Table 1.

Characteristics of reviewed studies

Study, country, and underlying qualitative theory (where described)	Setting and participants	Aim, study design	Summary of emergent themes	Quality rating	Strengths	Limitations
Ben-Harush et al. (2017) Israel	Medical and mental health professionals in long term care, primary care, and hospitals 29 clinicians: Physicians (16 F, 4 M), nurses (5 F) and social workers (4 F) Age not stated	Aim: to evaluate and compare ageism amongst physicians, nurses, and social workers Design: three focus groups were provided with 11 set questions	Perceived difficulties related to working with older adults and their families Invisibility of older people and discriminatory communication patterns with older patients (exclusion, disempowerment, patronising behaviour) Providing inappropriate care to older patients (fostering dependency to save time, aged-based treatment decisions)	A	Interviewer trained in qualitative research Clear statement of research aims Triangulation of responses of 3 different healthcare professional groups Method of thematic analysis well described Measures of trustworthiness reported (> 1 coder, peer debriefing, triangulation)	Limited scope for broader reflection with structured interviews Sample strategy of recruiting from clinicians attending education sessions may select those more motivated/ interested in older people Unclear if data saturation achieved
Bershtling et al. (2016) Israel Inductive approach	Hospital and community healthcare professionals 18: (8 Social workers and 10 Physicians) aged 28–58 and 15 older persons (aged 65–90)	Aim: to develop a better understanding of the right to health in old age Design: semi-structured focus group interviews	Self-positioning vis a vis the healthcare system (older adult patient perspectives) The Kafkaesque positioning of the health care system (referring to perceptions of the healthcare system, mainly those of older adults themselves: e.g., bureaucracy, lack of transparency and exclusion from care decisions limiting access to health rights) Social aspects influencing the right to health (healthcare professional views- system resources, family vs individualism, and a humane approach)	A	Utilised a separate observer to the moderator to take field notes and observe interactions Context well described Triangulation of responses of healthcare professional and older persons Clear description of content and form analysis Trustworthiness enhanced by having dual coders	Unclear how healthcare professionals were chosen or who declined to participate No comment on data saturation Results presented as a hybrid of theory, existing literature and derived themes, resulting in relatively less focus on empirical data and subjective meaning
Bulut et al. (2015) Turkey	Emergency Department 18 Emergency doctors and nurses Physicians (11) average age 30.78, Nurses (7) average age 28.23 years	Aim: assessment of the views of emergency service staff on ageing and older patients Design: mixed methods. Questionnaires* and focus group interviews with open-ended set questions *Quantitative results are not presented here	Understanding older patients’ situations (definitions of older adults) Good nursing care and medical treatment Factors affecting good nursing care (holistic, personalised) and medical treatment (optimising quality of life, diagnosis and safe treatment) Emotions experienced (by clinicians)—hopelessness, pity and stress	A	Clearly described aim and recruitment strategy, which captured half of the total possible sample in the qualitative arm Questionnaire data informed focus groups Triangulation between quantitative component and 2 different healthcare professional groups Robust method for data collection Implications for clinical practise and training were discussed	Method of thematic analysis not described Lacks consideration of reflexivity No separate analysis of qualitative data (quotations were used to support themes derived from questionnaire data) Unclear if data saturation was reached in qualitative analysis
Di Lorito et al. (2019) England Inductive approach	Forensic psychiatric secure services 13 participants: Psychiatrists (2), Specialty doctors (2), Specialist medical trainees (3), Nurses (4), Nursing assistants (2)	Aim: to explore views on how well secure services are meeting the challenges of an ageing population Design: focus groups with set topic guides	Identifying patient’s needs—protocols, staff skills and training, recognising cognitive impairment/dementia Addressing patient’s needs—facilitators (personalised care), barriers (lack of meaningful activity, invisibility, lack of resources) and service improvement (separation by age group, consumer input)	A	Researchers reflected on their potential biases and perspectives, demonstrating reflexivity Data collection and audit trail were well described. Triangulation of results with companion study of older patients in secure services Method of analysis well described Measures to optimise trustworthiness were described (e.g. negative cases)	No data on eligible participants declining to participate Data saturation not described No medium secure staff were recruited, although this is where the majority of older adults are
