How community-based palliative care is delivered for older adults: a scoping review

Community-based palliative care has shown promising results in supporting older adults to remain at home, whilst providing high-quality care. However, how such initiatives are organised and delivered in practice varies widely, and evidence regarding service models and factors influencing delivery for older adults remains fragmented. This scoping review aimed to map and synthesize existing community-based palliative care initiatives for older adults, identifying their key service components, delivery approaches, and determinants of successful implementation.

A scoping review was conducted using PubMed, CINAHL, Embase, the Cochrane Central Register of Controlled Trials, and Scopus for studies published between January 2005 and July 2025. Descriptive analysis was used to summarize the key components of community-based palliative care initiatives for older adults. A narrative synthesis was then undertaken to code implementation strategies using the Expert Recommendations for Implementing Change (ERIC) taxonomy and to integrate determinants influencing implementation, guided by the Consolidated Framework for Implementation Research (CFIR).

Sixteen studies describing 17 community-based palliative care initiatives for older adults were included, encompassing 56,581 older adults with mean ages ranging from 66.1 to 88.0 years. The initiatives predominantly addressed advanced life-limiting illness. Most initiatives were multidisciplinary and employed a home-based service model; all provided symptom management, care coordination, and advance care planning. Common implementation strategies included: 'Using advisory boards and working groups', 'Conducting educational meetings', 'Conducting educational outreach visits', and 'Revising professional roles.' Factors influencing delivery operated across multiple levels, including alignment with older adults' needs, organisational readiness and coordination, workforce capacity, and characteristics of the intervention. Limited integration across care settings and variable provision of staff training were commonly reported challenges.

Community-based palliative care initiatives for older adults are mainly home-based and multidisciplinary, with consistent emphasis on symptom management, coordination, and advance care planning. Successful implementation of initiatives depends on aligning services with older adults' needs, enhancing organizational readiness and cross-sector coordination, engaging patients and caregivers, and tailoring interventions to local contexts.