Complex Interventions For Elderly People Can Be Beneficial

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Main Category: Seniors / Aging
Also Included In: Rehabilitation / Physical Therapy
Article Date: 03 Mar 2008 - 0:00 PDT

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According to a meta-analysis published in The Lancet, elderly people can improve physical function and live more independently if provided with complex interventions such as preventive home visits and community-based care after hospital discharge. The study of over 90,000 elderly people also led authors to conclude that well-developed services for the elderly should not be withdrawn.

Elderly people tend to have reduced physical capabilities, which leads to increased dependence on others, a need for hospital and long-term nursing-home care, and premature death. Community-based complex interventions seek to preserve physical function and independence in elderly people. Researchers were interested in assessing the efficacy of interventions such as preventive home visits, care after hospital discharge, fall prevention, and education and counseling in a group setting.

The meta-analysis, performed by Andrew Beswick, Department of Social Medicine, University of Bristol, UK, and colleagues, included a systematic review on data from 89 trials. The data consisted of 97,984 people, averaging 65 years of age, who have been living home and had at least six months of follow-up.

The researchers focused on the outcomes of living at home, death, nursing home admission, hospital admission, falls, and physical functions. One typical study that concentrated on these outcomes was the Medical Research Council trial of assessment and management of elderly people in the community.

Results of the meta-analysis include:

• Complex interventions were associated with:
• a 13% reduced risk of nursing-home admission, and therefore improved the chances of living at home
• a 6% reduced risk of hospital admissions
• a 10% reduced risk in the occurrence of falls
• Those who received intervention also improved physical function
• There was no impact on the risk of death

The authors note that admission rates to nursing homes were lower in trials that reported higher death rates for the complex intervention groups.

Results were also different depending on the time period of the trial. Studies that started before 1993 were more likely to show benefits of complex intervention. The period immediately before this, the 1980s to 1990s, was a period of great change in elderly care. During this time, general practice began to include certain principals of effective care.

Beswick and colleagues point out that the specific type or intensity of intervention did not necessarily have an impact on the benefits. They suggest that it could be wise to tailor different types of care to the specific needs and desires of individuals, which could lead to improved care response and adherence without losing any potential benefits.

"Our systematic review and meta-analysis showed that complex interventions can help elderly 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," conclude to the authors. "Complex interventions can help elderly 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 the elderly] would be inappropriate."

Dr. David Stott, Academic Section of Geriatric Medicine, University of Glasgow, and Glasgow Royal Infirmary, UK, and colleagues write in an accompanying editorial: "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."

Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis
Andrew D Beswick, Karen Rees, Paul Dieppe, Salma Ayis, Rachael Gooberman-Hill, Jeremy Horwood, and Shah Ebrahim
The Lancet (2008). 371:725-735
doi:10.1016/S0140-6736(08)60342-6
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Written by: Peter M Crosta
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