Howe Rebecca J, Rieke Katherine, Bayer Thomas, Ja Mai Htun, Sullivan Jennifer L, Driver Jane A, Rickard Taylor, Trikalinos Thomas A, Rudolph James, McCreedy Ellen, Jutkowitz Eric
VA Providence Healthcare System, Providence, RI, USA.
Warren Alpert Medical School of Brown University, Providence, RI, USA.
Inquiry. 2025 Jan-Dec;62:469580251318244. doi: 10.1177/00469580251318244.
The Age-Friendly Health System (AFHS) movement has spread widely in recent years, with nearly 5000 healthcare organizations across the country recognized as Age-Friendly. Despite this broad recognition, there is little focus on how AFHS are implemented and the impact of implementation. The objectives of this study were to describe the strategies employed to support AFHS implementation in outpatient settings and to identify the measures used to evaluate implementation and effectiveness. We conducted a systematic review of literature from multiple databases spanning 2015 to March 2024, identified eligible studies using predefined inclusion/exclusion criteria, and extracted key data (eg, study design, study population, implementation strategies, outcomes/measures). We identified ten eligible studies from primary care clinics (N = 8), convenient care clinics (N = 1) and a cancer center (N = 1). The studies employed over 65 implementation strategies and 98 outcomes or measures. The vast majority of measures mapped to components of the 4Ms (Mobility, Mentation, Medication, What Matters), with up to ten measures per M category. Five of ten studies had reporting discrepancies and four did not fully define outcomes. The ten included studies serve as clear examples for the need for more evidence to support AFHS implementation in outpatient settings. Existing research lacks strategy specification and standardization of measures. We present gaps and opportunities to advance from AFHS "recognition" to impact.
近年来，老年友好型医疗系统（AFHS）运动广泛传播，全国近5000个医疗机构被认定为老年友好型。尽管得到了广泛认可，但对于AFHS如何实施以及实施的影响却鲜有关注。本研究的目的是描述在门诊环境中支持AFHS实施所采用的策略，并确定用于评估实施情况和效果的措施。我们对2015年至2024年3月期间多个数据库中的文献进行了系统综述，使用预先定义的纳入/排除标准确定符合条件的研究，并提取关键数据（如研究设计、研究人群、实施策略、结果/措施）。我们从基层医疗诊所（N = 8）、便捷护理诊所（N = 1）和一个癌症中心（N = 1）中确定了十项符合条件的研究。这些研究采用了65多种实施策略以及98种结果或措施。绝大多数措施对应于4M（移动性、思维能力、药物治疗、重要事项）的组成部分，每个M类别最多有十项措施。十项研究中有五项存在报告差异，四项未完全定义结果。这十项纳入研究清楚地表明，需要更多证据来支持AFHS在门诊环境中的实施。现有研究缺乏策略规范和措施标准化。我们提出了从AFHS“认可”到产生影响的差距和机会。
