{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T01:51:04Z","timestamp":1771638664896,"version":"3.50.1"},"reference-count":61,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2021,1,16]],"date-time":"2021-01-16T00:00:00Z","timestamp":1610755200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001871","name":"Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia","doi-asserted-by":"publisher","award":["SFRH\/BD\/144156\/2019"],"award-info":[{"award-number":["SFRH\/BD\/144156\/2019"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Healthcare"],"abstract":"<jats:p>Background: Health care provided to older adults must take into account the characteristics of chronic diseases and the comorbidities resulting from ageing. However, health services are still too oriented towards acute situations. To overcome this problem, the World Health Organization (WHO) proposed a set of Age-Friendly Principles that seek to optimize the provision of health care for this population. This article aims to understand how such Principles are considered in the implementation of age-friendly health care worldwide. Methods: A systematic review was conducted to synthesize the literature on age-friendly health care in accordance with the PRISMA recommendations in the PubMed, Web of Science, and Scopus databases. Results: The research identified 34 articles, with only seven recognizing the WHO Principles and only four using the implementation toolkit. In addition, in the context of primary care, three studies recognize the WHO Principles, but only two use the toolkit. Conclusions: The WHO Principles are being implemented in health care, but in a smaller scale than desired, which reveals possible flaws in their dissemination and standardization. Thus, a greater scientific investment in age-friendly health care should be considered, which represents a greater operationalization of the Principles and an evaluation of their effectiveness and impacts.<\/jats:p>","DOI":"10.3390\/healthcare9010083","type":"journal-article","created":{"date-parts":[[2021,1,18]],"date-time":"2021-01-18T05:17:34Z","timestamp":1610947054000},"page":"83","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Age-Friendly Health Care: A Systematic Review"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2678-5972","authenticated-orcid":false,"given":"J\u00e9ssica","family":"Tavares","sequence":"first","affiliation":[{"name":"GOVCOPP, Department of Social, Political and Territorial Sciences, University of Aveiro, 3810-193 Aveiro, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4732-5959","authenticated-orcid":false,"given":"Gon\u00e7alo","family":"Santinha","sequence":"additional","affiliation":[{"name":"GOVCOPP, Department of Social, Political and Territorial Sciences, University of Aveiro, 3810-193 Aveiro, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3801-7249","authenticated-orcid":false,"given":"Nelson P.","family":"Rocha","sequence":"additional","affiliation":[{"name":"IEETA, Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2021,1,16]]},"reference":[{"key":"ref_1","unstructured":"(2020, September 15). WHO Methods and Data Sources for Global Burden of Disease Estimates 2000\u20132016. Available online: https:\/\/www.who.int\/healthinfo\/global_burden_disease\/GlobalDALY_method_2000_2016.pdf."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1093\/geront\/47.2.150","article-title":"Health Trends in the Elderly Population: Getting Better and Getting Worse","volume":"47","author":"Parker","year":"2007","journal-title":"Gerontologist"},{"key":"ref_3","unstructured":"Guimar\u00e3es, J. (2006). Envelhecimento Populacional: Demandas e Possibilidades na \u00c1rea da Sa\u00fade. Demografia dos neg\u00f3cios: Campo de estudo, perspectivas e aplica\u00e7\u00f5es, AEBP Campinas. [1st ed.]."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1197\/aemj.10.3.271","article-title":"A New Model for Emergency Care of Geriatric Patients","volume":"10","author":"Adams","year":"2003","journal-title":"Acad. Emerg. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2163","DOI":"10.1111\/jgs.13097","article-title":"A System-Wide Analysis Using a Senior-Friendly Hospital Framework Identifies Current Practices and Opportunities for Improvement in the Care of Hospitalized Older Adults","volume":"62","author":"Wong","year":"2014","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1503\/cmaj.050051","article-title":"A global clinical measure of fitness and frailty in elderly people","volume":"173","author":"Rockwood","year":"2005","journal-title":"Can. Med. Assoc. J."