Barriers to Effective Prescribing in Older Adults: Applying the Theoretical Domains Framework in the Ambulatory Setting – A Scoping Review

Abstract Background: As the population ages, potentially inappropriate prescribing (PIP) in the older adults may become increasingly prevalent. This undermines patient safety and creates a potential source of major morbidity and mortality. Understanding the factors that influence prescribing behaviour may allow development of interventions to reduce PIP. The aim of this study is to apply the Theoretical Domains Framework (TDF) to explore barriers to effective prescribing for older adults in the ambulatory setting. Methods: A scoping review was performed based on the five-stage methodological framework developed by Arksey and O’Malley. From 30 Aug 2018 to 5 Sep 2018, we conducted our search on PubMed, CINAHL, EMBASE, the Cochrane Database of Systematic Reviews, and Web of Science. We also searched five electronic journals, Google and Google Scholar to identify additional sources and grey literature. Two reviewers applied eligibility criteria to the title and abstract screening, followed by full text screening, before systematically charting the data. Results: A total of 5,731 articles were screened. 29 studies met the selection criteria for qualitative analysis. We mapped our results using the 14-domain TDF, eventually identifying 10 domains of interest for barriers to effective prescribing. Of these, significant domains include physician-related factors such as “Knowledge”, “Skills”, and “Social/Professional Role and Identity”; issues with “Environmental Context and Resources”; and the impact of “Social Influences” and “Emotion” on prescribing behaviour. Conclusion: The TDF elicited multiple domains which both independently and collectively lead to barriers to effective prescribing for older adults in the ambulatory setting. Changing the prescribing climate will thus require interventions targeting multiple stakeholders, including physicians, patients and hospital/clinic systems. Further work is needed to explore individual domains and guide development of frameworks to aid guide prescribing for older adults in the ambulatory setting.

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Barriers to effective prescribing in older adults: applying the theoretical domains framework in the ambulatory setting – a scoping review

BMC Geriatrics ◽

10.1186/s12877-020-01766-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Sabrina Lau ◽

Penny Lun ◽

Wendy Ang ◽

Keng Teng Tan ◽

Yew Yoong Ding

Keyword(s):

Older Adults ◽

Scoping Review ◽

Grey Literature ◽

Inappropriate Prescribing ◽

Theoretical Domains Framework ◽

Ambulatory Setting ◽

Eligibility Criteria ◽

Related Factors ◽

Prescribing Behaviour ◽

The Impact

Abstract Background As the population ages, potentially inappropriate prescribing (PIP) in the older adults may become increasingly prevalent. This undermines patient safety and creates a potential source of major morbidity and mortality. Understanding the factors that influence prescribing behaviour may allow development of interventions to reduce PIP. The aim of this study is to apply the Theoretical Domains Framework (TDF) to explore barriers to effective prescribing for older adults in the ambulatory setting. Methods A scoping review was performed based on the five-stage methodological framework developed by Arksey and O’Malley. From 30 Aug 2018 to 5 Sep 2018, we conducted our search on PubMed, CINAHL, EMBASE, the Cochrane Database of Systematic Reviews, and Web of Science. We also searched five electronic journals, Google and Google Scholar to identify additional sources and grey literature. Two reviewers applied eligibility criteria to the title and abstract screening, followed by full text screening, before systematically charting the data. Results A total of 5731 articles were screened. Twenty-nine studies met the selection criteria for qualitative analysis. We mapped our results using the 14-domain TDF, eventually identifying 10 domains of interest for barriers to effective prescribing. Of these, significant domains include physician-related factors such as “Knowledge”, “Skills”, and “Social/Professional Role and Identity”; issues with “Environmental Context and Resources”; and the impact of “Social Influences” and “Emotion” on prescribing behaviour. Conclusion The TDF elicited multiple domains which both independently and collectively lead to barriers to effective prescribing for older adults in the ambulatory setting. Changing the prescribing climate will thus require interventions targeting multiple stakeholders, including physicians, patients and hospital/clinic systems. Further work is needed to explore individual domains and guide development of frameworks to aid guide prescribing for older adults in the ambulatory setting.

