title: Supportive care for older people with frailty in hospital: An integrative review.
abstract: BACKGROUND
  Growing numbers of older people living with frailty and chronic health conditions are being referred to hospitals with acute care needs. Supportive care is a potentially highly relevant and clinically important approach which could bridge the practice gap between curative models of care and palliative care. However, future interventions need to be informed and underpinned by existing knowledge of supportive care.
  
  
  OBJECTIVE
  To identify and build upon existing theories and evidence about supportive care, specifically in relation to the hospital care of older people with frailty, to inform future interventions and their evaluation.
  
  
  METHODS
  An integrative review was used to identify and integrate theory and evidence. Electronic databases (Cochrane Medline, EMBASE and CIHAHL) were searched using the key term 'supportive care'. Screening identified studies employing qualitative and/or quantitative methods published between January 1990 and December 2015. Citation searches, reference checking and searches of the grey literature were also undertaken.
  
  
  METHODS
  Literature searches identified 2733 articles. After screening, and applying eligibility criteria based on relevance to the research question, studies were subject to methodological quality appraisal. Findings from included articles (n=52) were integrated using synthesis of themes.
  
  
  RESULTS
  Relevant evidence was identified across different research literatures, on clinical conditions and contexts. Seven distinct themes of the synthesis were identified, these were: Ensuring fundamental aspects of care are met, Communicating and connecting with the patient, Carer and family engagement, Building up a picture of the person and their circumstances, Decisions and advice about best care for the person, Enabling self-help and connection to wider support, and Supporting patients through transitions in care. A tentative integrative model of supportive care for frail older people is developed from the findings.
  
  
  CONCLUSIONS
  The findings and model developed here will inform future interventions and can help staff and hospital managers to develop appropriate strategies, staff training and resource allocation models to improve the quality of health care for older people.
authors.affiliation: Supportive and End of Life Care (Nursing), King's College London/St. Christopher's Hospice, King's College London, Florence Nightingale Faculty of Nursing and Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, United Kingdom. Electronic address: Caroline.nicholson@kcl.ac.uk.
authors.forename: Caroline
authors.initials: C
authors.lastname: Nicholson
authors.affiliation: Research Support, Northern Ireland, Belfast, Northern Ireland BT30 9QT, United Kingdom. Electronic address: Elizabethmmorrow@hotmail.co.uk.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Morrow
authors.affiliation: City University of London, School of Health Sciences, United Kingdom.
authors.forename: Allan
authors.initials: A
authors.lastname: Hicks
authors.affiliation: King's College London, Florence Nightingale Faculty of Nursing and Midwifery, United Kingdom.
authors.forename: Joanne
authors.initials: J
authors.lastname: Fitzpatrick
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016330:Frail Elderly; D006760:Hospitalization; D006801:Humans
keywords: Frailty; Health services for older people; Palliative care; Quality of healthcare; Supportive care