Craciun (2016) Romania Thematic analysis	General practitioners in public clinics or private practise 34 participants: 17 women, 17 men. All aged 30–60	Aim: to examine the views of general practitioners on old age and what role they perceive gender may have in their representations of ageing Design: individual episodic interviews with nine set questions regarding their experience with older adults and perceptions of ageing	De-Gendered representations of aging amongst GPs* (ageing as negative, chronological, subjective ageing and ageing well) De-gendered representations and actions towards older patients (difficult patients, dependent. vulnerable, not understanding, non-compliant) *The effect of gender was explored two ways: the gender of the GPs and whether GPs treat male or female older people differently	B	Thematic coding method well described Subjective meaning was privileged by use of frequent illustrative quotes Immersion in interview transcripts	Little detail provided on structured questions, particularly those relating to perceptions of gender (the key aim of the study) The method of data collection was not described (e.g. was audio-recording used?) Unclear if data saturation was achieved The analysis was not conducted in line with purported aims- e.g. data from male or female GPs were not thematically analysed as separate groups Data were not triangulated
Craciun and Flick (2016) Country not specified	Professionals working with older people or services pertaining to preparation for old age 7 participants: General Practitioner (1), psychologists (3), social worker (1), occupational therapist (1) and an Insurance agent (1)	Aim: to assess health care professional of multiple disciplines regarding their views on positive ageing Design: individual episodic interviews with set questions covering the participant’s work in services for ageing populations, representations of ageing, promotion of old age, and what factors interfered with their work	Negative representations of age (subtheme-ageing as decline) Patterns referring to the promotion of a positive old age (subthemes staying mentally fit, taking personal responsibility for positive ageing, being socially engaged, integrating technology in coping with ageing) Healthcare professional reflections on personal ageing (ability and activity rather than chronological age; attitude and adaptation to ageing)	A	Clear aims Systematic data collection Method of analysis well described Findings privilege subjective meaning (numerous illustrative quotes provided) Implications for clinical practise discussed	Context and setting of study are unclear Sampling strategy is not described Unclear whether data saturation was achieved Inadequate representation of healthcare professional disciplines Lacks consideration of reflexivity
Flatt et al. (2013) United States of America Grounded theory	Anti-ageing physicians and practitioners from an online directory 31 anti-ageing practitioners (71% medical doctors, 29% doctors of naturopathy, osteopathic medicine or nurse practitioner) Age 33–71 23 (74%) white/Caucasian 19 (61%) male	Aim: evaluate how descriptions of their work, definitions of ageing and goals for patients intersect with ‘successful ageing’ Design: semi-structured individual phone interviews	Personal responsibility for poor ageing (self-inflicted) Functional losses are not ‘normal’ ageing Ageing as a hormone deficit Loss of energy equated with ageing Ageing well is individually determined Good (less disease, less cost, productivity) vs bad ageing	A	Clear aims with corresponding study design well suited to investigate aims Measures taken for improving inter-rater reliability Data analysis well described Findings privilege subjective meaning (numerous illustrative quotes provided) Detailed discussion of factors influencing findings	Unclear whether data saturation achieved Reflexivity not considered Study limitations not described
Higashi et al. (2012) United States of America ethnography	General hospital 21 participants: interns, residents, medical students (numbers of each not stated)	Aims: explore attitudes of physicians in training to older patients Design: individual interviews and participant observation	Negative characteristics of old age (frailty, dementia, multiple chronic illnesses and lack of social support) Older patients inherently at end of life Cognitive impairment is assumed (older people are infantalised and perceived as frustrating) Therapeutic nihilism Complexity (both a plus and negative) Older people as time-consuming, needy, and inflexible Older people are better attended by other HCP Older people respect junior doctors	C	Robust data collection (recordings and observations) Triangulation of data sources Researchers immersed with participants in their clinical role	Sampling strategy not described Audit trail for observations not described No information on method of data analysis No comment on data saturation Reflexivity not discussed although researcher was embedded with medical team Authors did not consider limitations Poor consideration of implications for policy and practise No mention of ethical approval