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Barriers to Effective Prescribing in Older Adults: Applying the Theoretical Domains Framework in the Ambulatory Setting

10.21203/rs.3.rs-19415/v2 ◽

2020 ◽

Author(s):

Sabrina Lau ◽

Penny Lun ◽

Wendy Ang ◽

Keng Teng Tan ◽

Yew Yoong Ding

Keyword(s):

Older Adults ◽

Grey Literature ◽

Inappropriate Prescribing ◽

Theoretical Domains Framework ◽

Ambulatory Setting ◽

Eligibility Criteria ◽

Related Factors ◽

Cochrane Database ◽

Prescribing Behaviour ◽

The Impact

Abstract Background: As the population ages, potentially inappropriate prescribing (PIP) in the older adults may become increasingly prevalent. This undermines patient safety and creates a potential source of major morbidity and mortality. Understanding the factors that influence prescribing behaviour may allow development of interventions to reduce PIP. The aim of this study is to apply the Theoretical Domains Framework (TDF) to explore barriers to effective prescribing for older adults in the ambulatory setting. Methods: A scoping review was performed based on the five-stage methodological framework developed by Arksey and O’Malley. From 30 Aug 2018 to 5 Sep 2018, we conducted our search on PubMed, CINAHL, EMBASE, the Cochrane Database of Systematic Reviews, and Web of Science. We also searched five electronic journals, Google and Google Scholar to identify additional sources and grey literature. Two reviewers applied eligibility criteria to the title and abstract screening, followed by full text screening, before systematically charting the data. Results: A total of 5,731 articles were screened. 29 studies met the selection criteria for qualitative analysis. We mapped our results using the 14-domain TDF, eventually identifying 10 domains of interest for barriers to effective prescribing. Of these, significant domains include physician-related factors such as “Knowledge”, “Skills”, and “Social/Professional Role and Identity”; issues with “Environmental Context and Resources”; and the impact of “Social Influences” and “Emotion” on prescribing behaviour.Conclusion: The TDF elicited multiple domains which both independently and collectively lead to barriers to effective prescribing for older adults in the ambulatory setting. Changing the prescribing climate will thus require interventions targeting multiple stakeholders, including physicians, patients and hospital/clinic systems. Further work is needed to explore individual domains and guide development of frameworks to aid guide prescribing for older adults in the ambulatory setting.

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Barriers to Effective Prescribing in the Elderly: Applying the Theoretical Domains Framework in the Ambulatory Setting

10.21203/rs.3.rs-19415/v1 ◽

2020 ◽

Author(s):

Sabrina Lau ◽

Penny Lun ◽

Wendy Ang ◽

Keng Teng Tan ◽

Yew Yoong Ding

Keyword(s):

