{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T02:11:42Z","timestamp":1788315102817,"version":"build-2803163510"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:00:00Z","timestamp":1756425600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,29]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Recent consensus-based recommendations on the management of people aged \u226580\u00a0years in intensive care units (ICUs) were developed to guide the management of quality care.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To understand perceived barriers and facilitators to consensus-based recommendations to support their implementation into multi-professional and disciplinary clinical practice.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Analysis of comments made by an international multiprofessional group of intensive care, emergency and geriatric medicine specialists in the Delphi consensus on the management of people aged \u226580\u00a0years in ICUs. Barrier and facilitators were analysed using the Theoretical Domains Framework.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Care statement comments were provided by 99 of the 124 (79.8%) participants completing the Delphi first round; primarily identifying barriers (239\/258; 92.6%). Most participants identified limitations in the environmental context and resources within the healthcare system (152, 63.6%); predominantly limitations in resources\/material resources, with staffing (60, 25.1%), and beds or facilities (30, 12.6%) concerns. Potentially modifiable domains focused on inadequate knowledge (25, 10.5%), beliefs about consequences (18, 7.5%), care goals (16, 6.7%) and social\/professional role and identity (16, 6.7%). Facilitators focused on improving staff knowledge, particularly amongst geriatric medicine and intensive care medicine specialities, and environmental context and resources (both 8, 42.1%).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The environmental context and resources domain was the most common barrier identified. Behaviour change opportunities are centred on the domains knowledge, beliefs about consequences, goals and social\/professional role and identity. Linked behaviour change techniques can be identified and developed according to local healthcare context to support implementation of care recommendations.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/ageing\/afaf272","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T14:26:02Z","timestamp":1758896762000},"source":"Crossref","is-referenced-by-count":3,"title":["Understanding barriers and facilitators to implementation of consensus-based recommendations for the management of very old people in intensive care"],"prefix":"10.1093","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0893-525X","authenticated-orcid":false,"given":"Richard S","family":"Bourne","sequence":"first","affiliation":[{"name":"Pharmacy and Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield ,","place":["UK"]},{"name":"National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (GM PSRC) , University of Manchester, Manchester,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Alberto","sequence":"additional","affiliation":[{"name":"Consejo Nacional de Investigaciones Cient\u00edficas y T\u00e9cnicas, Instituto de Investigaci\u00f3n en Medicina y Ciencias de la Salud, Universidad del Salvador, Ciudad de Buenos Aires ,","place":["Argentina"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan E","family":"Brummel","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University College of Medicine , Columbus, Ohio ,","place":["USA"]},{"name":"Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center , Columbus, Ohio ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bas","family":"de Groot","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Radboudumc , Nijmegen, GE ,","place":["The Netherlands"]},{"name":"Research Centre for Emergency Medicine, Aarhus University Hospital , Aarhus, Central Denmark Region ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0191-7270","authenticated-orcid":false,"given":"Dylan W","family":"De Lange","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Utrecht University , Heidelberglaan 100, Utrecht, Utrecht 3584 CX ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Elbers","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Amsterdam University Medical Center Locatie Academic Medical Center , Amsterdam ,","place":["Netherlands"]},{"name":"Center for Critical Care Computational Intelligence, Vrije Universiteit , Amsterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marielle H","family":"Emmelot-Vonk","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, University Medical Centre Utrecht , Utrecht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9186-3482","authenticated-orcid":false,"given":"Hans","family":"Flaatten","sequence":"additional","affiliation":[{"name":"Department of Research and Development, Haukeland Universitetssjukehus , Bergen ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonathan","family":"Freund","sequence":"additional","affiliation":[{"name":"IMProving Emergency Care, University Hospital Federations, Sorbonne Universit\u00e9 , Paris, \u00cele-de-France ,","place":["France"]},{"name":"Emergency Department, Assistance Publique\u2014Hopitaux de Paris, Piti\u00e9-Salp\u00e9tri\u00e8re Hospital , Paris, \u00cele-de-France ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Galazzi","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, Libera Universit\u00e0 Mediterranea, Casamassima, Bari ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Garcia-Martinez","sequence":"additional","affiliation":[{"name":"Emergency Department, IDIBAPS, Hospital Cl\u00ednic , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bertrand","family":"Guidet","sequence":"additional","affiliation":[{"name":"Institut Pierre Louis d\u2019Epid\u00e9miologie et de Sant\u00e9 Publique, Sorbonne Universite , Paris, \u00cele-de-France ,","place":["France"]},{"name":"Service de R\u00e9animation M\u00e9dicale, Assistance Publique\u2014H\u00f4pitaux de Paris , Paris, \u00cele-de-France 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Chinese University of Hong Kong , Hong Kong ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susannah","family":"Leaver","sequence":"additional","affiliation":[{"name":"General Intensive Care, St George\u2019s University Hospitals NHS Foundation Trust , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Leone","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care Medicine, H\u00f4pital Nord, Assistance Publique des H\u00f4pitaux de Marseille, Aix Marseille University , Marseille ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bairbre","family":"McNicholas","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care Medicine, School of Medicine, University of Galway, Galway , County Galway, 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