Understanding barriers and facilitators to implementation of consensus-based recommendations for the management of very old people in intensive care

Richard S. Bourne; Laura Alberto; Nathan E. Brummel; Bas De Groot; Dylan W. De Lange; Paul Elbers; Marielle H. Emmelot-Vonk; Hans Flaatten; Yonathan Freund; Alessandro Galazzi; Ana Garcia-Martinez; Bertrand Guidet; Iva Holmerová; Jeremy M. Jacobs; Gavin M. Joynt; Susannah Leaver; Marc Leone; Bairbre McNicholas; David McWilliams; Victoria Metaxa; Christian H. Nickel; Daniele Poole; Chiara Robba; Kevin Roedl; Marc Romain; Anne Françoise Rousseau; Sviri Sigal; Wojciech Szczeklik; Hélène Vallet; James Van Oppen; Christian Jung; Michael Beil

doi:10.1093/ageing/afaf272

Understanding barriers and facilitators to implementation of consensus-based recommendations for the management of very old people in intensive care

Richard S. Bourne
, Laura Alberto
, Nathan E. Brummel
, Bas De Groot
, Dylan W. De Lange
, Paul Elbers
, Marielle H. Emmelot-Vonk
, Hans Flaatten
, Yonathan Freund
, Alessandro Galazzi
, Ana Garcia-Martinez
, Bertrand Guidet
, Iva Holmerová
, Jeremy M. Jacobs
, Gavin M. Joynt
, Susannah Leaver
, Marc Leone
, Bairbre McNicholas
, David McWilliams
, Victoria Metaxa

Christian H. Nickel, Daniele Poole, Chiara Robba, Kevin Roedl, Marc Romain, Anne Françoise Rousseau, Sviri Sigal, Wojciech Szczeklik, Hélène Vallet, James Van Oppen, Christian Jung, Michael Beil

Sheffield Teaching Hospitals NHS Foundation Trust
University of Manchester
Universidad del Salvador
The Ohio State University College of Medicine
The Ohio State University Wexner Medical Center
Radboud University Medical Center
Aarhus University Hospital
University of Utrecht
Amsterdam UMC
VU University Amsterdam
University Hospital
Haukeland University Hospital
Sorbonne Universités
Sorbonne University
Libera Università Mediterranea
Hospital Clínic de Barcelona
Assistance Publique – Hôpitaux de Paris
Charles University
Hadassah-Hebrew University Medical Center and Faculty of Medicine
Chinese University of Hong Kong
St George’s University Hospitals NHS Foundation Trust
Aix-Marseille University
University of Galway
King’s College Hospital NHS Foundation Trust
King's College London
University Hospital Bern
University of Basel
IRCCS Policlinico San Martino Hospital
Università degli studi di Genova
University Medical Center Hamburg-Eppendorf
University Hospital of Liège
University of Liège
Jagiellonian University
Hôpital Saint-Antoine
University of Sheffield
University of Leicester
Heinrich Heine University Düsseldorf
Imperial College Healthcare NHS Trust

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

Abstract

Background: Recent consensus-based recommendations on the management of people aged ≥80 years in intensive care units (ICUs) were developed to guide the management of quality care. Objective: To understand perceived barriers and facilitators to consensus-based recommendations to support their implementation into multi-professional and disciplinary clinical practice. Methods: Analysis of comments made by an international multiprofessional group of intensive care, emergency and geriatric medicine specialists in the Delphi consensus on the management of people aged ≥80 years in ICUs. Barrier and facilitators were analysed using the Theoretical Domains Framework. Results: Care statement comments were provided by 99 of the 124 (79.8%) participants completing the Delphi first round; primarily identifying barriers (239/258; 92.6%). Most participants identified limitations in the environmental context and resources within the healthcare system (152, 63.6%); predominantly limitations in resources/material resources, with staffing (60, 25.1%), and beds or facilities (30, 12.6%) concerns. Potentially modifiable domains focused on inadequate knowledge (25, 10.5%), beliefs about consequences (18, 7.5%), care goals (16, 6.7%) and social/professional role and identity (16, 6.7%). Facilitators focused on improving staff knowledge, particularly amongst geriatric medicine and intensive care medicine specialities, and environmental context and resources (both 8, 42.1%). Conclusions: The environmental context and resources domain was the most common barrier identified. Behaviour change opportunities are centred on the domains knowledge, beliefs about consequences, goals and social/professional role and identity. Linked behaviour change techniques can be identified and developed according to local healthcare context to support implementation of care recommendations.