},{"key":"ref_7","first-page":"1","article-title":"Incidence of delirium in the Canadian emergency department and its consequences on hospital length of stay: A prospective observational multicentre cohort study","volume":"8","author":"Boucher","year":"2018","journal-title":"BMJ Open"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1111\/j.1532-5415.2005.53305.x","article-title":"Outcomes of Older People Admitted to Postacute Facilities with Delirium","volume":"53","author":"Marcantonio","year":"2005","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"360","DOI":"10.7861\/clinmedicine.17-4-360","article-title":"Prevention of falls in hospital","volume":"17","author":"Morris","year":"2017","journal-title":"J. Clin. Med."},{"key":"ref_10","unstructured":"Gill, E. (2015). Reducing hospital acquired pressure ulcers in intensive care. BMJ Qual. Improv. Rep., 1\u20135."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1111\/hex.12443","article-title":"\u201cWell, if the kids can do it, I can do it\u201d: Older rehabilitation patients\u2019 experiences of telerehabilitation","volume":"20","author":"Shulver","year":"2017","journal-title":"Health Expectat."},{"key":"ref_12","first-page":"704","article-title":"Getting Back to Normal: A Grounded Theory Study of Function in Post-hospitalized Older Adults","volume":"60","author":"Liebzeit","year":"2020","journal-title":"Gerontologist"},{"key":"ref_13","unstructured":"World Health Organization (2020, September 18). Global Age-friendly Cities: A Guide. Available online: https:\/\/www.who.int\/ageing\/publications\/Global_age_friendly_cities_Guide_English.pdf."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1080\/08959420.2018.1430414","article-title":"A Manifesto for the Age-Friendly Movement: Developing a New Urban Agenda","volume":"30","author":"Buffel","year":"2018","journal-title":"J. Aging Soc. Policy"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1093\/geront\/gnw102","article-title":"The Structural Burden of Caregiving: Shared Challenges in the United States and Canada","volume":"57","author":"Taylor","year":"2017","journal-title":"Gerontologist"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/S0840-4704(10)60717-X","article-title":"Creating an Elder-Friendly Hospital","volume":"12","author":"Parke","year":"1999","journal-title":"Healthc. Manage. Forum"},{"key":"ref_17","unstructured":"World Health Organization (2020, August 21). Towards Age-friendly Primary Health Care. Available online: https:\/\/www.who.int\/ageing\/publications\/phc\/en\/."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1080\/10400435.1998.10131955","article-title":"Maximizing Usability: The Principles of Universal Design","volume":"10","author":"Story","year":"1998","journal-title":"Assist. Technol."},{"key":"ref_19","unstructured":"World Health Organization (2020, October 26). Age-friendly Primary Health Care Centres Toolkit. Available online: https:\/\/www.who.int\/ageing\/publications\/upcoming_publications\/en\/."},{"key":"ref_20","unstructured":"International Network of Health Promoting Hospitals and Health Services (Vienna) (2020, October 26). Task Force on HPH and Age-Friendly Health Care. Available online: https:\/\/www.euro.who.int\/__data\/assets\/pdf_file\/0009\/99801\/E90777.pdf."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1007\/s40520-020-01641-w","article-title":"Improving the care of older patients during the COVID-19 pandemic","volume":"32","author":"Bianchetti","year":"2020","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Fhon, J., Silva, L., Leit\u00f3n-Espinoza, Z., Matiello, F., Ara\u00fajo, J., and Rodrigues, R. (2020). Hospital care for elderly COVID-19 patients. Rev. Latino-Am. Enfermagem, 28.","DOI":"10.1590\/1518-8345.4649.3396"},{"key":"ref_23","first-page":"1","article-title":"The fight against COVID-19: A report from the Italian trenches","volume":"20","author":"Trabucchi","year":"2020","journal-title":"Int. Psychogeriatr."},{"key":"ref_24","unstructured":"Egger, M., Davey-Smith, G., and Altman, D. (2003). Systematic Reviews in Health Care: Meta-Analysis in Context, BMJ Publishing Group. [3rd ed.]."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1728","DOI":"10.1016\/S0140-6736(00)04934-5","article-title":"Bringing it all together: Lancet -Cochrane collaborate on systematic reviews","volume":"357","author":"Clarke","year":"2001","journal-title":"Lancet."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"264","DOI":"10.7326\/0003-4819-151-4-200908180-00135","article-title":"Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement","volume":"151","author":"Moher","year":"2009","journal-title":"Ann. Intern. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1093\/geront\/gnt004","article-title":"Care of the Older Adult in the Emergency Department: Nurses Views of the Pressing Issues","volume":"53","author":"Boltz","year":"2013","journal-title":"Gerontologist"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s41999-018-0151-2","article-title":"Development of a comprehensive, multidisciplinary program of care for frailty in an emergency department","volume":"10","author":"Campmany","year":"2019","journal-title":"Eur. Geriatr. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1258\/jhsrp.2010.009132","article-title":"Senior-Friendly Emergency Department Care: An Environmental Assessment","volume":"16","author":"Kelley","year":"2011","journal-title":"J. Health Serv. Res. Pol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"18","DOI":"10.3928\/02793695-20150127-01","article-title":"Enhancing care of older adults in the emergency department: Old problems and new solutions","volume":"53","author":"Mcclelland","year":"2015","journal-title":"J. Psychosoc. Nurs. Ment. Health Serv."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.1111\/j.1532-5415.2012.04058.x","article-title":"The Elder-Friendly Emergency Department Assessment Tool: Development of a Quality Assessment Tool for Emergency Department\u2014Based Geriatric Care","volume":"60","author":"McCusker","year":"2015","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1111\/jgs.15137","article-title":"Elder-Friendly Emergency Department: Development and Validation of a Quality Assessment Tool","volume":"66","author":"McCusker","year":"2018","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_33","first-page":"594","article-title":"Elder-friendly emergency services in Brazil: Necessary conditions for care","volume":"50","author":"Santos","year":"2016","journal-title":"J. Sch. Nurs."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12913-017-2481-z","article-title":"Facilitators and barriers of change toward an elder-friendly surgical environment: Perspectives of clinician stakeholder groups","volume":"17","author":"Hanson","year":"2017","journal-title":"BMC Health Serv. Res."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Khadaroo, R., Padwal, R., Wagg, A., Clement, F., Warkentin, L., and Holroyd-Leduc, J. (2015). Optimizing senior\u2019s surgical care\u2014Elder-friendly Approaches to the Surgical Environment (EASE) study: Rationale and objectives. BMC Health Serv. Res., 15.","DOI":"10.1186\/s12913-015-1001-2"},{"key":"ref_36","unstructured":"Malone, M., Capezuti, E., and Palmer, R. (2014). How to use the ACE unit to improve hospital safety and quality for older patients: From ACE units to elder-friendly hospitals. Acute Care for Elders: A Model for Interdisciplinary Care, Springer. [1st ed.]."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"14","DOI":"10.12927\/hcq.2017.25142","article-title":"Healthcare for the Aging Citizen and the Aging Citizen for Healthcare: Involving Patient Advisors in Elder-Friendly Care Improvement","volume":"20","author":"Verma","year":"2017","journal-title":"Healthc. Q."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.archger.2010.09.013","article-title":"Improving outpatient services for elderly patients in Taiwan: A qualitative study","volume":"53","author":"Kuo","year":"2011","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1590\/1981-22562017020.160095","article-title":"Assessment of hospital environments and policies: Seeking an age-friendly hospital","volume":"20","author":"Tavares","year":"2017","journal-title":"Rev. Bras. Geriatr. Gerontol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"42","DOI":"10.15171\/hpp.2015.006","article-title":"Towards Age-Friendly Hospitals in Developing Countries: A Case Study in Iran","volume":"5","author":"Ahmadi","year":"2015","journal-title":"Health. Promot. Perspect."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1016\/S0167-4943(09)70004-4","article-title":"Towards age-friendly hospitals and health services","volume":"49","author":"Chiou","year":"2009","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1111\/joid.12034","article-title":"Exploring perceptions of designers and medical staff in south korea about design elements for the elder-friendly hospital","volume":"39","author":"Kim","year":"2014","journal-title":"J. Interior. Des."},{"key":"ref_43","first-page":"49","article-title":"Creating a Senior Friendly Physical Environment in our Hospitals","volume":"7","year":"2004","journal-title":"Can. Geriatr. J."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pone.0213496","article-title":"Facilitating a change model in age-friendly hospital certification: Strategies and effects","volume":"14","author":"Kuo","year":"2019","journal-title":"PLoS ONE"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"62","DOI":"10.12927\/cjnl.2004.16344","article-title":"An Elder-Friendly Hospital: Translating a dream into reality","volume":"17","author":"Parke","year":"2004","journal-title":"Nurse. Lead."