Care For Older People Research Articles

Approximately half of the nursing students confirmed their willingness to participate in caring for older people: a systematic review and meta-analysis

BackgroundGlobal population aging poses a significant global challenge, necessitating an increased demand for proficient caregivers specialized in elderly care. In our study, a systematic review and meta-analysis were conducted to synthesize the evidence concerning nursing students’ willingness to participate in caring for older people.MethodsEligibility criteria focused on cross-sectional studies involving nursing students’ willingness to participate in caring for older people and were reported in English or Chinese. PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and WANFANG databases were searched from inception until July 24, 2022. The methodological quality assessment in the included studies was evaluated using the AHRQ instrument. The pooled effects of the nursing students’ willingness to participate in caring for older people were computed using a random-effects model. Funnel plots and Egger’s test were employed to evaluate publication bias. Meta-regression and subgroup analysis were performed to explore the sources of heterogeneity. Sensitivity analysis was conducted to verify the robustness of the meta-analysis findings. All statistical tests were conducted with Stata 16.0 software.ResultsA total of 68 studies of medium or high quality met the eligibility criteria, involving 30,328 nursing students. The rate of nursing students’ willingness to participate in caring for older people was 49.0% (95% CI = 46–53%, I2 = 98.1%, P = 0.000). The results of meta-regression analysis showed that the following four predictor variables were significantly associated with nursing students’ willingness to participate in caring for older people: experience of living with and caring for older people, nursing as their first choice and their year-level in education, respectively. Subgroup analyses for these four predictor variables revealed the following pooled estimates of nursing students’ willingness: having experience of living with older people (0.54, 95% CI = 0.46–0.62) vs. no such experience (0.38, 95% CI = 0.30–0.46), having experience of caring for older people (0.55, 95% CI = 0.48–0.63) vs. no such experience (0.38, 95% CI = 0.30–0.46), nursing as their first choice (0.54, 95% CI = 0.51–0.58) vs. not their first choice (0.44, 95% CI = 0.35–0.53), being in the first year of nursing education (0.44, 95% CI = 0.34–0.55), second year (0.45, 95% CI = 0.34–0.56), and third and fourth year (0.62, 95% CI = 0.53–0.71).ConclusionThe study found that approximately half of the nursing students confirmed their willingness to participate in caring for older people.The present study can serve as a resource for policymakers to increase the willingness of nursing students to participate in caring for older people.

How to make a shared decision with older persons for end-stage kidney disease treatment: the added value of geronto-nephrology.

Improving care for older people with end-stage kidney disease (ESKD) requires the adaptation of standards to meet their needs. This may be complex due to their heterogeneity in terms of multimorbidity, frailty, cognitive decline and healthcare priorities. As benefits and risks are uncertain for these persons, choosing an appropriate treatment is a daily challenge for nephrologists. In this narrative review, we aimed to describe the issues associated with healthcare for older people, with a specific focus on decision-making processes; apply these concepts to the context of ESKD; identify components and modalities of shared decision-making and suggest means to improve care pathways. To this end, we propose a geronto-nephrology dynamic, described here as the necessary collaboration between these specialties. Underscoring gaps in the current evidence in this field led us to suggest priority research orientations.

Aging-Related Metabolome Analysis of the Masseter Muscle in Senescence-Accelerated Mouse-Prone 8.

Frailty is a vulnerable state that marks the transition to long-term care for older people. Early detection and prevention of sarcopenia, the main symptom of frailty, are important to ensure an excellent quality of life for older people. Recently, the relationship between frailty, sarcopenia, and oral function has been attracting attention. This study aimed to clarify the changes in metabolites and metabolic pathways due to aging in the masseter muscle of senescence-accelerated mouse-prone 8 (SAMP8) mice. A capillary electrophoresis-mass spectrometry metabolome analysis was performed on the masseter muscle of 12-week-old, 40-week-old, and 55-week-old mice. The expression of enzymes involved in metabolome pathways considered to be related to aging was confirmed using reverse transcription polymerase chain reaction. Clear metabolic fluctuations were observed between 12, 40-week-old, and 55-week-old SAMP8 mice. The extracted metabolic pathways were the glycolysis, polyamine metabolome, and purine metabolome pathways. Nine fluctuated metabolites were common among the groups. Spermidine and Val were increased, which was regarded as a characteristic change in the masseter muscle due to aging. In conclusion, the age-related metabolic pathways in SAMP8 mice were the glycolysis, polyamine metabolome, and purine metabolome pathways. The increased spermidine and Val levels in the masseter muscle compared with the lower limbs are characteristic changes.

