Age­friendly Health Systems for Elderly: a systematic review

Miranti Dea Dora1, Joni Haryanto2, and Siti Nur Kholifah3
1
Student Program Master Nursing, Airlangga University Surabaya, Surabaya, 60115, 
Indonesia  
2
Lecturer Program Master Nursing, Airlangga University Surabaya, Surabaya, 60115, 
Indonesia
3
Lecturer Nursing Department, Kemenkes Polytechnic of Health Surabaya, Surabaya,
60176,Indonesia

miranti.dea.dora­2017@fkp.unair.ac.id

Abstract. Background: Elderly people sustain various decrease in anatomical, physiological,
social and economic aspects.  Elderly has resulted increasing  demand in  aged friendly health
systems for management of chronic diseases. It caused elderly people need aged friendly health
systems.   The   objective   of   this   research  is  was  to  identify   age   friendly   health   systems   for
elderly.  in  In  this   article,   the   authors   conducted   a   relevant  systematicliterature  review   in
various data using the keywords “age friendly”, “health system”, “elderly”. Data based based
on SCOPUS, Science Direct, Proquest, Pubmed and Google Scholar. The criteria consisted of
full text published in criteria were five years limit journal (20132­2018) use 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 the WHO guidelines in the
following   areas:Information,   education   and   training,   community­based   health   care
management systems, and the physical environment.  Discussions aged friendly health system
to support elderly health of choronic diseases, well­being, and ability to age in place.

1.  Introduction 
Elderly people sustain various decrease in anatomical, physiological, social and economic aspects
 ( 1 ).Elderly has resulted increasing demand in aged friendly health systems for management of chronic
diseases. It caused elderly people need aged friendly health systems ( 2 ). 
 Based on the focus groups findings and backed by background research and a consensus meeting
of experts, WHO developed aset of age­friendly 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 ).
Age friendly health system is a health care system that aims to provide elderly with the best care
possible,   to  reduce  health  care  related   harms   to  elderly   ,   and  to  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 and included in the treatment plan, and safe
and better transitions  of patients from different care settings are ensured.  Such a system will likely
enhance the quality of care for elderly and optimize value for health systems in measurable ways  (5 ).
Age­Friendly Health System, health care related harms to  elderly are dramatically reduced and
approach   zero;  elderly  get   the   best   care   possible   and   are   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
evidence­based   care;   staff  who   are  specifically   trained   and   proficient   in   the   care   of   older   adults;
highperformingcare 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  Age­Friendly  Health  Systems   initiatif  would   reduce   harm   to   older   adults   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   older   adults   across   all   care   settings:   inpatient,  post­acute,   and   in­home   and
ambulatory settings (7) .
Based on all studies,    age friendly health system  based on the WHO guidelines in the following
areas:Information, education and training, community based health care management systems, and the
physical environment (  .Therefore, this systematic review aimed to identify age friendly health systems
8)

for elderly.

2.  Material and Methods 
This systematic review was reported in accordance with the PRISMA (Preferred Reporting Items for
Systematic reviews and Meta­Analyses) Statement  (  .
9)

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, full­text article, English language and we excluded studies with  non­elderly
participants, and study protocols. 

2.3 Data extraction and quality assessment
 All   citations   retrieves   from   electronic   databases   were   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   various   data   using   the
keywords “age friendly”, “health system”, “elderly”.  Data of included 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, gender). A detail description
of  age friendly health system.    We used  WHO guidelines  as the main outcome    of this systematic
review. 

3.1 Literature Search 
We conducted an identification of 567 studies in database searches. Seven duplicate studies were
excluded   continued   by   401   studies   due   to   non­elderly   participant,   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= 567620 through other sources, n = 0
Screening 

# of records after duplicates

removed, n = 401613

# of records excluded, n = 572;

Eligibility 

# of records screened, n = due to non-elderly participant,

401613 non-RCT, irrelevant studies, study
protocol

# of full-text articles
assessed for eligibility, n = # of records excluded, n = 35; due
Included 

3421 to out of Asian country and the

outcome is not blood pressure
monitoring
# 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 search to identify age friendly health system

3.2 Study Characteristics
Data is extracted from each study that meets the requirements. The extracted data includes 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   are   not
relevant according to the inclusion criteria,
3. If the title and abstract seem to meet the inclusion criteria and in accordance with the objectives
of the systematic review, the next step is the selection of journals with full text
4. The final step is the selection of articles

3.3 Data Analysis 
Studies are grouped according to identify of  age friendly health system 

3.  Discussion
Age­friendly environmental factors that may have some influence  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 in the transmission of information  (10) .
7 of the 8 domains of the WHO Framework (transportation, housing, social participation, respect
and social approval, civic participation, communication and information and community support and
health services) show significant results. Interviews were conducted with weak and not weak elderly
people.   Results  shows   that   gender,   age   and   especially   fragility   are   related   to   environmental
characteristics.   Elderly   people   who   are   aware   of   fragility   admit   that   they   need   an   age   friendly
environmen ( 11) . 
Age   friendly  communities  influences   the   subjective   well­being  of   the   elderly  and  significantly
increases   the   life   satisfaction   of   the   elderly  ( 12) .  Age   friendly   environmental   characteristics   as   a
modification environmental resources that can improve the well­being of psychology in the elderly  ( 13) .
In   the   domain   of   Applying   WHO   community   and   health   service   Age­Friendly   Communities
Framework   has   significant   effect   on   rural   (0.08)   and   urban   (0.46)
Applying the WHO Age­Friendly Communities Framework is needed for rural elderly people    ( 14) .
Age­Friendly Primary Health Care was able to improve Current Service Provision  ( 15) .
4.  Limitations

There are several potential limitations associated with this systematic review, namely (1) the search
is limited to published research, which might introduce the risk of publication bias, (2) there is a
possibility that bias is introduced by the way studies are chosen or search criteria are determined, (3)
what what we consider to be the main outcome is not always the same as in other studies.

5.  Strengths

The purpose of this systematic review is to identify age friendly healh system. Based on the results
of the analysis there are many positive effects age friendly healh system for elderly. Based on a review
of   the   journal   it   was   found   that  elderly   need   age   friendly   healh   system  reviewed  environmental
characteristics, increase well­being of elderly, 

6.  Conclusion

Age friendly health system to support elderly health of choronic diseases, well­being, 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. 

Age­friendly   health  systems  focus   on  the  communication  health   worker  with  elderly,     the
physical and social infrastructure to support older adults health, well­being, and ability to age
in place