Helping older people live safely and independently

Complex interventions such as preventive home visits and community-based care after hospital discharge can help improve physical function and maintain independent living in older people, according to a Bristol University study of more than 90,000 older people published in this week's edition of the Lancet.

The authors also advise against withdrawal of existing well-developed services for older people.

In old age, reduction of physical function leads to loss of independence, the need for hospital and long-term nursing-home care, and premature death.

Andrew Beswick of Bristol's Department of Social Medicine and colleagues at Oxford University and the London School of Hygiene and Tropical Medicine did a systematic review to assess the effectiveness of community-based complex interventions in preserving physical function and independence in older people. These interventions include preventive home visits for older people, community based care after hospital discharge, fall prevention, and group education and counselling.

They did a meta-analysis (which combines results from previous studies) on  data from 89 trials which involved 97,984 older people.  The outcomes studied were living at home, death, nursing home and hospital admissions, falls, and physical function.

The researchers found that complex interventions improved the chances of living at home, explained mainly by a 13 per cent reduced risk of nursing-home admission. Mortality was unaffected. The risk of hospital admission was reduced by 6 per cent, the occurrence of falls by 10 per cent, and physical function was improved in those receiving the intervention.

Andrew Beswick said: “Our systematic review and meta-analysis showed that complex interventions can help older people to continue living at home, largely through prevention of the need for nursing home care, and can help to reduce the rate of falls.

“Such interventions can also help older people to live safely and independently, and could be tailored to meet individuals' needs and preferences. We believe that our general conclusion, drawn from all the available randomised evidence suggests that a withdrawal of existing well developed services for older people would be inappropriate.”

In an accompanying Comment, Dr David Stott, Academic Section of Geriatric Medicine, University of Glasgow, and Glasgow Royal Infirmary, UK said: “There are major challenges in the establishment of access to multifactorial intervention for frail older people living in the community. The numbers of qualified health-care workers are limited, and the number of older people that might benefit is growing. However, benefits will be maximised if we avoid ineffective or poorly coordinated systems of care, and concentrate on trying to replicate what we know works. It is vital we get this right – there is the potential to improve the quality of life for elderly people and their carers, and possibly even to reduce the costs of health and social care.”

Paper

Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis by Andrew D Beswick, Karen Rees, Paul Dieppe, Salma Ayis, Rachael Gooberman-Hill, Jeremy Horwood, Shah Ebrahim The Lancet Vol 37.