{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T04:08:04Z","timestamp":1774670884899,"version":"3.50.1"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T00:00:00Z","timestamp":1751241600000},"content-version":"vor","delay-in-days":30,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Health Education England (HEE)\/National Institute for Health Research"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Older people with severe frailty are nearing the end of life and require community services that span the care continuum, integrating older people\u2019s care (e.g. physical function; rehabilitation) and palliative care (e.g. symptoms; what matters most to the person). Little is known about current community service provision to this population.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To characterise the scope of community service provision to older people with severe frailty in England.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A cross-sectional online survey design identifying common components and service configurations of community services providing care to older people with severe frailty in England. A self-selecting sample of multidisciplinary care providers from multi-agency community services working with older people with severe frailty with end-of-life care needs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Two hundred ninety-eight participants from 102 unique services across all English regions reported information on their service, including frailty and end-of-life assessment, service components, training, service costs and service development. Identification and assessment of frailty and end of life were routinely practiced, but approaches to identification varied. Organisations\u2019 training and development were focussed on their own service provision with little focus on inter-organisational and cross-sectoral working.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Community care services responses were varied to this population\u2019s diverse needs, which risks less coordinated practice and poorer care outcomes. Poorly integrated services can only partially meet the needs of older people with severe frailty. Further research is needed to address barriers to integration, including cross-sector collaboration, consistent use of appropriate assessment tools and service innovations driven by older people\u2019s expressed needs.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ageing\/afaf174","type":"journal-article","created":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T09:04:19Z","timestamp":1751274259000},"source":"Crossref","is-referenced-by-count":1,"title":["Integrating community services provision for older people living with severe frailty: implications from an England-wide survey"],"prefix":"10.1093","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6141-5910","authenticated-orcid":false,"given":"Richard","family":"Green","sequence":"first","affiliation":[{"name":"University of Surrey - School of Health Sciences , Faculty of Health and Medical Sciences, Kate Granger Building, Priestley Road, Surrey Research Park, Guildford, Surrey GU2 7YH ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Combes","sequence":"additional","affiliation":[{"name":"University of Surrey - School of Health Sciences , Faculty of Health and Medical Sciences, Kate Granger Building, Priestley Road, Surrey Research Park, Guildford, Surrey GU2 7YH ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8933-117X","authenticated-orcid":false,"given":"Jenny","family":"Harris","sequence":"additional","affiliation":[{"name":"University of Surrey - School of Health Sciences , Faculty of Health and Medical Sciences, Kate Granger Building, Priestley Road, Surrey Research Park, Guildford, Surrey GU2 7YH ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline","family":"Nicholson","sequence":"additional","affiliation":[{"name":"University of Surrey - School of Health Sciences , Faculty of Health and Medical Sciences, Kate Granger Building, Priestley Road, Surrey Research Park, Guildford, Surrey GU2 7YH ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,6,30]]},"reference":[{"key":"2025070304271647400_ref1","author":"NHS","year":"2019"},{"key":"2025070304271647400_ref2","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1111\/1468-0009.12373","article-title":"Service delivery models to maximize quality of life for older people at the end of life: A rapid review","volume":"97","author":"Evans","year":"2019","journal-title":"Milbank Q"},{"key":"2025070304271647400_ref3","doi-asserted-by":"publisher","first-page":"e048417","DOI":"10.1136\/bmjopen-2020-048417","article-title":"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","volume":"11","author":"Bayly","year":"2021","journal-title":"BMJ Open"},{"key":"2025070304271647400_ref4","doi-asserted-by":"publisher","first-page":"1698","DOI":"10.1001\/jama.299.14.1698","article-title":"Effectiveness