Lee and Richardson, (2020) United States of America Inductive approach	Experienced (20 years +) geriatric community care workers from agencies providing home- and community-based services to older adults 20 participants: 85% were licenced social workers All women Aged 50–72	Aim: exploring the views of geriatric community health workers regarding retirement* and barriers/facilitators to ongoing engagement with the ageing population after retirement Design: Semistructured interviews *Results pertaining to views about retirement are not presented here	Facilitators: strong bonds to older adults (affection, compassion and passion to serve) Identifying themselves as a resource for older adults Barriers: Negative attitudes developed towards ageing and older adults Compassion fatigue	A	Clear aim and research question Method of thematic analysis is well described. Appropriate use of productive ageing framework to interpret data Trustworthiness enhanced by assessing inter-rater reliability of coders and peer review Implications for education and training discussed	Semistructured interview format not well described Limited variety of healthcare workers (85% licenced social workers) and all women Sample size not sufficient to achieve data saturation
Manasatchakun et al. (2018) Thailand Inductive, latent content analysis	Community nurses working in health promotion in Thailand 36 participants: aged 23–52 years One male participant	Aim: assess views of community nurses regarding healthy ageing Design: focus group interviews using prepared open-ended questions	Healthy ageing: -Being strong -Being a supporter and feeling supported Promoting healthy ageing: -providing health assessment -sharing knowledge -having limited resources (financial and workforce)	A	Data collection process clearly described (field notes, audio recordings, observations of nonverbal communication/power relations), all of which contribute to triangulation of interview and focus group data Clear audit trail of steps in thematic analysis Clear immersion in data Trustworthiness enhanced by dual coders and participant validation Reflexivity demonstrated Implications for policy discussed	Unclear whether saturation of themes achieved Funding not disclosed, which may be relevant as the first author is a nursing instructor in the region Sample included only those districts already involved in promotion of healthy ageing—other districts not sampled
Hosseini et al. (2020) Iran Content analysis	Educational and therapeutic hospitals Participants: nurses (13, 10 clinical, 3 ‘head’ nurses), educational supervisor (1) Work experience 4–21 years Age 25–52 5 women	Aim: elaborate the reasons for ageism at individual and system levels Design: semi-structured and in-depth individual interviews	Patient-related factors: older people are difficult, complex, dependent, cannot be helped Caregiver-related factors: therapeutic nihilism, older people should just be allowed to die Care provider system factors: waste of resources -Socioeconomic factors: self-inflicted problems Family related factors: lack of respect, absent	A	Aim well described Purposive sampling to maximise diversity of participants Data saturation achieved Data collection well described Method of analysis well described and results confirmed and validated Utilised respondent validation of results Considered study limitations	Limited application of findings to policy and practise Little consideration of reflexivity
Moore (2017) England	Nursing homes Participants: nursing home owners (12, 2 were nurses), nursing home managers (12, 10 were nurses), nurses/care staff (12)	Aim: unclear- relates to how personal values influence attitudes and behaviours towards residents Design: semi-structured face to face interviews	Older people are unworthy of communication Poor cognition ‘out of it’ Futility of treatment Proximity to death	C	Open questioning Implications of findings for policy development discussed	Study aims were unclear Sampling strategy not described No comment on data saturation Form of data collection not described, no mention of audit trail Method of data analysis not described Themes not clearly articulated Study limitations not considered Reflexivity not considered, although researcher was Commissioner of care and nursing home services No mention of ethical approval
Oeseburg et al. (2013) The Netherlands	6 GPs and 6 practise nurses	Aim: to develop and evaluate an interprofessional education programme for GPs and practise nurses (including examine knowledge and attitudes towards older people) Design: mixed methods (telephone interviews and questionnaire)	Elder care is more than just disease management Collaboration with other disciplines can change attitudes to elder care	D	Clear study aims Triangulation of qualitative and quantitative data	Context of the researchers was unclear, no reflexivity Unclear who gathered interview data No comment on data saturation No information on method of qualitative data analysis No quotations provided to illustrate themes No measures to enhance trustworthiness of findings No evidence provided to support change in attitudes of HCP to older people through education