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1111\/jgs.13243","article-title":"Development and Validation of the Geriatric In-Hospital","volume":"63","author":"Persoon","year":"2015","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"256","DOI":"10.4103\/0970-0218.193334","article-title":"Senior Friendly Hospitals: Development and Application of Criteria: A Descriptive Study","volume":"41","author":"Rashmi","year":"2016","journal-title":"Indian J. Community Med."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Kim, Y., Han, S., Hwang, J., Park, J., Lee, J., Choi, J., Moon, Y., Kim, H., Shin, G., and Lee, J. (2017). Development of the Korean framework for senior-friendly hospitals: A Delphi study. BMC Health Serv. Res., 17.","DOI":"10.1186\/s12913-017-2480-0"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.15537\/smj.2015.9.11789","article-title":"Evaluation of health care services provided for older adults in primary health care centers and its internal environment: A step towards age-friendly health centers","volume":"36","author":"Alhamdan","year":"2015","journal-title":"Saudi. Med. J."},{"key":"ref_50","first-page":"4","article-title":"Health Needs of Elderly People at Primary Health Care","volume":"16","author":"Kanevetci","year":"2018","journal-title":"Fam. Med. J."},{"key":"ref_51","first-page":"69","article-title":"Age-Friendly Primary Health Care: An Assessment of Current service Provision for Older Adults in Hong Kong","volume":"6","author":"Woo","year":"2013","journal-title":"Health Serv. Insights"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1080\/17508975.2018.1493569","article-title":"A structural approach for the redesign of a small-scale care facility as a guideline for decision-makers","volume":"12","author":"Huisman","year":"2018","journal-title":"Intell. Build. Int."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1080\/08946566.2018.1452658","article-title":"The Rosalie Wolf Memorial Lecture: Abuse-free Care in a World of Age-friendly Health Systems","volume":"30","author":"Fulmer","year":"2018","journal-title":"J. Elder Abuse Negl."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.nurpra.2017.09.001","article-title":"Age-Friendly Health Systems for Older Adults with Dementia","volume":"14","author":"Fulmer","year":"2018","journal-title":"J. Nurse Pract."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1111\/jgs.15076","article-title":"The Age-Friendly Health System Imperative","volume":"66","author":"Fulmer","year":"2018","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1377\/hlthaff.2018.05297","article-title":"The John A. Hartford foundation and the growth of geriatrics","volume":"38","author":"Isaacs","year":"2019","journal-title":"Health Aff."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.hjdsi.2017.05.005","article-title":"Creating Age-Friendly Health Systems\u2013A vision for better care of older adults","volume":"6","author":"Mate","year":"2018","journal-title":"Healthcare"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12877-019-1272-2","article-title":"Health systems readiness to provide geriatric friendly care services in Uganda: A cross-sectional study","volume":"19","author":"Ssensamba","year":"2019","journal-title":"BMC Geriatr."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1007\/978-1-4419-8354-1_9","article-title":"Elder-Friendly Service Delivery Models","volume":"Volume 5","author":"Woo","year":"2013","journal-title":"Aging in Hong Kong: A Comparative Perspective"},{"key":"ref_60","unstructured":"World Health Organization (2020, November 19). Integration of Health Care Delivery: Report of a Who Study Group. Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/38408."},{"key":"ref_61","unstructured":"(2020, November 26). Code Plus: Physical Design Components for an Elder Friendly Hospital. Available online: https:\/\/runnymedehc.ca\/files\/7813\/7934\/1677\/2012-2014_Associated_Appendices.pdf."}],"container-title":["Healthcare"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9032\/9\/1\/83\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:11:53Z","timestamp":1760159513000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9032\/9\/1\/83"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,16]]},"references-count":61,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,1]]}},"alternative-id":["healthcare9010083"],"URL":"https:\/\/doi.org\/10.3390\/healthcare9010083","relation":{},"ISSN":["2227-9032"],"issn-type":[{"value":"2227-9032","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,16]]}}}