of specialized palliative care: A systematic review","volume":"299","author":"Zimmermann","year":"2008","journal-title":"JAMA"},{"key":"2025070304271647400_ref5","author":"NHS","year":"2024"},{"key":"2025070304271647400_ref6","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1016\/j.archger.2005.01.002","article-title":"Frailty, morbidity and survival","volume":"41","author":"Klein","year":"2005","journal-title":"Arch Gerontol Geriatr"},{"key":"2025070304271647400_ref7","doi-asserted-by":"publisher","first-page":"e012576","DOI":"10.1136\/bmjopen-2016-012576","article-title":"What determines duration of palliative care before death for patients with advanced disease? A retrospective cohort study of community and hospital palliative care provision in a large UK city","volume":"6","author":"Bennett","year":"2016","journal-title":"BMJ Open"},{"key":"2025070304271647400_ref8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12916-017-0860-2","article-title":"How many people will need palliative care in 2040? Past trends, future projections and implications for services","volume":"15","author":"Etkind","year":"2017","journal-title":"BMC Med"},{"key":"2025070304271647400_ref9","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1177\/0269216317734435","article-title":"What is the impact of population ageing on the future provision of end-of-life care? Population-based projections of place of death","volume":"32","author":"Bone","year":"2018","journal-title":"Palliat Med"},{"key":"2025070304271647400_ref10","first-page":"132","article-title":"Why do older people get less palliative care than younger people","volume":"23","author":"Lloyd","year":"2016","journal-title":"Eur J Palliat Care"},{"key":"2025070304271647400_ref11","volume-title":"Making Care closer to Home a Reality","author":"Baird","year":"2024"},{"key":"2025070304271647400_ref12","doi-asserted-by":"publisher","first-page":"1832","DOI":"10.1177\/02692163211045917","article-title":"Identifying older adults with frailty approaching end-of-life: A systematic review","volume":"35","author":"Hall","year":"2021","journal-title":"Palliat Med"},{"key":"2025070304271647400_ref13","doi-asserted-by":"publisher","first-page":"75","DOI":"10.5430\/jnep.v3n7p75","article-title":"When frailty should mean palliative care","volume":"3","author":"Pialoux","year":"2013","journal-title":"J Nurs Educ Pract"},{"key":"2025070304271647400_ref14","doi-asserted-by":"publisher","first-page":"306","DOI":"10.7861\/clinmedicine.19-4-306","article-title":"Prognostication in palliative care","volume":"19","author":"Chu","year":"2019","journal-title":"Clin Med"},{"key":"2025070304271647400_ref15","doi-asserted-by":"publisher","first-page":"e2423","DOI":"10.1136\/bmjspcare-2021-003066","article-title":"Timely community palliative and end-of-life care: A realist synthesis","volume":"14","author":"Petrova","year":"2021","journal-title":"BMJ Support Palliat Care"},{"key":"2025070304271647400_ref16","doi-asserted-by":"publisher","first-page":"e0249763","DOI":"10.1371\/journal.pone.0249763","article-title":"Prognostic tools or clinical predictions: Which are better in palliative care?","volume":"16","author":"Stone","year":"2021","journal-title":"PLoS One"},{"key":"2025070304271647400_ref17","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1093\/intqhc\/mzw060","article-title":"Non-beneficial treatments in hospital at the end of life: A systematic review on extent of the problem","volume":"28","author":"Cardona-Morrell","year":"2016","journal-title":"Int J Qual Health Care"},{"key":"2025070304271647400_ref18","doi-asserted-by":"publisher","first-page":"j878","DOI":"10.1136\/bmj.j878","article-title":"Palliative care from diagnosis to death","volume":"356","author":"Murray","year":"2017","journal-title":"BMJ"},{"key":"2025070304271647400_ref19","first-page":"216","article-title":"How good is UK primary care at identifying patients for generalist and specialist palliative care: A mixed methods study","volume":"20","author":"Zheng","year":"2013","journal-title":"Eur J Palliat Care"},{"key":"2025070304271647400_ref20","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1177\/0269216313510341","article-title":"Place of death and end-of-life transitions experienced by very old people with differing cognitive status: Retrospective analysis of a prospective population-based cohort aged 85 and over","volume":"28","author":"Perrels","year":"2014","journal-title":"Palliat Med"},{"key":"2025070304271647400_ref21","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1016\/j.jpainsymman.2011.08.006","article-title":"Older adults' experiences of transitions between care settings at the end of life in England: A qualitative interview study","volume":"44","author":"Hanratty","year":"2012","journal-title":"J Pain Symptom