Author
Godfrey Mary;
Title
Preventative strategies for older people: mapping the literature on effectiveness and outcomes.
Publication details
Oxford: Anchor Housing, 1999.
Summary
The study was commissionedby the Joseph Rowntree Foundation and the Anchor Trust, on behalf of the National Preventative Task Group. The overall aim of the project was to carry out a systematic review of the research literature and identify the impact and effectiveness of preventative services in promoting successful ageing.
Context
In order to focus the review, the key problem posed at the outset was how to conceptualise prevention in the context of ageing? What kinds of services or interventions can be viewed as having a preventative emphasis? What are they preventing? And what kinds of outcomes can they be expected to deliver? There is increasing emphasis on the value of preventative strategies at national policy level. But a key problem at the heart of any consideration of the effectiveness is the different meanings attached to prevention in different policy contexts and within research literature.
Method
At the outset, the scope of the review was defined in very broad terms. The Task Group identified seven questions to shape the search for evidence. These questions addressed things such as which services were important in improving or maintaining quality of life for older people. As well as broad in scope the review was required to be both systematic and comprehensive. It was not part of the brief however to evaluate the quality of the research evidence located. Five electronic databases were initially identified for systematic searching; Medline, Cinahl. Sociofile, Helmis and Caredata. These specific databases were selected to ensure coverage of health and social care dimensions of prevention. After initial scoping exercises the Task Group decided the review should be centred on services/interventions within three broad areas:
- Services whose goal was to decrease dependency and maintain autonomy in the context of managing limitations and compensating for losses.
- Those designed to increase social support.
- Those aimed at preventing symptoms of depression consequent upon loss (psychological, interpersonal, social and functional).
This decision reflected the current policy interest in the effectiveness of such services and was an acknowledgement that in health there already existed several systematic review facilities. One significant area that wasn't covered in the review was the issue of services/interventions to support caregivers. Also excluded from the remit here were rehabilitation and recuperation.
Contents
The chapters are concerned with:
- Low intensity services to reduce dependency. This chapter looks at issues of home care and housing adaptations.
- Loneliness in old age: supporting social networks. This looks at volunteer linking or befriending and mutual support groups.
- Depression in older people. This looks at identifying and treating depression in older people and preventative interventions in depression.
Each of these chapters looks at the evidence base, the nature of evidence and findings, searching for and locating evidence and a summary of the evidence. The final chapter takes the form of a summary and conclusions and looks at conceptual and methodological difficulties, the evidence base and future research. There are four appendices, which contain brief abstracts of literature pertaining to each chapter.
Conclusion
"The overwhelming conclusion from the review is that if 'prevention' is to be taken forward, what is required is a sustained and explicit research endeavour. This would need to encompass more systematic evaluations of specific interventions and a consideration of what are the appropriate outcomes and measures of outcome against which to evaluate effectiveness. It also requires as indicated above, more sustained interdisciplinary research to develop understanding of the processes involved in "successful ageing.""
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