Determining the minimum data set of geriatric assessment at the Iran primary health care referral system: shifting from fragmentation to integration care for older people

BackgroundGeriatric assessment (GA) is a multidimensional process that disrupts the primary health care (PHC) referral system. Accessing consistent data is central to the provision of integrated geriatric care across multiple healthcare settings. However, due to poor-quality data and documentation of GA, developing an agreed minimum data set (MDS) is required. Therefore, this study aimed to develop a GA-MDS in the PHC referral system to improve data quality, data exchange, and continuum of care to address the multifaceted necessities of older people.MethodsIn our study, the items to be included within GA-MDS were determined in a three-stepwise process. First, an exploratory literature search was done to determine the related items. Then, we used a two-round Delphi survey to obtain an agreement view on items to be contained within GA-MDS. Finally, the validity of the GA-MDS content was evaluated.ResultsSixty specialists from different health geriatric care disciplines scored data items. After, the Delphi phase from the 230 selected items, 35 items were removed by calculating the content validity index (CVI), content validity ratio (CVR), and other statistical measures. Finally, GA-MDS was prepared with 195 items and four sections including administrative data, clinical, physiological, and psychological assessments.ConclusionsThe development of GA-MDS can serve as a platform to inform the geriatric referral system, standardize the GA process, and streamline their referral to specialized levels of care. We hope GA-MDS supports clinicians, researchers, and policymakers by providing aggregated data to inform medical practice and enhance patient-centered outcomes.

Turnover Intention among Staff Who Support Older Adults Living Alone in Japan: A Cross-Sectional Study

Older adults in Japan traditionally rely on family members for care. However, the growing number of older people living alone has increased staff burden in community general support centers (CGSCs), which provide care for older people in Japan. This study aimed to identify factors linked to turnover intention among CGSC staff. Of 1002 staff invited to participate, 283 completed a survey (response rate: 28.2%). Logistic regression analysis of 183 valid questionnaires examined demographic, job-related, and attitudinal factors associated with turnover intention. The results showed that the perceived difficulty of supporting older adults living alone was the main predictor of turnover intention. Staff reporting high perceived difficulty levels were more likely to consider leaving. Negative attitudes toward supporting this population also increased turnover risk. These findings highlight a pressing need for targeted interventions to strengthen the ability of CGSC staff to manage the challenges of caring for isolated older individuals. Addressing staff perceptions and providing essential training and resources could reduce turnover rates and increase the quality of care for this vulnerable group.

The Importance of Time: Nurses' Experiences of Working With Suicide Prevention and Suicide Risk Assessment in the Care of Older People

ABSTRACTAimTo describe nurses' experiences of working with suicide prevention and suicide risk assessment in the care of older people.BackgroundSuicide is a problem among older people, worldwide. Risk factors for suicide are, among others, depression, illness and pain and a feeling of isolation. Nurses have valuable experience in suicide prevention and risk assessments. This study can shed light on what is needed to promote the mental health of older people, which has been partly overlooked in previous research.Methods/DesignA descriptive qualitative study was conducted. Ten nurses working in care of older people across four different municipalities were interviewed. Conventional content analysis was used to analyse the data.ResultsDespite shortcomings in guidelines, nurses describe performing suicide risk assessments and suicide prevention in a similar manner. The importance of giving the patients time is emphasised, although time is exactly what appears to be lacking.ConclusionBy engaging with the experiences of nurses, important aspects that require further attention are highlighted. Nurses should inquire about suicidal ideation, even if older persons do not explicitly express such thoughts. Normal ageing needs to be comprehended and considered in assessments. In this work, time is important.Patient or Public ContributionThe results were coproduced by means of interviews with nurses working in care of older people.Reporting MethodThe study was conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.Implications for PracticeEncountering older people who may have experienced the loss of loved ones and addressing one's personal capabilities in the context of the ageing body imposes substantial challenges on nursing care, necessitating a capacity to adeptly navigate and address these complex issues.

