promote healing. This article explores how conducting holistic wound assessments, setting realistic treatment aims, and using wound management strategies tailored to each person's needs and wishes can have a positive effect on older people's quality of life.

Incidental findings in development and use of digital health ecosystems for older people

Healthcare sectors are globally facing challenges delivering services for older people,. Although the implementation of digital technology has brought positive effects on caring older people in their homes, it has also resulted in arising ethical challenges including incidental findings (IF). The purpose of this systematic review is to reveal ethical challenges in the development and use of digital health ecosystems for older people. The objectives are 1) to reveal incidental findings, 2) ethical vulnerabilities and treats for integrity associated with the use of Artificial Intelligence (AI); 3) to analyse ethical management of IF, and 4) to create recommendations for the use and development of digital health ecosystems. Systematic data search was completed in ProQuest, EBSCOhost, and Ovid databases. Peer-reviewed full text research articles on ethical guidelines for developing and implementing digital health ecosystems for care of older people published in English between 2012 and 2022 were included. Previously published articles focusing on younger population or other than digital services were excluded. The included thirteen articles were appraised by design specific tools (PRISMA 2009, SANRA, STROBE, CAGSCS). The article texts were analysed and reported thematically. The IF revealed were violation of user autonomy, independence, and privacy during the development and use of the ecosystems; social isolation of the end-user; user unfriendly devices; additional workload to the care providers; technology induced anxiety; and biases and errors in use of the ecosystems. The ethical vulnerabilities and threats to integrity associated with use of AI. Observation and implementation of ethical values were found important in co-creation of ethically conscious ecosystems for older people. Empowering the designers, developers, and healthcare professionals on ethical competencies, and inclusion of the end-users’ preferences in designing of digital health ecosystems were included in the constructed recommendations. This article disseminated within the SHAPES Horizon 2020 project.

The effect of progressive exercise prescription for group exercise guidance for Taiwan seniors and Integrated Care for old People: Post-event movement observation

PurposeThis study is aimed at the seniors of the “2022 Taiwan Senior Citizens Fitness Club Subsidy Plan” with a sample. MethodThe doctor will diagnose and confirm whether the physical condition suits participation. Then, the professional sports instructor will design and arrange a progressive fitness enhancement group course suitable for the Senior person's physical fitness, conducted four times a week, every 2 h, for three months of group course training. Afterward, four group course instructors analyzed the motor ability of the three periods through a video, divided into 21 evaluation indicators. The data collection will be from January to May 2023. In addition, the Integrated Care for Old People (ICOPE) was used to assess the situation. ResultThe results showed that all indexes were significantly better than those in week one at week 6. All indexes at week 12 were significantly better than those in week one and week 6 (p < .001), and the benefit of all indicators was the largest (Cohen's d: 2.79–5.11), the reliability of the scores of each index ICC (0.73–0.94). ConclusionProgressive and multifaceted guidance on how to safely and effectively enhance the physical activity of senior citizens may be the most suitable method. Through progressive energy enhancement, the participants' physical activity and cognitive function can be improved, especially the overall rhythm of the music, which can be combined with high and low impact, dynamic and static balance control, agility, flexibility, and extensibility to achieve the benefits of health promotion.