Manag"},{"key":"2025070304271647400_ref22","first-page":"475","volume-title":"Perspectives of Community-Dwelling Older People on their Palliative Care Needs: A Scoping Review","author":"Nicholson","year":"2022"},{"key":"2025070304271647400_ref23","first-page":":40","article-title":"Older people with severe frailty talking about their palliative care needs: An interview and survey study during the covid-19 pandemic","volume":"35","author":"Green","year":"2021","journal-title":"Palliat Med"},{"key":"2025070304271647400_ref24","author":"World Health Organization","year":"2013"},{"key":"2025070304271647400_ref25","first-page":"191","volume-title":"Living with Ageing and Dying: Palliative and End of Life Care for Older People","author":"Larkin PaH","year":"2011"},{"key":"2025070304271647400_ref26"},{"key":"2025070304271647400_ref27"},{"key":"2025070304271647400_ref28","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1023\/A:1023254226592","article-title":"Pretesting survey instruments: An overview of cognitive methods","volume":"12","author":"Collins","year":"2003","journal-title":"Qual Life Res"},{"key":"2025070304271647400_ref29","doi-asserted-by":"crossref","DOI":"10.1136\/spcare-2024-MCR.51","volume-title":"55 What Matters Most to Older People Living with Advancing Frailty?","author":"Combes","year":"2024"},{"key":"2025070304271647400_ref30","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual Res Psychol"},{"key":"2025070304271647400_ref31","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1177\/107327480301000603","article-title":"Comprehensive geriatric assessment","volume":"10","author":"Wieland","year":"2003","journal-title":"Cancer Control"},{"key":"2025070304271647400_ref32","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1177\/0269216319854264","article-title":"A brief, patient-and proxy-reported outcome measure in advanced illness: Validity, reliability and responsiveness of the integrated palliative care outcome scale (IPOS)","volume":"33","author":"Murtagh","year":"2019","journal-title":"Palliat Med"},{"key":"2025070304271647400_ref33","volume-title":"Chief Medical officer's Annual Report 2023","author":"Whitty","year":"2023"},{"key":"2025070304271647400_ref34","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.o1146","article-title":"David Oliver: A new legal duty to provide specialist palliative care","volume":"377","author":"Oliver","year":"2022","journal-title":"BMJ"},{"key":"2025070304271647400_ref35","doi-asserted-by":"crossref","DOI":"10.1136\/spcare-2023-MCRC.30","article-title":"Ambitions for palliative and end of life care: mapping examples of use in practice","volume-title":"BMC Palliative Care","author":"Borgstrom"},{"key":"2025070304271647400_ref36","volume-title":"Palliative and End of Life Care in Integrated Care Systems: Survey Report","author":"Curie","year":"2023"},{"key":"2025070304271647400_ref37","author":"European Association for Palliative Care","year":"2025"},{"key":"2025070304271647400_ref38","first-page":"1","volume-title":"Textbook of Palliative Care","author":"Nicholson","year":"2020"},{"key":"2025070304271647400_ref39","volume-title":"Policy Brief on Integrating Rehabilitation into Palliative Care Services","author":"World Health Organization","year":"2023"},{"key":"2025070304271647400_ref40","article-title":"Models of integrated care, health and housing","author":"Gilbert","year":"2020","journal-title":"Royal Commission into Aged Care Quality and Safety"},{"key":"2025070304271647400_ref41","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1089\/pmr.2020.0062","article-title":"Palliative care in public policy: Results from a global survey","volume":"1","author":"Clelland","year":"2020","journal-title":"Palliat Med Rep"},{"key":"2025070304271647400_ref42","doi-asserted-by":"publisher","volume-title":"Building Research Capacity and Capability to Enhance the Quality of Living and Dying Addressing Advancing Frailty through Integrated Care: The ALLIANCE Partnership","author":"Combes","DOI":"10.3310\/ACMW2401"}],"container-title":["Age and Ageing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ageing\/article-pdf\/54\/6\/afaf174\/63625461\/afaf174.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ageing\/article-pdf\/54\/6\/afaf174\/63625461\/afaf174.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,3]],"date-time":"2025-07-03T08:27:26Z","timestamp":1751531246000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ageing\/article\/doi\/10.1093\/ageing\/afaf174\/8178278"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,31]]},"references-count":42,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,5,31]]}},"URL":"https:\/\/doi.org\/10.1093\/ageing\/afaf174","relation":{},"ISSN":["0002-0729","1468-2834"],"issn-type":[{"value":"0002-0729","type":"print"},{"value":"1468-2834","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,6]]},"published":{"date-parts":[[2025,5,31]]},"article-number":"afaf174"}}