Aged-friendly primary health care: a systematic review

M D Dora1*, J Haryanto1 and S N Kholifah2

1
Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
2
Nursing Department, Kemenkes Polytechnic of Health Surabaya, Surabaya, Indonesia

*Corresponding author: e-mail: miranti.dea.dora-2017@fkp.unair.ac.id

Abstract. Elderly sustain variously of decrease in anatomical, physiological, social and

economic aspects. Elderly had showed that there was an increasing demand in aged friendly
health systems for management of chronic diseases. It can cause elderly people need aged
friendly health systems. The objective of this research was identifying age friendly health
systems for elderly. In this article, the authors conducted a relevant systematic review in various
data used the keywords “age friendly”, “health system”, “elderly.” Data based on SCOPUS,
Science Direct, Proquest, Pubmed and Google Scholar. The criteria consisted of full text
published in five years limit journal (2013-2018) and used article in English. The results as much
as 386 articles found, and selected 15 article that suitable with criteria. The result introduction
of age friendly health system based on WHO’s guidelines in the following areas:Information,
education and training, community-based health care management systems, and the physical
environment. Suggestion for elderly health service is aged friendly health system can support
elderly health of chronic diseases, well-being and ability to age in place.

1. Introduction
Elderly sustain variously of decrease in anatomical, physiological, social and economic aspects [1]
. Elderly had showed that there was an increasing demand in aged friendly health systems for
management of chronic diseases. It can cause elderly people need aged friendly health systems[2]. Based
on the focus groups found and backed by background research and a consensus meeting of experts,
WHO developed asset of age-friendly principles. The first dimension of principles is in the areas of
information, education, and training; the second is in the area of community based health care
management systems and the third is in the area of the physical environment. These principles can be
adapted to outpatient services and hospitals in addition to primary care centers or clinics[3].
Aged friendly primary health care is a health care system that aims to provide elderly with the best
care possible, reduce health care related harms to elderly, and optimize value of all, including patients,
families, caregivers, health care providers, and health systems[4]. Patients goals and preferences are
valued, family caregivers are supported, included in the treatment plan, and safe and better transitions
of patients from different care settings are ensured. The systems will perhaps enhance the quality of care
for elderly and optimize value for health systems in measurable ways[5].
Aged friendly primary health care, health care related harms to elderly are dramatically reduced and
approached zero; elderly get the best care possible and being satisfied with their care; and value is
optimized for everyone and initiative builds upon a number of fundamental characteristics common to
existing geriatric care models, including leadership committed to addressing ageism; reliable use of
evidence-based care; stay who are specifically trained and proficient in the care of older adults; high
performing care teams focused on measurable outcomes; a systematic approach for coordinating care
with other organizations and for engaging with patients and their families and caregivers; and a clear
process for eliciting patient goals and priorities and using those goals to individualize care [6].
Implemented of Aged friendly primary health care would reduce harm for elderly and improve health
outcomes while avoiding unwanted or duplicative care. In addition, ensuring the reliable execution of
these interventions requires a set of foundational elements including leadership, teamwork, and
information and communications systems. Importantly, the goal of the initiative is to improve care for
elderly across all care settings: inpatient, post-acute, and in-home and ambulatory settings [5]. Based on
all studies, age friendly health system based on WHO's guidelines in the following areas:Information,
education and training, community based health care management systems and the physical
environment[8]. Therefore, this systematic review aims to identify Aged friendly primary health care.

2. Methods
This systematic review was reported in accordance with the PRISMA (Preferred Reporting Items for
Systematic reviews and Meta-Analyses) Statement[7].

2.1 Data Sources and Searches

Databased searched from SCOPUS, Science Direct, Proquest, Pubmed and Google Scholar provide
studies related to identify age friendly health systems for elderly, determined from 2013 to 2019.

2.2 Study Selection

The studies selected by inclution criterias were open access, cross sectional and qualitative study with
elderly participants, full-text article, English language and we excluded studies with non-elderly
participants, and study protocols.

2.3 Data extraction and quality assessment

All citations retrieves from electronic databases that imported to Mendeley Program. Two reviewers
(BU, SNK) independently analyzed the titles and abstracts of every studies retrieved from the literature
search to identify potentially eligible studies. The fulltext of the remaining studies was obtain for further
examination. The last review conducted by a first reviewer (TPD).
In this article, the authors conducted a relevant systematic review in variously of data used the
keywords “age friendly”, “health system”, “elderly”. Data of studies were independently extracted by
the same two reviewers by including first author’s name, year of publication, sample size, study design,
duration of trial, general characteristics of participants (age and gender). A detail description of age
friendly health system. WHO’s guidelines as the main outcome of this systematic review.

