Optimising Rural Primary Healthcare for Older People in India: A Mixed-Methods Situational Assessment of Service Gaps and Care Pathways

Aim To evaluate the availability of geriatric healthcare services in rural India, identify facilitators and barriers to care provision from a nursing perspective, and develop a nurse-integrated conceptual model for comprehensive geriatric care pathways. Design A mixed-methods study combining facility mapping and qualitative approaches. Methods Conducted between March and May 2025 in Tigiria, Odisha, the study included a structured facility mapping of 19 healthcare facilities using checklists adapted from national geriatric care guidelines. Qualitative data were collected through in-depth interviews (n=8), focus group discussions (n=4; 27 participants), and key informant interviews (n=2). Participants included Community Health Officers (nurses), medical officers, and older adults (≥60 years). Data were analysed using thematic analysis with ATLAS.ti. This study was reported in accordance with COREQ and STROBE guidelines. Results Healthcare service availability varied across facilities. Basic preventive and curative services were accessible at the primary care level; however, specialised geriatric services, including rehabilitation, were limited. Nurses played a key role in preventive care and chronic disease management. Facilitators included community engagement and informal care networks, while barriers comprised resource constraints and lack of geriatric-specific training. Conclusion Strengthening geriatric competencies among primary care nurses is a critical strategy for addressing service gaps in low-resource settings. The proposed integration of nurse-led comprehensive geriatric assessment (CGA) and telemedicine presents a potential pathway to optimize rural primary geriatric care. Impact The study highlights the pivotal role of nurses in rural geriatric care and provides a practical framework for strengthening services through training and integrated care models in similar low- and middle-income settings. Patient or Public Contribution Older adults and community members contributed through interviews and discussions, sharing experiences of healthcare access and needs.