Towards Evidence-based Care: Promoting Cognitive Well-being of Older People

The article by Mamayson and Lacanaria 1 in Acta Medica Philippina summarized the available evidence on the effects of cognitively stimulating activities (CSA) on the overall cognitive functioning of older people with mild cognitive impairment(MCI). Aside from the new evidence, it also provided insights on how the findings of study will inform the nursing profession in terms of clinical practice, leadership and policy, research, and education.&#x0D; Utilizing a meta-analysis of three randomized controlled trials (RCTs), the authors reported that cognitive training using CSA improves overall cognitive function among older people with MCI. 1 Calligraphy, cognitive, and language trainings werethe cognitively stimulating activities included in the reviewed RCTs which were conducted over the past years in Hong Kong, China, and Greece, respectively. The authors acknowledged that such activities are effective and practical, inexpensive, non- pharmacological approaches to slow down cognitive decline. 1 The strength of the paper is the inclusion of good methodical quality studies and only RCTs which are considered gold standard for evaluating the effectiveness of interventions. However, the authors emphasized that the interpretation of study results requires caution. This is due to the small number of studies reviewed which limits the generalizability of the findings.&#x0D; Older people with mild cognitive impairment are at increased risk of dementia since aging is a primary predictor of MCI progression to dementia. 2 The Global Action Plan on the Public Health Response to Dementia 2017-2025 outlined the growing consensus on protective measures which can reduce the risk of cognitive decline and dementia. These measures include healthy lifestyle (e.g., physical activity, balanced diet, smoking, and alcohol cessation), management of hypertension and diabetes, social engagement, and promotion of cognitively stimulating activities and learning. 3 These are aligned with the recommendations of the Lancet Commission which emphasized that dementia prevention is about policy and individuals. Preventive actions require both public health strategies and individually-tailored interventions. 4&#x0D; In the Philippines and as mandated by the Republic Act No. 9994 or also known as the Expanded Senior Citizens Act, the Department of Health (DOH) in coordination with relevant stakeholders shall institute a national health program andprovide an integrated health service for senior citizens. 5 The DOH developed the Health and Wellness Program for Senior Citizens 6 and several policies on the care of older people 7,8 . Specific policies relevant to cognition include the 2022 Omnibus Health Guidelines for the Elderly. The guidelines contain the conduct of cognitive stimulation therapy by a psychologist or mental health specialist for people with cognitive decline who may benefit from cognitive stimulation. 7 The implementation of this specific guideline is challenging due to the limited number of health workforce. In particular, there are only approximately 1600 psychologists and 500 psychiatrists serving about 110 million Filipinos. 9&#x0D; In the era of and prior to the introduction of evidence-based practice, nurses are one of the major key players in the care of older people. The study of Mamayson and Lacanaria added evidence which will be useful in guiding the current and future professional nursing practice. 1 Nurses can promote cognitive wellness by educating the older patient, family members, and the community on the importance of engaging in appropriate cognitively stimulating activities and the potential benefits of these non-pharmacological approaches. The recommendations on the incorporation of the findings into the gerontology courses, introduction of certification programs for dementia and MCI care specialists, and advocating for policy changes call for action. These recommendations can be put into action in close coordination with the right stakeholders. The involvement of key national government agencies namely Commission on Higher Education, Professional Regulation Commission, Department of Health, National Commission of Senior Citizens, as well as academic institutions, and professional societies such as the Philippine Nurses Association, Gerontology Nurses Association of the Philippines, and the Philippine Society of Geriatrics and Gerontology is crucial.&#x0D; The research recommendations outlined by Mamayson and Lacanaria highlighted the conduct of future studies with larger samples, longer follow ups, less language restrictions, and more rigorous analysis. 1 It is notable that no local study oncognitively stimulating activities that was cited or included in the review. Given this, the country should strengthen local evidence generation to develop age-, gender-, culturally-sensitive, and responsive interventions. The most recent NationalUnified Health Research Agenda of the Philippines included geriatric health and tailoring novel mental health interventions to different life-stages as priority topics. 10 This is an opportunity for professional societies, academe, and research institutions to pursue research, contribute to the local evidence base, promote cognitive well-being, and ultimately, improve the care and quality of life of older Filipinos. 

Implementation of Interprofessional Pharmaceutical Care Initiatives: Lessons Learned from Successful Bottom-Up Initiatives in Primary Care.

Although there is evidence that interprofessional, person-centred, integrated care is important for optimising pharmaceutical care of older people with polypharmacy, this way of working is often not implemented in practice. The aim of this study was to identify common characteristics of successful interprofessional initiatives and factors influencing their implementation, in order to close this know-do gap. A qualitative, explorative design with in-depth semi-structured interviews was used. Flemish primary healthcare professionals (HCPs) and patients aged over 75, involved in successful initiatives of interprofessional pharmaceutical care for older people with polypharmacy, were included. Inductive analysis was conducted to identify main topics. Fifteen HCPs and four patients, involved in nine interprofessional initiatives, were interviewed. In all initiatives the HCPs had interprofessional consultations about older people with polypharmacy. The interaction between the characteristics of the initiatives and the context had an important impact on the implementation. These context factors were positioned under the micro-, meso- and macro context. Implementation strategies, actions to enhance the initiatives' adoption, corresponded with three themes: communication and influence, coordination by different stakeholders, and (dis)incentives. The identification of these success factors might inspire HCPs, providers of interprofessional education and policymakers to facilitate interprofessional pharmaceutical care.