3. Result
3.1 Study Size
We conducted an identification of 567 studies in database sources. Seven duplicate studies were
excluded continued by 401 studies due to non-elderly participants, irrelevant studies and study protocols.
The six remain studies included in the current systematic review.
 Identification

# of records identified through # of additional records identified

database searching, n= 567 through other sources, n = 0

# of records after duplicates

Screening

removed, n = 401

# of records excluded, due to non-

# of records screened, n = elderly participant, irrelevant
401 studies, study protocol
Eligibility

# of full-text articles
assessed for eligibility, n = # of records excluded, n = 35; due
32 to out of Asian country and the
outcome is not blood pressure
monitoring
Included

# of studies included in
qualitative synthesis, n = 6

# of studies included in
quantitative synthesis
(meta-analysis), n = 0

Figure 1. Flow diagram of the literature sources to identify age friendly health system

3.2 Study Characteristics

Data was extracted from each study that needed the requirements. The extracted data included the
characteristics of the study, characteristics of age friendly health system, characteristics of the results
and summary of results.
Standard protocol for selecting studies as suggested in the systematic review method guide, PRISMA.
The steps taken are:
1. Removal of duplication
2. Examination independently of titles, abstracts and keywords and delete citations that were not
relevant according to the inclusion criteria,
3. If the title and abstract likely in accordance with the inclusion criteria and the objectives of the
systematic review, the next step was the selection of journals with full text.
4. The final step was the selection of articles
4. Discussion

Age-friendly environmental factors that may have some affects in health results: Several factors that
may hinder health care of the elderly have been found related to physical difficulties in accessing to the
health centers, in their structure and the transmission of information[4].
7 of the 8 domains of WHO Framework (transportation, housing, social participation, respect and
social approval, civic participation, communication and information, community support and health
services) showed significant results. Interviews were conducted with weak and not weak elderly people.
Results showed that gender, age and especially fragility were related to environmental characteristics.
Elderly who were aware of fragility admited that they needed an age friendly environment[9].
Age friendly communities affects the subjective well-being of the elderly and significantly increases
the life satisfaction of the elderly[10]. Age friendly environmental characteristics as a modification
environmental resources that can improve the well-being of psychology for the elderly.
According to WHO, community and health service Aged-Friendly Framework had been significant
effect on rural (0.08) and urban (0.46). According to, WHO Aged-Friendly Communities Framework
was needed for rural elderly[11]. Aged-friendly primary health care was able to improve current service
provision(3].

5. Implication

The purpose of this systematic review was identify aged friendly primary health care. Based on the
results of the analysis there were many positive effects in aged friendly primary health care. Based on a
review of the journal it was found that elderly needed age friendly healh system by reviewed
environmental characteristics, and it could increase well-being of elderly,

6. Conclusion

Aged friendly primary health care can support elderly health of choronic diseases, well-being, and
ability to age in place. Based on these data we fully recommend the use of age friendly health system
for elderly applied to elderly health services.
Reference

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 Table 1 Description of the study characteristics, outcome, measurement, interventions and results.

First Author Study Characteristic Outcome and Intervention Results

(Year) 1. Design Measurement 1. Treatment group(s)
2. Sample 2. Type, dose, frequency and
administration method
3. Duration per session/Total number of
sessions/Total Duration of intervention
1 Alhamdan Evaluation of 1. Cross Age-friendly - The clinical management of patients
AA health care Sectional PHCCs toolkit of reaches an acceptable level, however,
et al (2015) services 2. 564 the WHO aspects related to information,
provided for physical
older adults in barriers and transportation must be
primary health improved
care centers
and its internal
environment.
A step towards
age friendly
health centers

2 Cramm, Van The creation of 1. Cross sectional Age friendly - 7 of the 8 domains of the WHO
Dijk, & age-friendly and Qualitative cities 8 domain Framework (transportation, housing,
Nieboer, environments 2. Sample WHO social participation, respect and social
(2018) is especially a. Cross framework approval, civic participation,
important to sectional : 558 communication and information and
frail older b. Qualitative : community support and health
people 32 services) show significant results.
Interviews were conducted with weak
and not weak elderly people.
3 Xie, (2018) Age-Friendly 1. Survey Age-Friendly - Age friendly communities affects the
Communities 2. 9965 Community subjective well-being of the elderly
and Life Indicators. and significantly increases the life
Satisfaction Housing Local satisfaction of the elderly
 Among the amenities
Elderly Community
in Urban services Social
China inclusion

4 S. Park & Age-friendly 1. Cross Indicators - Consistent with the environmental

Lee, (2017) environments sectional from the World docility hypothesis, members of the
and life 2. 1657 Health most vulnerable subgroup in the
satisfaction Organizations Korean context older adults who are
among South (WHO) living alone and poor are more likely
Korean elders: framework for to have higher life satisfaction when
person - age friendly they have higher levels of support in
environment cities (ACF) physical and social environments.
fit perspective Interestingly, a higher level of support
in the service environment was related
to lower life satisfaction for this
subgroup.
5 Wang, Applying 1. Cross sectional The CHARLS - In the domain of Applying WHO
Gonzales, & WHO’s Age- 2. 453 community community and health service Age-
Morrow- Friendly survey Friendly Communities
Howell Communities contained Framework has significant effect on
(2017) Framework to questions rural (0.08) and urban (0.46)
a National Applying the WHO Age-Friendly
Survey in Communities Framework is needed
China for rural elderly people
6 Woo, Mak, & Age-Friendly 1. Qualitative - - Age-Friendly Primary Health Care
Yeung (2013) Primary Health 2. 12 hospital was able to improve Current Service
Care: An staff working Provision.
Assessment of in a public
Current service system,
Provision for consisting of
Older Adults geriatrics (5),
in Hong Kong nurses (4) and
health staff (1)