Original language	English
Article number	afaf272
Number of pages	8
Journal	Age and Ageing
Volume	54
Issue number	9
DOIs	https://doi.org/10.1093/ageing/afaf272
Publication status	Published - 26 Sept 2025

Bibliographical note

Publisher Copyright:
© The Author(s) 2025. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.

Funding

RSB is supported by a National Institute for Health and Care Research (NIHR) Senior Clinical and Practitioner Research Award (NIHR304524). JvO is supported by a NIHR Clinical Lectureship. NB was supported by the National Institute on Aging and the National Institute of Child Health and Human Development of the National Institutes of Health under award numbers R03AG083556, R01AG077644, R01HD107103. The implementation of the Delphi study on the Welphi platform ( www.welphi.com ) was funded by ESICM. The authors thank all the consensus process participants for their informative comments. RSB is supportedby a National Institute for Health and Care Research(NIHR) Senior Clinical and Practitioner Research Award(NIHR304524). JvO is supported by a NIHR ClinicalLectureship. NB was supported by the National Instituteon Aging and the National Institute of Child Health andHuman Development of the National Institutes of Healthunder award numbers R03AG083556, R01AG077644,R01HD107103. The implementation of the Delphi studyon the Welphi platform (www. welphi.com) was funded byESICM.The views expressed in this publication are those of theauthor(s) and not necessarily those of the NHS, the NationalInstitute for Health and Care Research or the Department ofHealth and Social Care.

Funders	Funder number
National Institute for Health and Care Research	NIHR304524
National Institute on Aging
National Institute of Child Health and Human Development
European Society of Intensive Care Medicine
National Institutes of Health	R03AG083556, R01HD107103, R01AG077644

Keywords

barriers and facilitators
consensus
intensive care
older people
recommendations

ASJC Scopus subject areas

Ageing
Geriatrics and Gerontology

Access to Document

10.1093/ageing/afaf272

Cite this

Bourne, R. S., Alberto, L., Brummel, N. E., De Groot, B., De Lange, D. W., Elbers, P., Emmelot-Vonk, M. H., Flaatten, H., Freund, Y., Galazzi, A., Garcia-Martinez, A., Guidet, B., Holmerová, I., Jacobs, J. M., Joynt, G. M., Leaver, S., Leone, M., McNicholas, B., McWilliams, D., ... Beil, M. (2025). Understanding barriers and facilitators to implementation of consensus-based recommendations for the management of very old people in intensive care. Age and Ageing, 54(9), Article afaf272. https://doi.org/10.1093/ageing/afaf272

Bourne, RS, Alberto, L, Brummel, NE, De Groot, B, De Lange, DW, Elbers, P, Emmelot-Vonk, MH, Flaatten, H, Freund, Y, Galazzi, A, Garcia-Martinez, A, Guidet, B, Holmerová, I, Jacobs, JM, Joynt, GM, Leaver, S, Leone, M, McNicholas, B, McWilliams, D, Metaxa, V, Nickel, CH, Poole, D, Robba, C, Roedl, K, Romain, M, Rousseau, AF, Sigal, S, Szczeklik, W, Vallet, H, Van Oppen, J, Jung, C & Beil, M 2025, 'Understanding barriers and facilitators to implementation of consensus-based recommendations for the management of very old people in intensive care', Age and Ageing, vol. 54, no. 9, afaf272. https://doi.org/10.1093/ageing/afaf272

