Personalised care planning for older people with frailty: a review of factors influencing implementation

Background: Frailty increases vulnerability to major health changes because of seemingly small health problems. It affects around 10% of people aged over 65.Older adults with frailty frequently have multiple long-term conditions, personal challenges, and social problems. Personalised Care Planning (PCP) based on 'goal-setting' and 'action planning' is a promising way to address the needs of older adults living with frailty.

Aim: To identify and explore factors that influence the implementation of personalised care planning style interventions for older adults.

Design & setting: We conducted a scoping review and identified a small number of interventions that explicitly employed 'goal setting' and 'action planning'.

Method: We used a range of sources to identify relevant material. We included all interventions inclusive of patients aged 65 and over and reported in English. We excluded end-of-life care interventions, group education and/or, those that did not involve one-to-one engagement. We explored all related papers which described, examined, or discussed implementation. We constructed a thematic framework in NVivo 11. Findings were narratively synthesised.

Results: We identified 18 potentially relevant PCP-style interventions. Within these, were seven main categories of potentially modifiable influences relevant to older adults with frailty related to: Primary care engagement; Delivery staff characteristics; Training; Client engagement; Collaborative working; Organisation and management; Systems.

Conclusions: Many modifiable factors can influence the implementation of PCP. We identified several influences which have informed the development and implementation of a novel intervention for older adults with frailty, PROSPER.