Primary healthcare service delivery for older people with progressive multimorbidity in low- and middle-income countries: a systematic review.

Ensuring primary healthcare (PHC) accessibility to older people with multimorbidity is vital in preventing unnecessary health deterioration. However, older people ≥50 y of age in low- and middle-income countries (LMICs) face challenges in effectively accessing and utilizing PHC. A systematic review was conducted adopting the Andersen-Newman theoretical framework for health services utilization to assess evidence on factors that affect access to PHC by older people. This framework predicts that a series of factors (predisposing, enabling and need factors) influence the utilization of health services by people in general. Seven publications were identified and a narrative analytical method revealed limited research in this area. Facilitating factors included family support, closeness to the PHC facility, friendly service providers and improved functional status of the older people. Barriers included long distance and disjointed PHC services, fewer health professionals and a lack of person-centred care. The following needs were identified: increasing the number of health professionals, provision of PHC services under one roof and regular screening services. There is a need for more investment in infrastructure development, coordination of service delivery and capacity building of service providers in LMICs to improve access and utilization of PHC services for older people.

Why don't people use the phone any more?

'Ping me an email'. To most people, those four words are quite innocuous, nothing to stir the soul or incite anyone to wrath. But to a nurse….

Please don't make me ask 'How did I do?'

Here I am, gaunt, twitching with stress and bug-eyed. Just another nurse revalidation, in other words.

Confusion abounds after a cataract op.

What about my eye pad?' asked a patient after his cataract operation. Funnily enough I had been compiling basic ophthalmology competencies that morning and 'the application of an eye pad' was one of them.

Speak out if you see patients being treated insensitively.

I'm often told not to 'interfere', so have learned to rein myself in. But sometimes….

Keep your carrots, just give us a pay rise.

Golden hellos? I must be dreaming. Employers across the country are offering financial inducements as carrots to entice nurses to work for them.

No wonder we all hate hospitals.

'I hate hospitals,' patients often say, and I always agree with them. I don't know why they are surprised - maybe they forget nurses are human too, with our own baggage. Perhaps they think we are so dedicated to our work that every moment in harness is a delight.

There's nothing like a bit of research to give flagging spirits a boost.

A recent study in Spain suggests that our month of birth can make us more susceptible to certain health conditions.

Blessings that banished boils.

With the current political uncertainty, at least we can be thankful for something - nowadays we rarely get boils. This occurred to me when someone described a puss-filled, painful excrescence that had arisen around a hair follicle, and they didn't know what it was.

Nurses are becoming an endangered species.

Like my fellow wildlife enthusiasts, I am concerned about the decline in the number of butterflies. We can only hope that the dry and warm weather at the end of June will have boosted their numbers.

Unrelenting time and ever-crazy workloads.

The sight of Big Ben and the sound of its iconic chime hold no romance for me. Instead, they make me shudder, even after all these years.

When all is calm, please don't utter the 'q' word.

'Labour will put a stop to bad language,' I heard in the run-up to the election. Quite right, I thought. All that effing and blinding; totally unnecessary. Then I realised they had said 'bad landlords'. Must make that audiology appointment….

How we eat dictates our overall well-being.

Few things give more pleasure than wining and dining with old friends, but I was glad not to be chef on this occasion as each of us is on a set diet. Sorry, I mean 'eating plan' - dieting is so 20th century.

Keep unfit drivers off the road.

'He'd be better off on a horse,' the patient's son told me. 'At least the horse can see where it's going.'

Let's celebrate the feel-good factor.

I am ignored. Disregarded. A non-person. Part of the furniture. But I don't mind. In fact, it gives me a warm glow.

It's time to raise the profile of endometriosis.

'I never thought I'd be standing on Westminster Bridge shouting about periods,' said a friend. She had been on a march to highlight the importance of early diagnosis of a life-changing, fertility-wrecking, career-destroying condition.

Banter can help get the message across.

When giving postoperative advice to older ophthalmic patients who have a spouse in tow, I often feel like a stand-up comedian with the audience in the palm of my hand.

Workplace violence is unacceptable.

'No one should feel threatened in the workplace for simply doing their job,' said the newspaper report.

All the world's a stage.

Whenever an actor describes their job as hard work, I have been known to guffaw ungenerously. But I have had to eat humble pie.

The fine art of diversion.

What about the NHS?' says Jeremy. 'Things are getting to breaking point, and I mean breaking point.'