eprintid: 1564950 rev_number: 15 eprint_status: archive userid: 608 dir: disk0/01/56/49/50 datestamp: 2017-07-16 10:55:51 lastmod: 2017-07-18 08:47:51 status_changed: 2017-07-18 08:47:51 type: article metadata_visibility: show creators_name: Salway, SM creators_name: Payne, N creators_name: Rimmer, M creators_name: Buckner, S creators_name: Jordan, H creators_name: Adams, J creators_name: Walters, K creators_name: Sowden, SL creators_name: Forrest, L creators_name: Sharp, L creators_name: Hidajat, M creators_name: White, M creators_name: Ben-Shlomo, Y title: Identifying inequitable healthcare in older people: systematic review of current research practice ispublished: pub divisions: SLIMEDSC divisions: G6 divisions: GZ full_text_status: public keywords: Ageism, Disparity, Equity, Healthcare, Methodology note: © The Author(s). 2017. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. abstract: BACKGROUND: There is growing consensus on the importance of identifying age-related inequities in the receipt of public health and healthcare interventions, but concerns regarding conceptual and methodological rigour in this area of research. Establishing age inequity in receipt requires evidence of a difference that is not an artefact of poor measurement of need or receipt; is not warranted on the grounds of patient preference or clinical safety; and is judged to be unfair. METHOD: A systematic, thematic literature review was undertaken with the objective of characterising recent research approaches. Studies were eligible if the population was in a country within the Organisation for Economic Co-operation and Development and analyses included an explicit focus on age-related patterns of healthcare receipt including those 60 years or older. A structured extraction template was applied. Extracted material was synthesised in thematic memos. A set of categorical codes were then defined and applied to produce summary counts across key dimensions. This process was iterative to allow reconciliation of discrepancies and ensure reliability. RESULTS: Forty nine studies met the eligibility criteria. A wide variety of concepts, terms and methodologies were used across these studies. Thirty five studies employed multivariable techniques to produce adjusted receipt-need ratios, though few clearly articulated their rationale, indicating the need for great conceptual clarity. Eighteen studies made reference to patient preference as a relevant consideration, but just one incorporated any kind of adjustment for this factor. Twenty five studies discussed effectiveness among older adults, with fourteen raising the possibility of differential effectiveness, and one differential cost-effectiveness, by age. Just three studies made explicit reference to the ethical nature of healthcare resource allocation by age. While many authors presented suitably cautious conclusions, some appeared to over-stretch their findings concluding that observed differences were 'inequitable'. Limitations include possible biases in the retrieved material due to inconsistent database indexing and a focus on OECD country populations and studies with English titles. CONCLUSIONS: Caution is needed among clinicians and other evidence-users in accepting claims of healthcare 'ageism' in some published papers. Principles for improved research practice are proposed. date: 2017-07-11 date_type: published publication: International Journal for Equity in Health volume: 16 event_location: England issn: 1475-9276 official_url: http://doi.org/10.1186/s12939-017-0605-z oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green article_type_text: Journal Article verified: verified_manual elements_id: 1384908 doi: 10.1186/s12939-017-0605-z pii: 10.1186/s12939-017-0605-z article_number: 123 lyricists_name: Walters, Katherine lyricists_id: KWALT44 actors_name: Walters, Katherine actors_name: Laslett, David actors_id: KWALT44 actors_id: DLASL34 actors_role: owner actors_role: impersonator citation: Salway, SM; Payne, N; Rimmer, M; Buckner, S; Jordan, H; Adams, J; Walters, K; Salway, SM; Payne, N; Rimmer, M; Buckner, S; Jordan, H; Adams, J; Walters, K; Sowden, SL; Forrest, L; Sharp, L; Hidajat, M; White, M; Ben-Shlomo, Y; - view fewer <#> (2017) Identifying inequitable healthcare in older people: systematic review of current research practice. International Journal for Equity in Health , 16 , Article 123. 10.1186/s12939-017-0605-z . Green open access document_url: http://discovery.ucl.ac.uk/1564950/1/Walters_document%287%29.pdf