Backround
Internationally, standards exist for assessing healthcare quality, providing organisations with indicators to enhance quality of care (QoC). From the perspective of older adults, the quality of geriatric rehabilitation is significantly influenced by interpersonal dynamics and organisational factors. However, it is unclear priorities are unknown. Through group discussions, we aim to prioritise key topics relevant for the quality of geriatric rehabilitation from the perspective of the older adult.
Approach
The nominal group technique methodology was conducted according the following stages: introduction, idea generation, exchange of ideas, discussion, and ordering and ranking. Thematic analysis was employed to analyse the qualitative data, and the prioritisation of themes was determined based on ranking by older adults after the group discussion. The priorities from the four sessions have been combined.
Results
Four nominal group technique interviews were conducted at four different geriatric rehabilitation centers in the Netherlands, involving a total of 22 participants. The consolidation of prioritisation from the four groups has resulted in the following top four quality interests of older adults. (1) Effective preparation and organization of rehabilitation. (2) Autonomy in decision-making regarding involvement in treatment discussions. (3) Effective communication, interpersonal interaction, clarity, and respect. (4) Establishing rapport with healthcare personnel and being treated as individuals were also emphasized. The thematic analysis highlights the importance of a personalised approach and seeing the individual, and more specifically, the importance of permanent staff.
Implications
Older adults prioritise the following key areas essential for QOC: expertise of the HCP and good organisation of the rehabilitation, knowing the older adults and familiar HCPs.

Background
Healthcare professionals (HCPs) play an indispensable role in meeting the complex demands of rehabilitation. Navigating the intricate terrain of geriatric rehabilitation (GR), especially in understanding and empathizing the diverse needs of older adults (OA) are challenging. The aim of this study is to increase awareness among HCPs in GR by allowing them to experience the rehabilitation process from the perspective of the older adult.
Approach
We used a mixed-methods procedure for data collection and analysis. After watching the VR-video (15 minutes), all participants were asked to fill out a questionnaire with structured interview questions on paper to gather quantitative insights into participants' opinions and perspectives. Focus group discussions were conducted to gain a better understanding of, with recordings transcribed for analysis.
Results
200 HCPs filled in the questionnaire and 24 HCPs participated in the focus groups. The initial reactions that arise after watching the VR-video: you become completely absorbed, questioning whether what you do is truly in line with the OA's wishes, the importance of approaching and communicating at eye level, acknowledging and apologizing for mistakes. As a caregiver, everything may seem obvious, but becoming aware that it's not so obvious for the OA’s. A preliminary average score from the questionnaires conducted is 8,3/10.
Implications
The impact of the VR-video will be improved with a follow-up discussion with colleagues. The added value of the VR-glasses is that you fully immerse yourself in the video and not be distracted.

Background: Around 60% of all cancers occur in people over age 65, an age group that is growing and is far from homogenous. Age alone cannot guide treatment approaches or predict survival, but all older adults would benefit from a review of their global health status before deciding on the best treatment option. Older people too often confront longer waits for diagnosis, under- or over-treatment and inadequate follow-up to simultaneously address cancer care and achieve life goals. Best practices in cancer care for older people have been identified, and include professional training, coordination of care and services and participation in research, but these have yet to become standard in health systems. This presentation reports on deliberative discussions on priority actions for improving care and services for older adults living with and beyond cancer.

Approach: We held deliberative discussions among providers, decision-makers and older people with cancer from France and Quebec, along with international experts in geriatric oncology. The question we put out for deliberation was: How can we work towards best practices in a way that considers the local environment and is attentive to the realities and preferences of older people? Deliberative discussion sought to identify, prioritise and link critical factors to enacting best practices in integrated geriatric and cancer care. Data were collected through fuzzy cognitive mapping to integrate real world perspectives with scientific evidence and establish causal relationships between concepts that represent participant perspectives.
Presentations from clinicians, researchers and seniors with cancer provided the 74 participants with a common set of evidence-based and experiential knowledge. Two innovative models of integrated geriatric oncology care were described: one was a dedicated clinic, and the other as a collaborative integrated network. Participants were divided into heterogeneous groups of 6 to 9, including a trained facilitator. Groups were asked to produce a cognitive map of words reflecting the 12 SIOG priorities involved in comprehensive integrated care for older people with cancer. Their objective was to achieve consensus on priorities for action, using boxes and arrows to trace causal links. The maps were subsequently analysed using Mental Modeller software to quantify the centrality of actions.

Results: Cognitive mapping identified pragmatic possibilities for action. The exercise to co-create a common representation of priorities in the care of older adults with cancer brought a clearer understanding of the links between them and offered pathways for improving geriatric oncology care. There will always be challenges in fitting recognized best practices into local realities. The effort involves reaching consensus on the meaning of priorities that support internationally recognized best practices, forming partnerships with seniors living with cancer and paying attention to the local environment. Actors outside the healthcare sector, including municipalities and groups that can help address issues of discrimination, may play a role.

Implications: Enacting evidence-based best practices within a considerate person-centred approach draws on collective capacities within and beyond a given health system. Deliberative discussion and conceptual mapping provide a participatory approach to arrive at recommendations for practice and system improvement.

The Ontario healthcare system is currently under pressure due to ongoing human resource shortages and increasing demands for care from a growing and aging population. Adding to the pressure is an increasing number of older patients living with frailty who no longer require acute care but remain in hospital with no safe place to go. For these older people languishing in acute care beds, there is an increased risk of physical and cognitive decline, which can later be exacerbated by poorly planned and supported hospital-to-home transitions. For hospitals, the inability to discharge these patients to a safe environment leads to a lack of beds for other incoming patients in need of acute level care.
Through ethnographic interviews and group workshop sessions, we collaborated with older people, their informal essential caregivers, healthcare professionals, and leadership from both hospital and community to explore their individual lived experiences, mapping the gaps and challenges that currently exist and highlighting opportunities for innovation. Through this human-centred approach we built a comprehensive understanding of the diversity of needs that exist for older people and their informal caregivers as well as the systemic factors that impact current decision making and policies.
The insights uncovered during the exploration of lived experiences became the building blocks for a large in-person World Cafe style co-design session. All of our key stakeholder groups came together to work collaboratively and reimagine transitions in care and create digitally enabled and integrated pathways to home that support whole-person care.
A set of guiding principles served to bridge the gap between the insights and creative solutions developed during the co-design session, ensuring the voice of older people, their caregivers, and hospital and community care providers led decision making.
This presentation will explore our unique approach to research and how it informed the development of an Integrated Transitional Care Model (ITCM) providing pathways to support aging in the right place with the right level of care and support at the right time.
The ITCM spotlights the need for whole person care for both older people and their informal caregivers, placing a primacy on collaborative and localized community care to support existing connections and foster new ones. Warm transitions in care are facilitated through community partnerships, extending hospital connections during transitional phases, and engaging community partners earlier in the acute and rehab care journey. An expansion of transitional care and the expansion of digitally-supported home monitoring fills noted gaps in care and provides an opportunity for anticipatory care and planning.
Participants will learn about the unique needs of older people living with frailty and their informal caregivers and how they affect the design of care pathways and digital solutions. Including collaboration with older people and their caregivers when we reimagine how we might better promote aging in place. Successes, values, and barriers encountered throughout the project when integrating qualitative and quantitative data. Methods used, such as in person ethnographic interviewing, and virtual one on one discussions, as well as in-person, virtual, and hybrid workshop sessions.