Optimising the end to end care pathway for older adults; A multi-stakeholder informed approach.

Introduction: As life expectancy increases, the proportion of older adults is rising in many countries. Ireland is no exception, where the older person population is expected to increase to 1.56 million by 2051. However, these projected increases in life expectancy do not equate to increases in “healthy life expectancy”, with latter years often characterised by age-related multi-morbidity due to one or more chronic diseases, resulting in an important reduction in quality of life and increasing cost to health care utilisation and budgets. This increased incidence in multimorbidity has resulted in increasing numbers of older persons accessing acute and community based care. The Carlow Kilkenny ICPOP was established in 2021 and aims to facilitate integration and collaborative delivery of services for older persons, acting as a conduit to and co-ordinator of integrated care in tandem public and private health and social care providers for older persons. In line with Slainte care and the provision of the right service, right place, right time mantra, ICPOP aims to facilitate admission avoidance from community and ED and optimise integrated care for older persons. To develop appropriate and fit for purpose services for older persons, their perceived needs must first be explored and considered. Aim & Objectives: To evaluate perceptions of health care services for older persons in Carlow and Kilkenny and to identify perceived barriers and facilitators to service access in an attempt to inform future service planning and innovation.​ Methods: A qualitative descriptive (QD) study design was adopted to allow in-depth examination of the views and experiences of this topic from the perspective of the individual. Recruitment methods included dissemination of invitation to participate using local and social media, notifications provided to older person day care centres, local healthcare offices and community venues. Focus groups were completed across Carlow and Kilkenny in a variety of geographical areas to improve accessibility for participation. Audio-recorded, open-ended, semi-structured world cafe style focus groups were conducted to allow in-depth exploration of participants’ perspectives and experiences. All audio-recordings were fully transcribed verbatim. NVivo software package (version 12) was employed to organize, store and retrieve data which was then collectively analysed using a reflexive approach to thematic analysis. Results: Eight local world café style focus groups involving the following stakeholders were completed; ​ Older Adults living in the community​ Older Adult Health Service users, their families and informal carers​ Health care providers​ Third party community service providers​. A total of 41 older persons (mean age 75) and 23 health and social care providers participated. Two main themes were identified; Access to local services, continuity of care, improved transport and reliable information to support older persons to live where they wish to live. Recognition of the person primarily as a person and not a condition Findings informed development of five one day multi stakeholder workshops as part of Rapid Improvement Event. Conclusion: Findings provided valuable insight into what both service users and providers want from the health services accessible to older persons, thereby informing future service innovation and planning. ​