‘Letting it be’: a grounded theory about dementia care in Fiji

Objectives This research study aimed to discover how dementia affecting older people was perceived, experienced, and managed by stakeholders in the Pacific Island country of Fiji. Method A transformational grounded theory approach was used. Semi-structured interviews and focus groups with key stakeholders in the major towns of Suva, Lautoka, and Nadi were carried out. Transcripts were analysed in line with transformational grounded theory methods. Results A total of 50 participants (40 service providers, eight family caregivers, one person with dementia, and one village elder) shared their views and experiences about dementia. A grounded theory about dementia care management was constructed. ‘Letting it be’ is the grounding socio-cultural construct that interweaves and binds together the processes of dementia care management. It expresses a compassionate approach to caring for older people with dementia that involves searching for knowledge and support, and application of traditional care practices within the strength of family and community networks. Conclusion In Fiji, support for dementia centres on the integration of community understandings, and promotion of cultural values of wellbeing and care, with service provision. It also focuses on support for families and communities through social welfare, community networks, and education.

Bettering communication around advance care planning including DNACPR discussions and use of the Urgent Care Plan for patients admitted under Care of Older People

Bettering communication around advance care planning including DNACPR discussions and use of the Urgent Care Plan for patients admitted under Care of Older People

Making Drug Therapy Safer and More Effective Is a Primary Concern for Pharmacists Everywhere.

Evidence is a critical consideration in any clinical process, where there is usually potential for interventions to cause harm or to have unintended consequences arising from a change to the course of patient management. Pharmacists working in the care of older people are well-versed in this concept, given that medication use can create clinical benefit and drug-related harm through mechanisms such as toxicities and drug interactions. Published in this edition of the journal, there is discussion of the utility of pharmacogenomics to guide drug therapy. This is meritorious science, but if everyone is honest, it is hardly something new, or for that matter, widely used. But what underlies the imperative to continue to disseminate this information in a peer-reviewed, indexed journal? The answer lies not so much in validating the science but in promoting the approach.

The risk of being older: Working with risk in older adults mental health services

When working as healthcare professionals, we incorporate an array of narratives and structures which come with the role. It is our clinical responsibility to acknowledge and name different factors at play in different conditions, and we are trained to work and support teams with constructs such as vulnerability and power. Working with older people, other dynamics entering the picture are ageing, dementia and frailty. Risk is another example of such forces, an overarching concept which we need to be constantly aware of as professionals. This article will explore the concept of risk and what it means to be working with risk in community-based care for older people. The aim is to generate a conversation about common risks in the older population, challenging assumptions and offering a space for reflection on how to best explore and support.

Frailty recommendations and guidelines: an evaluation of the implementability and a critical appraisal of clinical applicability by the ISPRM Frailty Focus Group.

Aging is associated with an increased burden of multi-morbidity and disease related functional loss and disability, widely impacting patients and health care systems. Frailty is a major actor in age-related disability and is an important target for rehabilitation interventions, considering that is a reversible condition. A working group of members of the ISPRM, responding to WHO 2030 call for action to strengthen rehabilitation, was established to assess the quality and implementability of the existing guidelines for the rehabilitation of frailty. Guidelines were retrieved using a systematic search on Pubmed, Scopus and Web of Science and from the reference lists of screened articles. The included guidelines were evaluated using the AGREE II to assess their quality and using the AGREE-REX to assess their clinical credibility and implementability. Guidelines with a score >4 in the AGREE II item evaluating the overall quality of the guideline were considered for endorsement. Finally, nine external reviewers evaluated the applicability of each recommendation from the endorsed guidelines, providing comments about the barriers and facilitators for their implementation in their country. Ten guidelines were retrieved and evaluated by the working group, of which four guidelines, i.e. the WHO Guidelines on Integrated Care for Older People, the FOCUS guidelines, the Asia-Pacific Clinical Practice Guidelines for the Management of Frailty and the ICFSR International Clinical Practice Guidelines for Identification and Management of Frailty, were considered for endorsement. All these guidelines were rated as of adequate quality and implementability. The WHO Guidelines on Integrated Care for Older people (24) the ICFSR International Clinical Practice Guidelines for Identification and management of Frailty (15), the FOCUS guidelines (25) and the Asia Pacific Clinical Practice Guidelines (14) for the Management of Frailty have the best quality and applicability of the existing guidelines on the management of frailty, we suggest that should be employed to define the standards of care for patients with frailty. There are barriers for their implementation, as stated by our experts, to take into account, and some of them are country- or region-specific. Screening for frailty, exercise, nutrition, pharmacological management, social and psychological support, management of incontinence, and an overall comprehensive clinical management are the best tools to face upon frailty.