Quality indicators to monitor the quality and safety of care for older people: a scoping review protocol.

The objective of this review is to identify quality indicators used to monitor the quality and safety of care provided to older people (≥ 65 years old) in 8 care settings: primary care; hospital/acute care; aged care (including residential aged care and home or community care); palliative care; rehabilitation care; care transitions; dementia care; and care in rural areas. There is a need for high-quality, holistic, person-centered care for older people. Older people receive care across multiple care settings, and population-level monitoring of quality and safety of care across settings represents a significant challenge. National and international quality indicators used to monitor and evaluate the quality and safety of care at the population level for older individuals in the 8 key care settings will be considered for inclusion. English-language quantitative and mixed method studies published from 2012 will be considered. Academic (MEDLINE, Embase) and gray (government websites, clinical guidelines, Google) literature searches will be conducted. A standardized data extraction tool will be used to describe the identified quality indicators and associated tools. Quality indicators will be categorized by key domains (ie, pain, function, consumer experience, service delivery); quality indicator type (structure, process, outcome); and the Institute of Medicine's 6 dimensions of care quality (eg, efficiency, effectiveness, appropriateness, accessibility, acceptability/person-centered, safety). The scoping review will be conducted in accordance with the JBI methodology for scoping reviews and will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Open Science Framework https://osf.io/8czun.

Saparuik and Moknehi: Kinship-based Tensions in Care for Older People

This article provides information on a comparison of elderly care systems in two regions in Indonesia with different ethnicities and cultures, namely the Minangkabau in West Sumatra and the Abui of Alor. This article shows how the saparuik kinship in the Minangkabau community which is matrilineal with different customary constellations and how the patrilineal moknehi kinship in the Abui community takes care of elderly women. This paper explains the influence of caregivers’ life journey on their burdens of life. The burden of life perceived by caregivers arises from various factors. Among the various influencing factors are emotions, economy, knowledge, kinship and the right to manage inheritance. Kinship is a form of reciprocal relationship between various elements in both Minangkabau and Abui societies. In the Minangkabau ethnic group, the smallest kinship system in society is called saparuik kinship (Minang language), while the smallest kinship system in Abui is called moknehi (Abui language) which means “brother”. Paruik can be interpreted as “stomach”. While the word moknehi, which has variants in Abui such as muknehi, mokneng and motneng, likely derives from words moku “child” and neng “male”, whose meaning is equivalent to “brother, sibling”. Literally, saparuik are people who come from the same stomach or mother, while moknehi refers to people who come from the same mother and or father. People who are in saparuik are people who come from the same grandmother, while moknehi are male brothers who come from the same grandfather, who then develop into several extended families. Both extended families in paruik or moknehi consist of several nuclear families. Likewise, saparuik and moknehi consist of several extended families. The extended family in saparuik is formed in one grandmother (not a literal grandmother, the grandmother in this case is the mother of the grandmother or the grandmother of the grandmother), in one “rumah gadang”, and sharing inheritance. Otherwise, moknehi are not only formed in one grandfather, but also male great-grandfather and great-great-grandfather (male great-grandfather and great-great-grandfather in this case are father of grandfather and grandfather of grandfather), in one clan, and sharing inheritance.

