Article Text

Original research
Common elements of service delivery models that optimise quality of life and health service use among older people with advanced progressive conditions: a tertiary systematic review
  1. Joanne Bayly1,2,
  2. Anna E Bone1,
  3. Clare Ellis-Smith1,
  4. India Tunnard1,
  5. Shuja Yaqub1,
  6. Deokhee Yi1,
  7. Kennedy B Nkhoma3,
  8. Amelia Cook1,
  9. Sarah Combes3,4,5,
  10. Sabrina Bajwah1,
  11. Richard Harding1,
  12. Caroline Nicholson4,5,
  13. Charles Normand1,6,
  14. Shalini Ahuja7,
  15. Pamela Turrillas1,
  16. Yoshiyuki Kizawa8,
  17. Tatsuya Morita9,
  18. Nanako Nishiyama10,
  19. Satoru Tsuneto11,
  20. Paul Ong12,
  21. Irene J Higginson1,
  22. Catherine J Evans1,13,
  23. Matthew Maddocks1
  1. 1Cicely Saunders Institute for Palliative Care, Policy and Rehabilitation, King's College London, London, UK
  2. 2St Barnabas Hospice, Worthing, UK
  3. 3Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King's College London, London, UK
  4. 4St Christopher's Hospice, London, UK
  5. 5University of Surrey Faculty of Health and Medical Sciences, Guildford, UK
  6. 6Centre for Health Policy and Management, The University of Dublin Trinity College, Dublin, Ireland
  7. 7Health Service and Population Research Department, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
  8. 8Department of Palliative Medicine, Kobe University, Kobe, Japan
  9. 9Palliative and Supportive Care Division, Seirei Mikatahara Hospital, Hamamatsu, Japan
  10. 10Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Japan
  11. 11Department of Human Health Sciences, Department of Palliative Medicine, Kyoto University Hospital, Kyoto, Japan
  12. 12WHO Centre for Health Development (WKC), Kobe, Japan
  13. 13Sussex Community NHS Foundation Trust, Brighton, UK
  1. Correspondence to Dr Matthew Maddocks; matthew.maddocks{at}


Introduction Health and social care services worldwide need to support ageing populations to live well with advanced progressive conditions while adapting to functional decline and finitude. We aimed to identify and map common elements of effective geriatric and palliative care services and consider their scalability and generalisability to high, middle and low-income countries.

Methods Tertiary systematic review (Cochrane Database of Systematic Reviews, CINAHL, Embase, January 2000–October 2019) of studies in geriatric or palliative care that demonstrated improved quality of life and/or health service use outcomes among older people with advanced progressive conditions. Using frameworks for health system analysis, service elements were identified. We used a staged, iterative process to develop a ‘common components’ logic model and consulted experts in geriatric or palliative care from high, middle and low-income countries on its scalability.

Results 78 studies (59 geriatric and 19 palliative) spanning all WHO regions were included. Data were available from 17 739 participants. Nearly half the studies recruited patients with heart failure (n=36) and one-third recruited patients with mixed diagnoses (n=26). Common service elements (≥80% of studies) included collaborative working, ongoing assessment, active patient participation, patient/family education and patient self-management. Effective services incorporated patient engagement, patient goal-driven care and the centrality of patient needs. Stakeholders (n=20) emphasised that wider implementation of such services would require access to skilled, multidisciplinary teams with sufficient resource to meet patients’ needs. Identified barriers to scalability included the political and societal will to invest in and prioritise palliative and geriatric care for older people, alongside geographical and socioeconomic factors.

Conclusion Our logic model combines elements of effective services to achieve optimal quality of life and health service use among older people with advanced progressive conditions. The model transcends current best practice in geriatric and palliative care and applies across the care continuum, from prevention of functional decline to end-of-life care.

PROSPERO registration number CRD42020150252.

  • geriatric medicine
  • palliative care
  • organisation of health services
  • health policy
  • quality in health care

Data availability statement

Data are available upon reasonable request. Extracted data is available on request from the corresponding author. .

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available upon reasonable request. Extracted data is available on request from the corresponding author. .

View Full Text

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.


  • CJE and MM are joint senior authors.

  • Twitter @KennedyNkhoma6, @RHardingCSI, @IJ_Higginson, @CatherineJanee1, @MTMaddocks

  • Contributors JB, AB, CE-S, RH, CNo, SA, PT, YK, TM, NN, ST, PO, IH, CE and MM conceived and designed the study. JB, AB, CE-S, IT, SY, DY, KBN, AC, SC, SB, CE and MM extracted data. JB, AB, CE-S, SY, AC, SC, CNi, CNo, RH, KBN, CE and MM analysed data. JB, AB, AC, SC, CNi, PO, CE and MM drafted the manuscript, All authors critically revised the draft and approved the final manuscript. MM is responsible for the overall content as the guarantor.

  • Funding This research was supported by the World Health Organization Centre for Health Development (WHO Kobe Centre – WKC: K19002), the Dunhill Medical Trust (grant number RPGF1906\177) and the National Institute of Health Research Applied Research Collaboration South London (NIHRARC South London NIHR200152) at King’s College Hospital NHS Foundation Trust. AB is supported by the Dunhill Medical Trust (number RPGF1906\177) and Cicely Saunders International. SC is funded by a Health Education England/NIHR Clinical Doctoral Research Fellowship (ICA-CDRF-2017-03-012) and CNi by a Health Education England/NIHR Senior Clinical Lectureship (ICA-SCL-2018-04-ST2-001). IH is an NIHR Senior Investigator Emeritus. CE is funded by a Health Education England/NIHR Senior Clinical Lectureship (ICA-SCL-2015-01-001) and MM is funded by an NIHR Career Development Fellowship (CDF-2017-10-009). This publication presents independent research supported by the National Institute for Health Research (NIHR). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, NIHR or the Department of Health and Social Care.

  • Competing interests PO reported that he was an employee of the funding sponsor, the WHO, and was involved in the extraction, analysis and interpretation of data. All other authors have no competing interests.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.