34What Works in Implementing a Frail Older Person’s Pathway? A Rapid Realist Review of the Literature

Abstract

Background: Attention has been focused on prioritising the best pathways for treating frail older adults. The research points to the importance of dedicated staffing, ongoing data collection, clinical champions and organisation support. Very little evidence is available on implementing these strategies within the Irish context. We aimed to respond to this by undertaking a rapid realist review (RRR) of the literature. Methods: A RRR is focused on iteratively building on the empirical and theoretical literature by accommodating and summarizing a diversity of evidence types. Key to its success is the active engagement of an expert panel who are tasked with ensuring the review reflects current thinking. Our expert panel consisted of seven members who agreed the RRR question: “what factors enable the successful development and implementation of a frail older person's pathway within the acute setting?” Two members of the team undertook a search of the literature using Cochrane, PubMed and CINAHL databases. This search was supplemented with key articles and other documents relevant from the grey literature. Results: Our review consisted of 18 documents. The expert panel validated and prioritized the conceptual model. We identified five contexts, five mechanisms, nine linked resources and three outcomes that enable successful implementation. These included the needed to identify frailty at the front door. However, there is a lack of evidence to guide the care of frail older people attending the ED. The review found that all staff need to be educated on frailty. Geriatricians and their teams can act as key enablers to support interprofessional collaboration. A significant challenge related to organisational boundaries. There is a need to recognise that older people are experts by their experiences and they must be included and consulted. Conclusion: RRRs produce accounts of what works based on a wide range of sources and enable innovative engagement with content specific experts.