Class and Gender in Older People Care in Rural Yogyakarta

This article explores care arrangements for older people in rural Yogyakarta, comparing and contrasting the experiences of older people in three agrarian classes: significant landowners, petty commodity producers and ‘classes of labour’. The study was conducted in two villages in Kulon Progo and Sleman Regencies. Qualitative interviews, observations, life histories and information on the changing social and economic contexts are used to analyse older people’s roles in social reproduction, the dynamics of intergenerational dependency, and the practicesof older-people care. We found great variation in the age at which engagement in productive and reproductive work declines and people enter the state of dependency. Older people may be receivers, or providers of care for younger dependents. As older people live longer, complex tri- and even quadri-generational care arrangements become more common. Class, gender and intergenerational relations shape care relations and practices. State and community programmes for older people, when functioning properly, can be of great importance to poorer households,even though the access is uneven and they do not always match older people’s care needs. Commodified (purchased) care provision is found in some relatively prosperous households, but rarely in the ‘classes of labour’, the landless and near-landless peasants, and worker households that make up the majority of the population.

Voluntary Care for Older People: A symbolic Health Efficacy of Community-based Health Meetings

Community healthcare in Indonesia relies on volunteer workers who engage their clients outside fixed health facilities with limited resources and formal training. These volunteers are called cadres who learn their tasks to improve community wellbeing through ongoing engagement and without prior skills. They are drawn from the community to serve the community. This paper is based on field research carried out with cadres through interviews and visits to integrated health meetings (Posyandu) held by primary healthcare centres for older adults in villages. The paper first discusses the recruitment requirements and the incentives for being a healthcare volunteer. It suggests that both recruitment and incentives are rooted in community values of helping and doing good for the community. Volunteer cadres must have a direct normative and semiotic connection with clients, as they must be members of the community who speak the same language and understand local norms. In line with this community-centred approach, the paper then focuses on the health efficacy of Posyandu as a recurring structured symbolic event held in the village. The argument is made that a more qualitative approach should be taken to understanding the efficacy of these meetings, drawing on research methods from the anthropology of ritual (symbolic and therapeutic) healing.

Delivering Integrated Care for Older People – A Feasibility Study on Online Training of Master Trainers

Abstract Introduction: The World Health Organization has advocated the training of healthcare workers in providing integrated care for older people (ICOPE). Due to physical and financial barriers, training through online mode was adopted. The aim of this study was to evaluate the acceptability, feasibility and effectiveness of the online ICOPE training programme. Subjects and Methods: It was an observational study and 102 doctors from seven South Asian countries were imparted ICOPE training online. Knowledge was tested through multiple-choice questions. Feedback was taken through a structured online questionnaire after each session and after 1 year. Results: About 88.4% found the session satisfactory to excellent for grasping the concept. Seventy-nine per cent of participants rated the session interaction to be satisfactory to excellent. About 91.8% of participants rated the utility of the session as satisfactory to excellent as a future master trainer. Participants demonstrated significant improvement in knowledge post-training (mean difference of 3.6 ± 2.8; P < 0.001). Post 1-year responses remained positive with 91.3% using the course materials and skills, and 82.6% providing further training to other doctors. Conclusions: The online training programme is feasible and effective in imparting ICOPE training.

Assessment of state policy and legal framework related to enhancing the well-being of the elderly in Thailand

The ageing of society significantly influences the economic system and social stability and is a global challenge of the 21st century. The study aimed to explore ways to improve the quality of life of older people in the Lower Central Region of Thailand. The study was based on a qualitative approach and was conducted by collecting information from 8 key informants through structured interviews. The study substantiated the expediency of creating a centralised database to improve communication between all actors in the system of ensuring the welfare of the elderly, which improves the quality of services provided, contributes to a better basis for political decisions and promotes a more rational use of resources. The study noted that key respondents identify expanding access to healthcare, increasing financial assistance and strengthening social support systems to ensure the holistic well-being of older people as urgent problems in the region. The need for wider use of the latest technologies and the creation of an intelligent information management system in the area of elderly people’s welfare is emphasised in the study. Given the negative impact of social isolation on the quality of life of older people, particular attention is devoted to the effective management of senior clubs, namely the priority of various activities, intergenerational interaction and meaningful leisure to strengthen social ties and belonging to society. The integration of Buddhist principles and psychological theories is emphasised as an important tool for developing compassion, mindfulness and positive outcomes. Overall, the findings highlight the importance of integrated approaches and comprehensive measures to optimise care for older people and improve their well-being. The results of the study can be used to determine the content of information to be included in the centralised database and to develop an algorithm for exchanging information between its users

Barriers and facilitators to accessing oral healthcare for older people in the UK: a scoping review.

