Adaptation of Practice Guidelines to Prevent Functional Decline in Hospitalized Elderly in Iran

Akram Karimi, Mahrokh Keshvari, Maryam Moghimian


Background: In Iran, many efforts have been made to improve the Quality of Life (QOL) of the elderly; however, despite the efforts made, there is no practice guideline based on the consensus of experts that can be used to prevent the functional decline of hospitalized elderly. Accordingly, the present study was conducted with the aim of adaptation of a practice guideline to prevent the functional decline of hospitalized elderly.

Materials and Methods: This study is a developmental study based on the adaptation steps of the practice guideline. First, a search was conducted in 8 databases. The only practice guideline that met the inclusion criteria was then evaluated by the research team using the Appraisal of Guidelines for REsearch and Evaluation (AGREE II) tool. After content analysis of this guideline, the recommendations were categorized in the Canadian Senior Friendly Care (sfCare) Framework and according to the community conditions. Relevant evidence was used to supplement the content. The draft practice guideline was evaluated and modified in two expert panels through the RAND technique.

Results: The categorized recommendations were developed in the eight chapters of introduction to the prevention of functional decline of the elderly, general practice guideline, organizational support, care processes, physical ecology, emotional and behavioral environment, ethics in care, and evaluation of function.

Conclusions: To prevent functional decline in hospitalized elderly individuals according to the adaptive practice guideline, the hospital and health team need to be aware of support, care processes, and effective function appraisal to be able to provide care with coherent and coordinated solutions.


Functional decline, Aged, practice guideline

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Hosseinpour S, Behpour N, Tadibi V, Ramezankhani A. Effect of cognitive‑motor exercises on physical health and cognitive status in elderly. Iran J Health Educ Health Promot 2018;5:336‑4.

Marsillas S, De Donder L, Kardol T, van Regenmortel S, Dury S, Brosens D, et al. Does active aging contribute to life satisfaction for older people? Testing a new model of active aging. Eur J Ageing 2017;14:295‑310.

Aging and health. World Health Organization. 2018.

World Population Ageing. Department of Economic and Social Affairs, New York: United Nations; 2017.

Iran Statistical Yearbook. Plan and Budget Organization. Tehran: Statistical Center of Iran; 2017.

Best practice approaches to minimize functional decline in the older person across the acute, sub‑acute and residential aged care settings. Practice Epidemiology, Health Services Evaluation Unit, Victorian Government Department of Human Services Melbourne, Victoria. 2004.

Colón‑Emeric CS, Whitson HE, Pavon J, Hoenig H. Functional decline in older adults. Am Fam Phys 2013;88:388‑94.

Beddoes‑Ley L, Khaw D, Duke M, Botti M. A profile of four patterns of vulnerability to functional decline in older general medicine patients in Victoria, Australia: A cross‑sectional survey. BMC Geriatr 2016;16:1‑12. doi: 10.1186/ s12877‑016‑0323‑1.

Boltz M, Resnick B, Capezuti E, Shuluk J, Secic M. Functional decline in hospitalized older adults: Can nursing make a difference? Geriatr Nurs 2012;33:272‑9.

Buurman BM, Hoogerduijn JG, de Haan RJ, Abu‑Hanna A, Lagaay AM, Verhaar HJ, et al. Geriatric conditions in acutely hospitalized older patients: Prevalence and one‑year survival and functional decline. PLoS One 2011;6:e26951.

Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: Implications for clinical practice and public health. Lancet 2019;394:1365‑75.

Beaton K, McEvoy C, Grimmer K. Identifying indicators of early functional decline in community‑dwelling older people: A review. Geriatr Gerontol Int 2015;15:133‑40.

Davies BR, Baxter H, Rooney J, Simons P, Sephton A, Purdy S, et al. Frailty assessment in primary health care and its association with unplanned secondary care use: A rapid review. BJGP Open 2018;2:18X101325. doi: 10.3399/bjgpopen18X101325.

Senior‑friendly care framework. RPG of Toronto. 2017.

Older people with social care needs and multiple long‑term conditions. National Institute for Health and Care Excellence guideline (NICE). 2015.

Preventing Falls and Reducing Injury from Falls. Registered Nurses Association of Ontario. 2017.

Excellence NIfHC. Older people: Independence and mental wellbeing: National Institute for Health and Care Excellence (NICE). 2015.

Martínez‑Velilla N, Casas‑Herrero A, Zambom‑Ferraresi F, Sáez de Asteasu ML, Lucia A, Galbete A, et al. Effect of exercise intervention on functional decline in very elderly patients during acute hospitalization: A randomized clinical trial [published correction appears in JAMA Intern Med 2019;179:127]. JAMA Intern Med 2019;179:28‑36.

Collaboration A. The ADAPTE manual and resource toolkit for guideline adaptation. Version 2.0. 2010.

Rashidian A, Yousefi-Nooraie R. Development of a Farsi translation of the AGREE instrument, and the effects of group discussion on improving the reliability of the scores. J Eval Pract 2012;18:676‑81.

Bell BG, Spencer R, Avery AJ, Campbell SM. Tools for measuring patient safety in primary care settings using the RAND/UCLA appropriateness method. BMC Fam Pract 2014;15:1‑7. doi: 10.1186/1471‑2296‑15‑110.

Preventing falls in older people overview. National Institute for Health and Care Excellence (NICE). 2017.

Older people: Independence and mental wellbeing. National Institute for Health and Care Excellence (NICE). 2015.

Beauchamp MR, Ruissen GR, Dunlop WL, Estabrooks PA, Harden SM, Wolf SA, et al. Group‑based physical activity for older adults (GOAL) randomized controlled trial: Exercise adherence outcomes. Health Psychol 2018;37:451‑61.

Volkert D. The role of nutrition in the prevention of sarcopenia. Wien Med Wochensch 2011;161:409‑15.

Cocanour CS. Ethics and the emergency care of the seriously ill and injured elderly patient. Curr Geriatr Rep 2016;5:55‑61.

Abbasi M, Zamani M, Ganjbakhsh M. Justice in health and its place in medical ethics. J Med Ethics 2009;3:11‑33.

Munn Z, Qaseem A. Disappearance of the national guideline clearinghouse: A huge loss for evidence‑based health care. Ann Intern Med 2018;169:648‑9.


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