Compassionate communities, Māori ageing and end-of-life: A systematic review.

Background: Māori people in Aotearoa New Zealand and Australia experience significant healthcare inequity as they age and towards the end of their lives. Compassionate community approaches to ageing and end-of-life care are increasing in popularity throughout the world. However, this approach has arisen from Eurocentric knowledge systems and not from First Nations people and their communities. Objectives: This research aimed to gain insight into what the Compassionate Communities approach means for First Nations people and identify implications for Māori in Aotearoa New Zealand and Australia. A systematic literature review explored the intersection of Compassionate Communities and First Nations peoples' perspectives and needs. Addressing the overarching question of: What does the Compassionate Communities approach mean for older First Nations people? Design: A Kaupapa Māori approach was used to answer the research question and to explore the literature retrieved. Methods: The main literature search was conducted during 2020-2022, with subsequent searches in 2023 and a final search in 2025. The review was conducted in Covidence systematic review software following the PRISMA process. Screening was completed by two reviewers and assessed against the inclusion and exclusion criteria. Kaupapa Māori theoretical questions were applied to each full-text article, with a rating of positive, neutral or negative allocated to establish conceptual alignment. NVivo thematic analysis software was utilised to code and explore themes. Results: Fifty papers were imported into Covidence, with 22 studies included in the final review. Conclusion: The review found minimal discussion about how Compassionate Communities approaches are implemented in a way that includes First Nations knowledges of ageing and end of life. There is a greater need to understand the contribution First Nations peoples' wellness philosophies make to the Compassionate Communities approach. Evaluations of Compassionate Community initiatives need to be more inclusive of First Nation peoples and their knowledges. In Aotearoa New Zealand and Australia, more research is needed to understand pathways to well-being for older Māori people based upon existing community strengths to ensure flourishing futures. Addressing these knowledge deficits will support efforts to address the inequities experienced by First Nations people as they age and at the end of life.