Introduction Access to dental services is a growing problem for older people in the UK. The aim of this scoping review is to identify the barriers and facilitators influencing older people's ability to access oral healthcare in the UK based on the existing literature.Methods The scoping review followed the framework proposed by Levac and colleagues (2010). Peer-reviewed literature was retrieved in April 2023 from Web of Science, Medline, PsycInfo and CINAHL for the period 1973-2023. After screening, data were extracted to identify barriers and facilitators mapped to individual, organisational and policy-level factors. The themes generated were used to identify gaps in the literature and policy recommendations.Results Overall, 27 studies fulfilled the inclusion criteria. Most studies published were from England; there was a large representation of opinion pieces. The main barriers and facilitators related to cost of services, perceptions of dentistry, availability of services and both the dental and social care workforce.Conclusion Multiple barriers exist surrounding access to dental care for older people. Various facilitators exist but not all are successful. More research needs to be carried out on older people's access to dental services in the community, particularly for the 'oldest old' and minority groups.

Mapping the way: functional modelling for community-based integrated care for older people

BackgroundHealthcare system sustainability is challenged by several critical issues; one of the most pressing is the ageing population. Traditional, episodic care delivery models are not designed for older people who are medically complex and frail. These individuals would benefit from health and social care that is more comprehensive, coordinated, person-centred and accessible in the communities in which they live. Delivering this is a challenging endeavour. Community-based health and social care professionals are siloed, dispersed across various locations and sectors, each with their own mental models, electronic health information systems, and means of communication. To move away from fragmented care delivery models and towards a more integrated approach to care, an analysis of the process of community-based comprehensive geriatric assessment was conducted in an urban location in Atlantic Canada. The purpose of the study was to identify where in the community-based comprehensive geriatric assessment process challenges and opportunities existed for moving towards a more integrated model of care delivery.MethodThe functional resonance analysis method (FRAM) and dynamic FRAM (DynaFRAM) modelling were used to model the community-based health and social care system and create a hypothetical patient journey scenario. Data collected to inform modelling consisted of document review, focus groups, and semi-structured interviews with health and social care professionals providing care and service to older people in the community setting.Findings.Challenges and opportunities for implementing integrated care in the local context were identified. Findings from the FRAM and DynaFRAM analysis informed the co-design of multi-level process improvement recommendations that aim to move the local community-based comprehensive geriatric assessment process towards a more integrated model of care.ConclusionsA transformative redesign of community-based health and social care in the local context is necessary but cannot be accomplished without an understanding of how health and social care professionals conduct their work and how older people may receive care under the dynamic conditions. The FRAM and DynaFRAM modelling provided an enhanced understanding of system operations and functionality and demonstrated a critical step that should not be overlooked for decision-makers in their efforts to implement a more integrated model of care.

First-line managers´ perceptions of missed nursing care in community health care for older people-A phenomenographic study.

First-line managers in Swedish communities have responsibility for that care to older people is provided, staffing is sufficient and the budget is balanced in their unit. It is a struggle with limited resources due to a growing population in need of care. This can lead to missed nursing care. The aim was to describe first-line managers´ perceptions of missed nursing care in community health care for older people. A qualitative design with a phenomenographic approach, interviewing 24 first-line managers. Ethics approval for the study was received from the Research Ethics Committee at Karlstad University (Dnr HNT 2020/566). The results are shown in six descriptive categories containing 15 perceptions. The descriptive categories are 'occurrence of missed nursing care', 'becoming aware of missed nursing care', 'reasons for missed nursing care', 'missed nursing care has consequences for the older persons', 'missed nursing care has consequences for the staff' and 'taking action to decrease missed nursing care'. It is important for first-line managers to become aware of the existence and reasons for missed nursing, as it has consequences for older people and staff. Managers need to take missed nursing care seriously in order to work with improvements for maintaining good quality of care and patient safety.

