Search results for ‘Subject term:"older people"’ Sort:
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An overview of reviews: the effectiveness of interventions to address loneliness at all stages of the life-course
- Authors:
- VICTOR Christina, et al
- Publisher:
- What Works Centre for Wellbeing
- Publication year:
- 2018
- Pagination:
- 87
- Place of publication:
- London
This systematic review of reviews examines the effectiveness of interventions to alleviate loneliness. Searches retrieved 364 evidence reviews for screening. The final review provides a synthesis of 14 reviews and 14 reports identified from the grey literature, focused on assessing interventions to alleviate loneliness. The material included is International and from within the UK. All published and grey literature studies included focus on older people. Key findings show that there is no one-size fits-all approach to alleviating loneliness in older population groups and that tailored approaches are more likely to reduce loneliness. A number of different approaches are being used to alleviate loneliness in older adults. These include: leisure activities; therapies; social and community interventions; educational approaches; befriending; and system-wide activities, such as changing the cultures of care. There was no evidence of approaches doing any harm, however there was a suggestion that some technology-based approaches are not suitable for everyone and could reinforce a sense of social isolation. A wide variety of loneliness measures were used, and the concept of loneliness was not clearly defined, with the terms loneliness and social isolation often used interchangeably. The results from controlled study designs in community settings and care homes showed no effect of interventions on loneliness. However, the review notes that loneliness is seldom reported as a primary outcome in the published literature. The review makes a number of recommendations for policy. (Edited publisher abstract)
Tackling loneliness: briefing
- Author:
- WHAT WORKS CENTRE FOR WELLBEING
- Publisher:
- What Works Centre for Wellbeing
- Publication year:
- 2018
- Pagination:
- 16
- Place of publication:
- London
Based on a systematic review of evidence reviews, this briefing summarises the evidence on what works in alleviating loneliness in people aged 55 years and older. A total of 364 reviews were identified and 28 were included in the final review. The review found there is a need for greater clarity on the concept of loneliness and how it differs from social isolation, for both researchers and practitioners. Other key findings show that there is no one-size fits-all approach to alleviating loneliness in older population groups and that tailored approaches are more likely to reduce loneliness. A number of different approaches are being used to alleviate loneliness in older adults. These include: leisure activities; therapies; social and community interventions; educational approaches; befriending; and system-wide activities, such as changing the cultures of care. There was no evidence of approaches doing any harm, however there was a suggestion that some technology-based approaches are not suitable for everyone and could reinforce a sense of social isolation. Suggestions are made on how to improve the evidence-based on interventions for loneliness. The briefing also provides a case study of Community Webs, a project to reduce loneliness and social isolation of patients presenting to GP practices by mobilising community assets. (Edited publisher abstract)
Interventions for preventing falls in older people in care facilities and hospitals (Review)
- Authors:
- CAMERON Ian D., et al
- Publisher:
- John Wiley and Sons
- Publication year:
- 2018
- Pagination:
- 385
An update of a review first published in 2010 and updated in 2012, to assess the effects of interventions designed to reduce the incidence of falls in older people in care facilities and hospitals. Search methods: The authors searched the healthcare literature for reports of randomised controlled trials relevant to this review up to August 2017. Study characteristics: The review included 95 randomised controlled trials involving 138,164 participants. Seventy-one trials (40,374 participants) were in care facilities, and 24 (97,790 participants) in hospitals. Key results: There was evidence, often from single studies, for a wide range of interventions used for preventing falls in both settings. This review summarises the falls outcomes for four key interventions in care facilities and three key interventions in hospitals. In relation to care facilities, the authors are uncertain of the effect of exercise on the rate of falls (very low-quality evidence) and it may make little or no difference to the risk of falling (low-quality evidence). General medication review may make little or no difference to the rate of falls (low-quality evidence) or the risk of falling (low-quality evidence). Prescription of vitamin D probably reduces the rate of falls (moderate-quality evidence) but probably makes little or no difference to the risk of falling (moderate-quality evidence). The population included in these studies appeared to have low vitamin D levels. The authors are uncertain of the effect of multifactorial interventions on the rate of falls (very low-quality evidence). They may make little or no difference to the risk of falling (low-quality evidence). In relation to hospitals: the authors are uncertain whether physiotherapy aimed specifically at reducing falls in addition to usual rehabilitation in the ward has an effect on the rate of falls or reduces the risk of falling (very low-quality evidence). The authors are uncertain of the effect of bed alarms on the rate of falls or risk of falling (very low-quality evidence). Multifactorial interventions may reduce the rate of falls, although this is more likely in a rehabilitation or geriatric ward setting (low-quality evidence). The authors are uncertain of the effect of these interventions on risk of falling. (Edited publisher abstract)