Delphi Study ◽

Grey Literature ◽

Inappropriate Prescribing ◽

Theoretical Domains Framework ◽

The Elderly ◽

Ambulatory Setting ◽

Eligibility Criteria ◽

Related Factors ◽

Prescribing Behaviour ◽

The Impact

Abstract Aims: As the population ages, potentially inappropriate prescribing (PIP) in the elderly may become increasingly prevalent. This undermines patient safety and creates a potential source of major morbidity and mortality. Understanding the factors that influence prescribing behaviour may allow development of interventions to reduce PIP. The aim of this study is to apply the Theoretical Domains Framework (TDF) to explore barriers to effective prescribing in the elderly in the ambulatory setting.Methods: A scoping review was performed based on the five-stage methodological framework developed by Arksey and O’Malley. Our search strategy included PubMed, CINAHL, EMBASE, the Cochrane Database of Systematic Reviews, and Web of Science. We also searched five electronic journals, Google and Google Scholar to identify additional sources and grey literature. Two reviewers applied eligibility criteria to the title and abstract screening, followed by full text screening, before systematically charting the data. Results: 5,731 articles were screened. 29 studies met the selection criteria for qualitative analysis. Using TDF, 14 domains for barriers to effective prescribing were identified. Significant domains include physician-related factors such as “Knowledge”, “Skills”, and “Social/Professional Role and Identity”; issues with “Environmental Context and Resources”; and the impact of “Social Influences” and “Emotion” on prescribing behaviour.Conclusion: The TDF elicited multiple domains which both independently and collectively lead to barriers to effective prescribing in elderly patients in the ambulatory setting. Changing the prescribing climate will thus require interventions targeting multiple stakeholders, including physicians, patients and hospital/clinic systems. Moving forward, we will perform a Delphi study to explore individual domains and ultimately develop a physician-pharmacist collaborative care intervention to guide prescribing for the elderly in the ambulatory setting.

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Scoping review of mental health in prisons through the COVID-19 pandemic

BMJ Open ◽

10.1136/bmjopen-2020-046547 ◽

2021 ◽

Vol 11 (5) ◽

pp. e046547

Author(s):

Luke Johnson ◽

Kerry Gutridge ◽

Julie Parkes ◽

Anjana Roy ◽

Emma Plugge

Keyword(s):

Mental Health ◽

Scoping Review ◽

Grey Literature ◽

Well Being ◽

Health Impact ◽

Poor Quality ◽

Eligibility Criteria ◽

Prison Staff ◽

The Impact

ObjectiveTo examine the extent, nature and quality of literature on the impact of the COVID-19 pandemic on the mental health of imprisoned people and prison staff.DesignScoping review.Data sourcesPubMed, Embase, CINAHL, Global Health, Cochrane, PsycINFO, PsychExtra, Web of Science and Scopus were searched for any paper from 2019 onwards that focused on the mental health impact of COVID-19 on imprisoned people and prison staff. A grey literature search focused on international and government sources and professional bodies representing healthcare, public health and prison staff was also performed. We also performed hand searching of the reference lists of included studies.Eligibility criteria for selection of studiesAll papers, regardless of study design, were included if they examined the mental health of imprisoned people or prison staff specifically during the COVID-19 pandemic. Imprisoned people could be of any age and from any countries. All languages were included. Two independent reviewers quality assessed appropriate papers.ResultsOf 647 articles found, 83 were eligible for inclusion, the majority (58%) of which were opinion pieces. The articles focused on the challenges to prisoner mental health. Fear of COVID-19, the impact of isolation, discontinuation of prison visits and reduced mental health services were all likely to have an adverse effect on the mental well-being of imprisoned people. The limited research and poor quality of articles included mean that the findings are not conclusive. However, they suggest a significant adverse impact on the mental health and well-being of those who live and work in prisons.ConclusionsIt is key to address the mental health impacts of the pandemic on people who live and work in prisons. These findings are discussed in terms of implications for getting the balance between infection control imperatives and the fundamental human rights of prison populations.

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Evaluation of the impact of patient involvement in health technology assessments: A scoping review

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462320000239 ◽

2020 ◽

Vol 36 (3) ◽

pp. 217-223

Author(s):

Robert J. Mason ◽

Karlee M. Searle ◽

Yvonne Bombard ◽

Amanda Rahmadian ◽

Alexandra Chambers ◽

...

