Who is being heard? Implementing change with people from diverse and marginalized groups in aged care: a scoping review.

Abstract

Introduction: Many older people belong to diverse and marginalized groups, with care needs and preferences outside of normative aged care services. Increasing the representation and contributions of these older people is central to an equity-sensitive implementation approach where adaptation to the context is critical.

Objective: This review assessed the extent and nature of the literature on implementing change in aged care contexts serving older people who belong to diverse and marginalized groups.

Methods: This scoping review searched for literature examining the implementation of change in any aged care context where older people from diverse and marginalized groups access care. The search was conducted in the PubMed, CINAHL, Scopus, and PsycINFO databases, and limited to papers published from 2013 onward. Of the 2,021 papers identified, 35 were included.

Results: The majority (70%) of studies were in a residential aged care context, and only 25% used an implementation framework. Less than half (40%) engaged with diverse and marginalized older people or their representatives to understand their needs and preferences. The majority engaged instead with staff or other stakeholders, and most engagement (64%) was limited to lower-level consultation such as seeking feedback rather than involving, collaborating, or empowering stakeholders to ensure their perspectives improved the implementation process.

Conclusions: There is little in the literature about ensuring changes in aged care identify and meet the needs and priorities of diverse and marginalized older people. This suggests a pressing need for implementation science to pay greater attention to equity and inclusion in the aged care context.

Spanish abstract: http://links.lww.com/IJEBH/A314.