Comprehensive assessment when older people are in hospital improves their chances of getting home and living independently
- Author:
- NATIONAL INSTITUTE FOR HEALTH RESEARCH. Dissemination Centre
- Publisher:
- National Institute for Health Research
- Publication year:
- 2017
- Place of publication:
- London
This NIHR Signal looks at the findings of an updated Cochrane review which compared the effectiveness of comprehensive geriatric assessment by a multidisciplinary specialist team with routine care for people over 65, excluding those with stroke and orthopaedic conditions. The findings show that older people who received comprehensive geriatric assessment when in hospital were slightly more likely to be living in their own homes one year later. People who received comprehensive geriatric assessment were also 20 percent less likely to be in a nursing home after three months or more. It concluded that comprehensive geriatric assessment may save NHS resources, but the quality of evidence was too low to assess this reliably. NIHR Signals highlight examples of important research and explain why the study was needed, what the study found and the implications of the findings. They include commentary from experts, researchers and those working in practice. (Edited publisher abstract)
Ways of integrating care that better coordinate services may benefit patients
- Author:
- NATIONAL INSTITUTE FOR HEALTH RESEARCH. Dissemination Centre
- Publisher:
- National Institute for Health Research
- Publication year:
- 2018
- Place of publication:
- London
New integrated care models can increase patient satisfaction, perceived quality of care and improve access to services. It is less clear whether there may be effects on hospital admissions, appointments or healthcare costs. This NIHR Signal focuses on an NIHR-funded review which looked at the international literature to understand how new integrated care models may affect patients, providers and systems. It included a qualitative review of attitudes, barriers and enablers of integration. Nearly half of the 267 studies came from the UK. Most investigated integrated care pathways, often as part of a multicomponent intervention including multidisciplinary teams and some form of case management. Most studies focused on older people. The review finds some positives in relation to improved patient satisfaction and perceived quality of care, but overall highlights the complexity of implementing and assessing new models of care. NIHR Signals highlight examples of important research and explain why the study was needed, what the study found and the implications of the findings. They include commentary from experts, researchers and those working in practice. (Edited publisher abstract)
Comprehensive geriatric assessment for older adults admitted to hospital
- Publisher:
- Cochrane Collaboration
- Publication year:
- 2018
- Pagination:
- 110
Background: Comprehensive geriatric assessment (CGA) is a multi-dimensional, multi-disciplinary diagnosis and therapeutic process conducted to determine the medical, mental, and functional problems of older people with frailty so that a co-ordinated and integrated plan for treatment and follow-up can be developed. This is an update of a previously published Cochrane review. Objectives: to critically appraise and summarize current evidence on the effectiveness and value of CGA for older adults admitted to hospital, and to use these data to estimate its cost-effectiveness. Search methods: searched CENTRAL, MEDLINE, Embase, three other databases, and two trials registers on 5 October 2016; and also checked reference lists and contacts. Selection criteria: randomized trials compared to CGAs (delivered on geriatric wards or by mobile teams) versus usual care on a general medical ward or a ward for older people, usually admitted to hospital for acute care or for inpatient rehabilitation after an acute admission were included. Data collection and analysis. The standard methodological procedures expected by Cochrane and Effective Practice and Organization of Care (EPOC) were followed. The GRADE approach was used to assess the certainty of evidence for the most important outcomes. Main results: Review authors found 29 rising trials from 13 countries. These studies compared CGA with routine care for patients over 65 who were admitted to hospital. Most trials evaluated CGA that was provided on a specialized hospital ward or across several wards by a mobile team. The review shows that older people are more likely to be admitted to hospital than to be admitted to hospital. There was no evidence that CGA appeared to be at risk of death during the follow-up period, and noted that CGA appeared to be. There was too much variation in cognitive function and length of hospital stay to draw a conclusion. Authors' conclusions: Older patients are more likely to be alive and in their own homes if they receive CGA on admission to hospital. We are not sure if this is the case. CGA can lead to a small increase in cost, and evidence for cost-effectiveness is low-certainty due to imprecision and inconsistency among studies. Further research that reports cost estimates are required-specific across different sectors of care are required. (Edited publisher abstract)
Reminiscence therapy for dementia
- Authors:
- WOODS Bob, et al
- Publisher:
- John Wiley and Sons
- Publication year:
- 2018
- Pagination:
- 133
