Keywords

1 Introduction

The aging of the world population is an inevitable and growing reality, which implies challenges and adaptations of health services. By 2020, the world population aged 60 and over exceeded 1 billion people, and by 2050 it is expected to reach 2.1 billion [1]. Health policies need to anticipate this trend and prepare health systems to be more adequate, effective, and accessible. They should focus on improving and meeting needs and preferences of older people, adapting health care to this population and providing outreach care, including primary health care, focusing on health promotion, monitoring and prevention of disabling and chronic conditions resulting from aging [2]. These services must be the first access to health care services for the older people. [3, 4].

According to a WHO study, the characteristics of an age-friendly primary health care encompass three dimensions: information, education and communication; health service management systems; and the physical environment [5]. Several authors agree that age-friendly care enables empowerment by increasing older people’s knowledge and autonomy so that they become involved and partners in their care process, ensuring the quality and dignity of care. Thus, it is recognized that the lower the barriers to access primary health care are, and the better the needs of people are met, health gains are obtained, and public health spending is substantially reduced. It is essential that these health centers also combine technology with gerontology, i.e., have the fundamentals of gerontotechnology in the context of a multidisciplinary intervention, which acts on the three levels of prevention to improve the quality of life of the older adults [6].

A preliminary search conducted in the JBI Database of Systematic Reviews and Implementation Reports, Cochrane Library, MEDLINE and CINAHL, revealed that there is no Scoping Review (published or in development) on Age-Friendly Primary Health Care. Thus, this review arises from the need to increase knowledge about the Age-Friendly Health Centers (AFHC) in order to contribute to the development of services that provide accessibility to care, health promotion, increased autonomy and involvement of older people in their own health process, promoting the Care-of-the-Self, and ensuring the quality of nursing care provided to older people and their families [7, 8].

2 Methods

2.1 Identifying the Research Question

The research question was formulated according to the Population, Concept and Context (PCC) terminology: What are the characteristics presented at age-friendly health care units in primary health care settings?

The aim of this research is to analyze and map the knowledge produced about the characteristics of age-friendly primary health care, intending to answer the following questions:

  • What are the characteristics of age-friendly primary health care centers identified in the studies?

  • How do they correspond to the WHO recommendations?

2.2 Research Strategy

The search was conducted on the EBSCOhost and Virtual Health Library platforms, in the databases: Cinahl Complete, Medline Complete, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, MedicLatina, Nursing & Allied Health Collection: Comprehensive, LILACS and BDENF, with application of temporal filter starting in 2004. The identification, exclusion and eligibility of articles were carried out in different phases, taking into account the previously defined inclusion and exclusion criteria. The search terms defined (Table 1) were grouped using Boolean operators, derived from the indexed language for the search in electronic databases.

The first phase of the search took place on May 8th, 2020, using the indexed language specific to each platform. Then, the results were sorted according to their relevance to the research question. In the last phase, the selected articles were manually analyzed in order to extract the relevant information to the research question.

Table 1. Research terms
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2.3 Inclusion Criteria

In this study, we included the articles involved older adults living in the community and excluded the studies conducted in hospital settings. The search terms, the inclusion and exclusion criteria (Table 2) were defined after reading the studies resulting from an empirical search in the main databases of the ESBCOhost platform on this topic.

Table 2. Inclusion and exclusion criteria for the articles identified in the search
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2.4 Selection of Articles

The selection of studies was performed by two independent researchers, after analyzing the abstract of each article, keeping in mind the inclusion and exclusion criteria and the research objectives. The selection of articles to be included in this scoping review followed four steps: Identification, Analysis, Eligibility, and Inclusion. In the databases, 56 articles were identified, from which 7 articles were excluded, 4 in Mandarin language, 1 systematic review, 1 integrative review, and 1 repeated article. After reading the abstracts and applying the inclusion criteria, 30 articles were selected, but only 22 articles were included in our study (review) after the full text analysis.