Keyword(s):

Scoping Review ◽

Literature Search ◽

Qualitative Interviews ◽

Grey Literature ◽

Health Technology ◽

Eligibility Criteria ◽

Health Technologies ◽

Methods Of Evaluation ◽

Patient Groups ◽

The Impact

ObjectivesWhile involving patients in health technology assessment (HTA) has become increasingly common and important around the world, little is known about the optimal methods of evaluating patients’ involvement (PI) in HTA. This scoping review was undertaken to provide an overview of currently available methods for the evaluation of PI, specifically the impact of PI on HTA recommendations.MethodsA literature search was conducted using nine databases as well as a grey literature search of the websites of 26 organizations related to the conduct, practice or research of HTA to identify articles, reports and abstracts related to the evaluation of PI impact in HTA.ResultsWe identified 1,248 unique citations, six of which met our eligibility criteria. These six records (five articles, and one report) were all published after 2012. Four assessed the impact of patient experience submissions on final HTA recommendations; one evaluated the impact of direct involvement on HTA committees, and one assessed impact of multiple forms of involvement. Methods of evaluation included quantitative analyses of reimbursement decisions, qualitative interviews with those directly involved in an assessment, surveys of patient groups and committee members, and the review of HTA reports.ConclusionsQuantitative evaluation of PI based on associations with funding decisions may not be feasible or fully capture the relevant impact of PI in the assessment of health technologies. Rather, a combination of both qualitative and quantitative strategies may allow for the most comprehensive assessment of the impact of PI on HTA recommendations when possible.

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Intergenerational Engagement in Residential Settings: A Scoping Review of the Literature

Innovation in Aging ◽

10.1093/geroni/igab046.3085 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 851-851

Author(s):

Andrea Gardiola ◽

Raza Mirza ◽

Amanda Bull ◽

Christopher Klinger ◽

Jessica Hsieh ◽

...

Keyword(s):

Older Adults ◽

Health Outcomes ◽

Scoping Review ◽

Grey Literature ◽

Age Groups ◽

Future Research ◽

Long Term Effects ◽

Hand Search ◽

Intergenerational Interactions ◽

The Impact

Abstract Intergenerational engagement provides a rich environment for people of different ages to come together and exchange life stories, skills, and knowledge. Today, intergenerational interactions are decreasing, however, these exchanges can have positive implications for seniors in residential care homes (RCHs) and younger persons. A scoping review following Arksey and O’Malley’s five-step framework was conducted to investigate the impact of intergenerational engagement and programs (IGPs) on older adults in RCHs. A systematic search of ten electronic databases and hand search of references was carried out; thematic content analysis to established key themes. A total of 1,183 academic and grey literature sources were reviewed, with 66 full-text studies assessed for eligibility. Of these sources, 35 studies met inclusion criteria. Studies highlighted four main themes: 1. Types of IGPs, 2. Psycho-social benefits for older adults and improved status among elders with cognitive impairments, 3. Younger person benefits, suggesting reduced ageism and improved social and communication skills, and 4. Program recommendations, including the need for enthusiastic program facilitators, coordination between facilities, sensitivity training for younger persons, detailed advertisements, and appropriate activities for different age groups. Findings inform future practice and research, highlighting that IGPs are an effective strategy to alleviate negative health outcomes for seniors in RCHs. Future research is needed to evaluate long-term effects and further health outcomes. IGPs provide an opportunity to facilitate purposeful and reciprocal relationships between generations, fostering intergenerational understanding. By studying IGPs and intergenerational interactions, we can better determine practices that meaningfully engage elders in RCHs in Canada.

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Intervention elements to reduce inappropriate prescribing for older adults with multimorbidity receiving outpatient care: a scoping review

BMJ Open ◽

10.1136/bmjopen-2020-039543 ◽

2020 ◽

Vol 10 (8) ◽

pp. e039543

Author(s):

Jia Qi Lee ◽

Kate Ying ◽

Penny Lun ◽

Keng Teng Tan ◽

Wendy Ang ◽

...