Care models for older people based on a case study-Geriatrics as an active discipline

Geriatrics can enable and monitor aholistic care of older people through acomprehensive geriatric assessment in a structured way. Therefore, it must be integrated much more closely with preventive, rehabilitative and acute care units. Geriatrics are not seen in any aspects as areplacement for general practitioners or in-hospital structures but much more as asupplement to them. With its function-oriented concept, geriatrics can best coordinate the demographically necessary triage between prevention, acute treatment, rehabilitation and palliative care, thus avoiding undertreatment and overtreatment. This can only succeed in collaboration with general practitioners and specialist colleagues. The article categorizes geriatric care structures, such as preventive home visits, acute complex medical treatment, delirium prevention, outpatient and inpatient rehabilitation services based on acase example and makes proposals for structural changes that urgently need to be considered in the current healthcare reform, such as outpatient geriatric centers (AGZ).

2241 ‘You learn by doing, and by falling over’: a simulation-based approach to frailty, falls and fractures.

Abstract Background Studies show that newly qualified doctors feel unprepared for clinical practice in several key areas in the care of older people, despite older people occupying two thirds of inpatient beds [1,2]. Grounded in experiential learning theory, simulation has been hugely effective in undergraduate education in geriatric medicine [3]. We aimed to evaluate a novel simulation series exploring practically challenging aspects of geriatric medicine, such as ‘silver trauma’ and using de-escalation strategies in the management of delirium. Methods Using quality improvement methodology, we developed two inpatient simulation scenarios for fourth-year medical students on their geriatric medicine clerkships. The scenarios (managing delirium and post-falls assessment) are commonly encountered during on-call shifts, with learning outcomes aligned to Outcomes for Graduates. Our initial cycle involved eight students piloting the two scenarios and evaluation tool. Using their feedback, we will iteratively improve the methods and evaluation before repeating and obtaining pre- and post-simulation data on students’ ‘preparedness for F1’. Results Following the pilot, 100% of participants agreed that they felt more prepared for clinical work in geriatrics as an F1 doctor. 12.5% felt confident assessing a patient following a fall pre-session, which increased to 100% afterwards. Confidence in using de-escalation techniques in managing delirium improved from 50% (pre-) to 100% (post-session). Common themes in free-text feedback were that the simulation felt realistic and effectively tested prioritisation. Conclusion Our work highlights the merits of using simulation in geriatric medicine to help undergraduates prepare for the complexities and uncertainty involved in caring for the ageing population.

2224 What are we teaching UK medical students about ageing? Results of the third BGS national curriculum survey

Abstract Introduction The ageing population means all doctors, regardless of specialty, will need knowledge, skills, and attitudes to care for older people with complex health conditions. An essential component of preparing the medical workforce to best care for older people is by including teaching on ageing and geriatric medicine in undergraduate medical curricula. Here we present results of the British Geriatrics Society (BGS) national curriculum survey 2021–22, highlighting progress made in undergraduate teaching in geriatric medicine. Methods All 35 UK GMC-registered medical schools at the time of data collection were invited to participate in an online survey on content, methodology, timing, and duration of teaching in ageing and geriatric medicine. The survey was structured around the 2013 BGS recommended undergraduate curriculum, for consistency with previous surveys. Results 30/35 of UK medical schools responded (83% response rate). Most teaching occurred in the fourth year of study (21/30, 70%). The majority (15/30, 50%) reported a discrete module for geriatric medicine lasting 4–8 weeks, an increase on previous surveys. However, several programmes have reduced the amount of in-person teaching since the COVID-19 pandemic. Notably, three schools reported geriatric medicine exposure lasting >12 weeks. Of these, two were integrated clerkships and one a dedicated geriatric medicine module. There is increasing focus on multidisciplinary education, with emphasis on combining virtual or simulated teaching with other healthcare professions (n = 7). Every school (n = 30) taught at least one topic as small-group or case-based learning. Conclusion There is a trend towards increasing exposure to geriatric medicine compared to previous surveys in 2008 and 2013. However, several of the programmes reporting greater exposure incorporate geriatric medicine in an integrated clerkship rather than as a dedicated module. Programmes demonstrated a move from didactic teaching towards small-group and case-based learning, employing a wider variety of assessment methods than previous.