2.5 Reviewing Process

The data extracted from the analyzed articles were presented in a table, following the Joanna Briggs Institute [9] methodology for scoping review. The analysis of the relevance of the articles as well as the extraction and synthesis of the data were performed by two independent reviewers.

2.6 Presentation of Data

The data collected from each article presented in Table 3, according to study reference, study population, context, type of study, objectives and WHO recommendations [1].

Table 3. Data extraction grid
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3 Results

After the analysis of the articles listed in the table above, we grouped the characteristics of the age-friendly health centers (AFHCs) into 7 main themes to characterize them:

  • 1- Information, education, and communication: To guarantee an efficient communication, professionals have the responsibility to gather all the specific technical competences to respond to the needs of the older adults and their families, demonstrating communicational abilities, voluntarism, and availability, not practicing ageism [10,11,12, 14, 15]. Technological resources are used to expedite the transmission of information, for scheduling appointments and identifying needs [15]. The use of uniforms and badges, by all members of the team, is indispensable, so that all the users know to whom they should go [3]. Information regarding the medication regimen is essential to avoid any errors or pharmacological interactions [16]. Improving the health of the older adults involves health education and promotion of healthy lifestyles, appropriate to their individuality, adopting the partnership model of care.

  • 2- Health care management systems: AFHC offer a complete, multifactorial assessment of the individuals’ needs, are responsible for having the resources available to support the development of their activities of daily living, provide all consultations, treatment, and complementary diagnostic tests so that all needs are met in a single visit, and resolve the problems of older people in a timely manner. [3, 12, 14, 17]. There is investment in chronic disease prevention and oral health care, avoiding long-term health system overload and achieving health gains [18, 19]. The articulation between public and private health care and between primary and differentiated health care is effective, and timely communication between all is ensured to improve the service provided to the older people and their families [20, 21].

  • 3- Care management process considering most common geriatric syndromes: Nursing care and assistance with basic life activities are provided at the older person’s home, avoiding their institutionalization (unless this is their wish). Family members are considered part of the holistic dimension of the older person’s well-being and a target of care [22]. Health care professionals should provide health education, geriatric assessment, and an individualized care plan focused on health promotion, disease prevention, maintenance of autonomy and meaningful social interactions [17, 23]. It is important to understand the interaction between the person’s characteristics and the context in which they live, as well as how these are involved in their aging process [24].

  • 4- Physical environment: When the AFHC are implemented near the community they serves, facilitates accessibility to the building in which care is provided, reducing the need for travel [14, 25]. Access to the exterior areas and to the interior of the building is facilitated and adapted to people with reduced mobility (parking spaces, access ramps); the circulation areas, waiting rooms, offices and bathrooms have ample structures that facilitate circulation with wheelchairs or other walking aid devices and/or the presence of a companion, are lit adequately, adapted for a safe circulation; the identification signs of the user circuit are visible, lit adequately, written with high contrast and also available in Braille [3, 11, 14, 17, 26]. In short, the physical space of the AFHC should be adapted to the specific needs of its public [12].

  • 5- Transportation network: Age-friendly communities (AFHCs) offer good public transportation options that are adapted to the needs of the older adults, such as the use of oxygen tanks, walking aids, and are affordable, allowing the presence of a companion [3, 17, 25, 26]. Drivers of these services should take into account the population they transport thus adapting their driving style (avoid sudden braking, wait for people to be sat down before starting to drive) [3].

  • 6- Keeping older adults in their own context: Maintaining residence in their home, or at least in their community, during the aging process is a factor that increases the quality of life of older people and their families [22, 27]. The use of home support from multidisciplinary teams and volunteer programs that ensure the psychological, cognitive, social, health, and well-being needs are met as well as support structures such as supermarkets, hairdressers, dry cleaners, etc. that allow older adults to maintain their autonomy [23, 24, 28]. However, the older person should be allowed to leave their home if they wish, and the community should provide those answers [29]. Residential care or nursing facilities for the older adults are established in the communities where older adults live, allowing them to remain in a familiar environment [14, 25]. AFHCs offer access to business and leisure, social interaction, good neighborhood, community involvement, transportation networks and public services [30].