Background: This updated Cochrane Review of reminiscence therapy (RT) for dementia was first published in 1998, and last updated in 2005. RT involves the discussion of memories and past experiences with other people using tangible prompts such as photographs or music to evoke memories and stimulate conversation. RT is implemented widely in a range of settings using a variety of formats. Objectives: To assess the effects of RT on people living with dementia and their carers, taking into account differences in its implementation, including setting (care home, community) and modality (group, individual). Search methods: ALOIS (the Cochrane Dementia and Cognitive Improvement Group's Specialized Register) was searched on 6 April 2017 using the search term 'reminiscence.' Selection criteria: all randomised controlled trials of RT for dementia in which the duration of the intervention was at least four weeks (or six sessions) and that had a 'no treatment' or passive control group were included. Outcomes of interest were quality of life (QoL), cognition, communication, behaviour, mood and carer outcomes. Data collection and analysis: Two authors (LOP and EF) independently extracted data and assessed risk of bias. Where necessary, we contacted study authors for additional information. Data was pooled from all sufficiently similar studies reporting on each outcome. Subgroup analysis by setting (community versus care home) and by modality (individual versus group) was undertaken. The GRADE methods to assess the overall quality of evidence for each outcome were used. Main results: included 22 studies involving 1972 people with dementia. Meta-analyses included data from 16 studies (1749 participants). Apart from six studies with risk of selection bias, the overall risk of bias in the studies was low. Overall, moderate quality evidence indicated RT did not have an important effect on QoL immediately after the intervention period compared with no treatment (standardised mean difference (SMD) 0.11, 95% confidence interval (CI) -0.12 to 0.33; I2 = 59%; 8 studies; 1060 participants). Inconsistency between studies mainly related to the study setting. There was probably a slight benefit in favour of RT in care homes post-treatment (SMD 0.46, 95% CI 0.18 to 0.75; 3 studies; 193 participants), but little or no difference in QoL in community settings (867 participants from five studies). For cognitive measures, there was high quality evidence for a very small benefit, of doubtful clinical importance, associated with reminiscence at the end of treatment (SMD 0.11, 95% CI 0.00 to 0.23; 14 studies; 1219 participants), but little or no difference at longer-term follow-up. There was a probable slight improvement for individual reminiscence and for care homes when analysed separately, but little or no difference for community settings or for group studies. Nine studies included the widely used Mini-Mental State Examination (MMSE) as a cognitive measure, and, on this scale, there was high quality evidence for an improvement at the end of treatment (mean difference (MD) 1.87 points, 95% CI 0.54 to 3.20; 437 participants). There was a similar effect at longer-term follow-up, but the quality of evidence for this analysis was low (1.8 points, 95% CI -0.06 to 3.65). For communication measures, there may have been a benefit of RT at the end of treatment (SMD -0.51 points, 95% CI -0.97 to -0.05; I2 = 62%; negative scores indicated improvement; 6 studies; 249 participants), but there was inconsistency between studies, related to the RT modality. At follow-up, there was probably a slight benefit of RT (SMD -0.49 points, 95% CI -0.77 to -0.21; 4 studies; 204 participants). Effects were uncertain for individual RT, with very low quality evidence available. For reminiscence groups, evidence of moderate quality indicated a probable slight benefit immediately (SMD -0.39, 95% CI -0.71 to -0.06; 4 studies; 153 participants), and at later follow-up. Community participants probably benefited at end of treatment and follow-up. For care home participants, the results were inconsistent between studies and, while there may be an improvement at follow-up, at the end of treatment the evidence quality was very low and effects were uncertain. Other outcome domains examined for people with dementia included mood, functioning in daily activities, agitation/irritability and relationship quality. There were no clear effects in these domains. Individual reminiscence was probably associated with a slight benefit on depression scales, although its clinical importance was uncertain (SMD -0.41, 95% CI -0.76 to -0.06; 4 studies; 131 participants). No evidence of any harmful effects on people with dementia was identified. The authors also looked at outcomes for carers, including stress, mood and quality of relationship with the person with dementia (from the carer's perspective). There was no evidence of effects on carers other than a potential adverse outcome related to carer anxiety at longer-term follow-up, based on two studies that had involved the carer jointly in reminiscence groups with people with dementia. The control group carers were probably slightly less anxious (MD 0.56 points, 95% CI -0.17 to 1.30; 464 participants), but this result is of uncertain clinical importance, and is also consistent with little or no effect. Authors' conclusions: The effects of reminiscence interventions are inconsistent, often small in size and can differ considerably across settings and modalities. RT has some positive effects on people with dementia in the domains of QoL, cognition, communication and mood. Care home studies show the widest range of benefits, including QoL, cognition and communication (at follow-up). Individual RT is associated with probable benefits for cognition and mood. Group RT and a community setting are associated with probable improvements in communication. The wide range of RT interventions across studies makes comparisons and evaluation of relative benefits difficult. Treatment protocols are not described in sufficient detail in many publications. There have been welcome improvements in the quality of research on RT since the previous version of this review, although there still remains a need for more randomised controlled trials following clear, detailed treatment protocols, especially allowing the effects of simple and integrative RT to be compared. (Edited publisher abstract)