Keyword(s):

Older Adults ◽

Scoping Review ◽

Data Extraction ◽

Adult Population ◽

Grey Literature ◽

Inappropriate Prescribing ◽

Complex Interventions ◽

Final Analysis ◽

Outpatient Setting ◽

Cochrane Library

ObjectivePolypharmacy occurs in approximately 30% of older adults aged 65 years or more, particularly among those with multimorbidity. With polypharmacy, there is an associated risk of potentially inappropriate prescribing (PIP). The aims of this scoping review were to (1) identify the intervention elements that have been adopted to reduce PIP in the outpatient setting and (2) determine the behaviour change wheel (BCW) intervention functions performed by each of the identified intervention elements.DesignScoping reviewData sourcesPubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Web of Science and Cochrane Library databases, grey literature sources, six key geriatrics journals and the reference lists of review papers.Study selectionAll studies reporting an intervention or strategy that addressed PIP in the older adult population (age ≥65) with multimorbidity in the outpatient setting and in which the primary prescriber is the physician.Data extractionData extracted from the included studies can be broadly categorised into (1) publication details, (2) intervention details and (3) results. This was followed by data synthesis and analysis based on the BCW framework.ResultsOf 8195 studies yielded, 80 studies were included in the final analysis and 14 intervention elements were identified. An average of two to three elements were adopted in each intervention. The three most frequently adopted intervention elements were medication review (70%), training (26.3%) and tool/instrument(s) (22.5%). Among medication reviews, 70% involved pharmacists. The 14 intervention elements were mapped onto five intervention functions: ‘education’, ‘persuasion’, ‘training’, ‘environmental restructuring’ and ‘enablement’.ConclusionPIP is a multifaceted problem that involves multiple stakeholders. As such, interventions that address PIP require multiple elements to target the behaviour of the various stakeholders. The intervention elements and their corresponding functions identified in this scoping review will serve to inform the design of complex interventions that aim to reduce PIP.

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Evidence of nonverbal communication between nurses and older adults: a scoping review

10.21203/rs.2.19132/v1 ◽

2019 ◽

Author(s):

Esther Lydie Wanko Keutchafo ◽

Jane Kerr ◽

Mary A. Jarvis

Keyword(s):

Older Adults ◽

Nonverbal Communication ◽

Scoping Review ◽

Grey Literature ◽

World Health ◽

Eligibility Criteria ◽

Communication Behaviors ◽

Negative Perceptions ◽

Communication Needs ◽

Health Organization

Abstract Background : Communication is an integral part of life and of nurse-patient relationships. Effective communication with patients can improve the quality of care. However, due to specific communication needs in older adults, the communication between them and nurses is not always effective. Additionally, though research has focused on communication, there is scant evidence on nonverbal communication between nurses and older adults with no communication impairment nor mental illness. Methods : This scoping review describes the type of nonverbal communication used by nurses to communicate with older adults. It also describes the older adults’ perceptions of nurses’ nonverbal communication cues. It followed Arksey and O’Malley’s framework. Relevant studies and grey literature were identified by searches in Pubmed, Science Direct, Sabinet, Academic search complete, CINAHL with Full Text, Education Source, Health Source- Consumer Edition, Health Source: Nursing/Academic Edition, and MEDLINE. Google Scholar, and World Health Organization library. The studies and grey literature were then filtered by two reviewers independently. Eligibility criteria for inclusion were: (i) studies focused on nurses’ nonverbal communication with older adults; (ii) studies focused on older adults’ interpretation of nurses’ communication behaviors; (iii) any existing literature from 2000 to 2019 and (iv) literature in English and French. Results : Twenty-two studies were included in this review. The results demonstrate limited published research addressing nonverbal communication between older adults and nurses. The review also revealed that haptics, kinesics, proxemics, and vocalics were most frequently used by nurses when communicating with older adults; while there was limited use of artefacts and chronemics. There was no mention of silence as a nonverbal communication cue used by nurses. Additionally, older adults had both positive and negative perceptions about nurses’ nonverbal communication behaviors. Conclusion : Nurses should be self-aware of their nonverbal communication behaviors as well as the way in which the meanings of the messages might be misinterpreted. In addition, nurses should identify their own style of nonverbal communication and understand its modification as necessary in accordance with patient’s needs.