  • 7- Health Policies: Legislative bodies define policies that enable the active, productive and successful aging of their population, promoting self-sufficiency and independence of each older person, reducing age-related stigma, integrating active older people into the community [10, 14, 19, 22]. Health professionals, through their institutional representatives, contribute to the discussion of health policies and, to the improvement older adults` quality of life [16]. The government is responsible for the equitable distribution of resources and the creation of emergency plans, the definition of social and economic policies to protect older people in their access to financially viable and long-term housing, and the development of flexible retirement plans [10, 23, 26]. Research on aging and AFHCs are stimulated, and the result of these studies should be implemented in practice as soon as possible [19, 25].

4 Discussion

The results of this study are consistent with those defined by the WHO [5] and add further complementary guidelines for the identification of AFHCs. Regarding information, education and communication, there is evidence that shortcomings continue to occur, namely that older people feel that they are not heard. It has been found that health services often do not provide the quality of care expected by citizens [14]. From the point of view of the health care management system, some studies have shown that services are poorly prepared to meet the specific needs of older people, due to a lack of coordination of all actors involved in decision making, from public funding to human resource management, leadership, political decision-making and structural conditions [14]. The emergency and comprehensive assessment systems of older adults do not meet their real needs and should be improved and implemented effectively [23]. The physical environment is widely explored by the literature reviewed, identifying shortcomings such as: insufficient and inadequate public transportation to meet the needs of the older adults, namely, the access to their appointments, treatments and examinations; sidewalks too narrow and busy, constituting an added danger for people with altered mobility [3, 26]. The inequities in the resources available to the rural and urban population are often discussed, making it difficult for older adults to stay at home. Moreover, the level of interaction with the surrounding community varies according to factors such as gender, ethnicity, economic and social status, and level of education [30]. As for the issue of health policies, it is evidenced the responsibility of national and municipal governments to expedite the best practices, offer technical conditions and manage the process of making institutions and cities friendly to the older adults [16].

Throughout this review, we could conclude that this is a topic that raises global interest and that has been discussed since 2002, when the WHO published “Active Ageing: a policy framework”. Despite not being a recent theme, studies have indicated that there is still much to be done regarding the primary health care providing to the older adults and their families their real needs. Moreover, a repeated recommendation in many of the articles analyzed here is the dissemination of age-friendly practices in these health care institutions [3, 14, 15, 17].

The contribution of gerontotechnology to improve health responses to the needs of the older adults is implicit in the analyzed articles, demonstrating that many of the means that are already available to health professionals can be better used to respond more effectively to the older population that uses health care services. However, this issue cannot be solved by direct care alone, which is why health professionals must have a voice in policymaking, research, and training [3, 10, 12, 14, 16, 19]. Coordination of all health professionals and administrative staff is needed, as well as political involvement, not only from the Ministry of Health, but from the whole government that should prioritize the issue of age-friendly institutions and communities.

5 Conclusion

The complexity of older adults’ health care is a challenge for health workers, and it is increasingly important to constantly update knowledge to improve practices and meet the real needs and expectations of older people and their families. Nurses play a key role and should adapt their interventions to the specific needs of these individuals, namely using gerontotechnology to promote their holistic care and contributing to a sustainable health [6, 31]. In line with the strategy defined by the WHO, a new strategy to provide care to the older adults is necessary and pertinent, in which health promotion and disease management are privileged as opposed to an approach centered on cure. In the approach centered on the older person and their family members living in the community and guided by their life project, nurses should work in partnership with them, helping to manage their health process, contributing to their safety, continuity of care, and active and healthy aging, besides promoting Care-of-the-Self [7, 8].

It is hoped that this scoping review will contribute to knowledge regarding the characteristics of age friendly health centers, to critical analysis in this area, regarding to what is recommended by the WHO, and will allow us to understand the impact of age-friendly health centers on the promotion Care-of-the-Self for the older adults.