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title = "Understanding barriers and facilitators to implementation of consensus-based recommendations for the management of very old people in intensive care",

abstract = "Background: Recent consensus-based recommendations on the management of people aged ≥80 years in intensive care units (ICUs) were developed to guide the management of quality care. Objective: To understand perceived barriers and facilitators to consensus-based recommendations to support their implementation into multi-professional and disciplinary clinical practice. Methods: Analysis of comments made by an international multiprofessional group of intensive care, emergency and geriatric medicine specialists in the Delphi consensus on the management of people aged ≥80 years in ICUs. Barrier and facilitators were analysed using the Theoretical Domains Framework. Results: Care statement comments were provided by 99 of the 124 (79.8\%) participants completing the Delphi first round; primarily identifying barriers (239/258; 92.6\%). Most participants identified limitations in the environmental context and resources within the healthcare system (152, 63.6\%); predominantly limitations in resources/material resources, with staffing (60, 25.1\%), and beds or facilities (30, 12.6\%) concerns. Potentially modifiable domains focused on inadequate knowledge (25, 10.5\%), beliefs about consequences (18, 7.5\%), care goals (16, 6.7\%) and social/professional role and identity (16, 6.7\%). Facilitators focused on improving staff knowledge, particularly amongst geriatric medicine and intensive care medicine specialities, and environmental context and resources (both 8, 42.1\%). Conclusions: The environmental context and resources domain was the most common barrier identified. Behaviour change opportunities are centred on the domains knowledge, beliefs about consequences, goals and social/professional role and identity. Linked behaviour change techniques can be identified and developed according to local healthcare context to support implementation of care recommendations.",

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AU - Bourne, Richard S.

AU - Alberto, Laura

AU - Brummel, Nathan E.

AU - De Groot, Bas

AU - De Lange, Dylan W.

AU - Elbers, Paul

AU - Emmelot-Vonk, Marielle H.

AU - Flaatten, Hans

AU - Freund, Yonathan

AU - Galazzi, Alessandro

AU - Garcia-Martinez, Ana

AU - Guidet, Bertrand

AU - Holmerová, Iva

AU - Jacobs, Jeremy M.

AU - Joynt, Gavin M.

AU - Leaver, Susannah

AU - Leone, Marc

AU - McNicholas, Bairbre

AU - McWilliams, David

AU - Metaxa, Victoria

AU - Nickel, Christian H.

AU - Poole, Daniele

AU - Robba, Chiara

AU - Roedl, Kevin

AU - Romain, Marc

AU - Rousseau, Anne Françoise

AU - Sigal, Sviri

AU - Szczeklik, Wojciech

AU - Vallet, Hélène

AU - Van Oppen, James

AU - Jung, Christian

AU - Beil, Michael

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AB - Background: Recent consensus-based recommendations on the management of people aged ≥80 years in intensive care units (ICUs) were developed to guide the management of quality care. Objective: To understand perceived barriers and facilitators to consensus-based recommendations to support their implementation into multi-professional and disciplinary clinical practice. Methods: Analysis of comments made by an international multiprofessional group of intensive care, emergency and geriatric medicine specialists in the Delphi consensus on the management of people aged ≥80 years in ICUs. Barrier and facilitators were analysed using the Theoretical Domains Framework. Results: Care statement comments were provided by 99 of the 124 (79.8%) participants completing the Delphi first round; primarily identifying barriers (239/258; 92.6%). Most participants identified limitations in the environmental context and resources within the healthcare system (152, 63.6%); predominantly limitations in resources/material resources, with staffing (60, 25.1%), and beds or facilities (30, 12.6%) concerns. Potentially modifiable domains focused on inadequate knowledge (25, 10.5%), beliefs about consequences (18, 7.5%), care goals (16, 6.7%) and social/professional role and identity (16, 6.7%). Facilitators focused on improving staff knowledge, particularly amongst geriatric medicine and intensive care medicine specialities, and environmental context and resources (both 8, 42.1%). Conclusions: The environmental context and resources domain was the most common barrier identified. Behaviour change opportunities are centred on the domains knowledge, beliefs about consequences, goals and social/professional role and identity. Linked behaviour change techniques can be identified and developed according to local healthcare context to support implementation of care recommendations.

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Understanding barriers and facilitators to implementation of consensus-based recommendations for the management of very old people in intensive care

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

Access to Document

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