2304 Models of care and the role of clinical pharmacists in UK primary care for older people: findings from a scoping review

Abstract Introduction Pharmacists have traditionally worked in primary care, in the community, and with GPs. However, the role of the clinical pharmacist in primary care is evolving and there are plans to employ more clinical pharmacists in the NHS. With an ageing UK population, there is an increase in the number of people living with multiple long-term conditions, accompanied by polypharmacy, posing numerous challenges to healthcare systems. This review investigates the evidence about the varied roles and services delivered by clinical pharmacists in primary care, capturing the perspectives of health and care professionals, older adults, and their carers. Method Our scoping review followed the framework for scoping reviews in accordance with the Joanna Briggs Institute (JBI) methodology. A broad search was conducted in 2023 in CINAHL, Cochrane, Medline, SCOPUS, and Web of Science. We included articles that explored the landscape of clinical pharmacy services for older people in the UK, focusing on roles and services delivered, perceptions, and experiences. Results A total of 23 articles was included. These shed light on the multifaceted responsibilities of clinical pharmacists for older people. Stakeholder perspectives, including healthcare professionals and care home staff, emphasise the positive outcomes of clinical pharmacist involvement, from reducing other practitioners’ workloads to improving patient safety. However, communication gaps among the primary care team and those living with dementia, concerns about competence, and the need for clear role definitions of clinical pharmacists emerge as challenges. Conclusions and implications The review enhances our understanding of the clinical pharmacist service in the UK and identifies gaps in research evidence, emphasising the need for empirical studies on the experiences of older people with cognitive impairment and those from minority ethnic backgrounds. The findings can be used for policymaking, workforce planning, and healthcare provision to improve the services for older people in the UK.

Economic burden of frailty in older adults accessing community-based aged care services in Australia.

To explore the utilization of permanent residential aged care (PRAC), healthcare costs, and mortality for frail compared with non-frail individuals following their first assessment by an aged care assessment team (ACAT) for a government-funded home care package. The study involved people aged 65 years and over who completed their first ACAT assessment in 2013 and were followed for up to 36 months. Frail and non-frail study participants were matched through caliper matching without replacement to adjust for potential unobserved confounders. Poisson regression estimated the impact of frailty on PRAC admission and mortality rates. Healthcare costs, encompassing hospital admissions, emergency department presentations, primary care consultations, and pharmaceutical use, from ACAT assessment to end of follow-up, PRAC entry or death were summarized monthly by frailty status. 13 315 non-frail controls were matched with up to three frail individuals (52 678 total). Frail individuals experienced higher mortality (incidence rate ratio [IRR] = 1.76; 95% confidence interval [CI] 1.70-1.83) and greater likelihood of entering PRAC (IRR = 1.73; 95% CI 1.67-1.79) compared with non-frail individuals. Total healthcare costs over the 3-year post-assessment period for 39 363 frail individuals were $1 277 659 900, compared with expected costs of $885 322 522 had they not been frail. The primary contributor to the mean monthly excess cost per frail individual (mean = $457, SD = 3192) was hospital admissions ($345; 75%). Frailty is associated with higher rates of mortality and of entering PRAC, and excess costs of frailty are substantial and sustained over time. These findings emphasize the potential economic value of providing home care for older people before they become frail. Geriatr Gerontol Int 2024; ••: ••-••.