Preventive interventions to improve older people’s health outcomes: systematic review and meta-analysis

Abstract

Aim: To examine the effectiveness of preventive primary care interventions for older people and to identify common components that contribute to intervention success. Design and setting. Systematic review and meta-analysis of 18 randomised controlled trials (RCTs) published from 2009–2019. Method: Search was conducted in PubMed, MEDLINE, Embase, Web of Science, CENTRAL, CINAHL, and the Cochrane Library. Inclusion – sample mainly aged 65+; delivered in primary care; non-disease-specific. Exclusion – non-RCTs; primarily pharmacologic or psychological interventions; outcomes of interest not reported. Risk of bias assessed using the original Cochrane tool. Outcomes were use of hospital and aged residential care (ARC), and patient-reported outcomes including activities of daily living (ADLs) and self-rated health (SRH). Results: Interventions had no overall benefit to health care use, but we observed higher basic ADL scores (standardised mean difference [SMD] 0.21, CI 0.01 to 0.40) and higher odds of reporting positive SRH (odds ratio [OR] 1.17, CI 1.01 to 1.37). When we examined intervention effects by components, better patient-reported outcomes were observed in studies that changed the care setting, studies that included educational components for health professionals, and studies that provided patient education. Additionally, intervention participants' hospitalisations were fewer by 23% in studies that changed the care setting (rate ratio 0.77, CI 0.63 to 0.95) and by 26% in studies that provided patient education (rate ratio 0.74, CI 0.56 to 0.97). Conclusion: Preventive primary care interventions are beneficial to older people’s functional ability and SRH but not for other outcomes.

Patient centred outcomes should be focus of interventions to sustain independence in older people

“…We recently reviewed the impact of complex preventive interventions as a whole and by their individual components, regardless of whether the components were considered to be active ingredients by the trialists 2. We were unable to find significant benefits in most of our analyses.…”