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Revealing the shape of knowledge using an intersectionality lens: results of a scoping review on the health and health care of ethnocultural minority older adults

Ageing and Society ◽

10.1017/s0144686x12000013 ◽

2012 ◽

Vol 33 (3) ◽

pp. 437-464 ◽

Cited By ~ 37

Author(s):

SHARON KOEHN ◽

SHEILA NEYSMITH ◽

KAREN KOBAYASHI ◽

HAMISH KHAMISA

Keyword(s):

Older Adults ◽

Health Care ◽

Scoping Review ◽

Health Care Access ◽

Minority Groups ◽

Health Care Systems ◽

South Asians ◽

Grey Literature ◽

Care Providers ◽

Eligibility Criteria

ABSTRACTThis paper uses an intersectionality theoretical lens to interrogate selected findings of a scoping review of published and grey literature on the health and health-care access of ethnocultural minority older adults. Our focus was on Canada and countries with similar immigrant populations and health-care systems. Approximately 3,300 source documents were reviewed covering the period 1980–2010: 816 met the eligibility criteria; 183 were Canadian. Summarised findings were presented to groups of older adults and care providers for critical review and discussion. Here we discuss the extent to which the literature accounts for the complexity of categories such as culture and ethnicity, recognises the compounding effects of multiple intersections of inequity that include social determinants of health as well as the specificities of immigration, and places the experience of those inequities within the context of systemic oppression. We found that Canada's two largest immigrant groups – Chinese and South Asians – had the highest representation in Canadian literature but, even for these groups, many topics remain unexplored and the heterogeneity within them is inadequately captured. Some qualitative literature, particularly in the health promotion and cultural competency domains, essentialises culture at the expense of other determinants and barriers, whereas the quantitative literature suffers from oversimplification of variables and their effects often due to the absence of proportionally representative data that captures the complexity of experience in minority groups.

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Mapping evidence of nurses’ attitudes toward older adults in Africa: a scoping review protocol

Systematic Reviews ◽

10.1186/s13643-021-01575-y ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Esther L. Wanko Keutchafo ◽

Jane Kerr ◽

Mary A. Jarvis ◽

Desmond Kuupiel

Keyword(s):

Older Adults ◽

Nursing Students ◽

Scoping Review ◽

Research Question ◽

Grey Literature ◽

Future Research ◽

African Countries ◽

Eligibility Criteria ◽

Students Attitudes

Abstract Background Culture influences nurses’ attitudes towards caring for older adults. Additionally, nursing students’ perceptions and attitudes towards older adults affect their behavior, possibly their career choices and/or the quality of care provided to older adults after graduation. In the context of lower–middle-income countries with a faster growing older adults population compared to upper income countries, the improvement of the quality care, inclusive of nurses’ attitudes towards older adults, is one of the strategies for strengthening nursing and midwifery in Africa. Furthermore, examining nurses and nursing students’ attitudes towards older adults will answer the United Nations’ call for more data to understand the needs and the status of older adults in Africa. Methods This scoping review will be guided by Arksey and O’Malley’s framework. The search will be performed using Scopus, PubMed databases, Academic search complete, CINAHL with full text, Education source, Health source: Nursing/Academic Edition, with words related to the topic. The reviewers will also use Google Scholar and the reference lists of the relevant articles. Primary studies and grey literature addressing the research question will be included. The search process will include a first stage where two reviewers will perform the title screening and the removal of duplicates, followed by a parallel abstract screening according to eligibility criteria. The second stage will involve the reading of full articles and the exclusion of articles, in accordance with the eligibility criteria. Data will be collated by two reviewers independently and parallel, using a predetermined data extraction form. Discrepancies will involve a third reviewer. The Mixed Methods Appraisal Tool, version 2018 will be used to assess the quality of the data of eligible articles. A narrative approach containing summary tables and graphs will facilitate synthesis. Discussion The review will provide insight into nurses' and nursing students’ attitudes towards older adults in African countries. The outcomes will guide future research, practice, and education in nursing.

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