Systematic review of social prescribing and older adults: where to from here?

Abstract

ObjectiveSocial prescribing is a person-centred model of care with emphases on lessening the impact of unmet social needs, supporting the delivery of personalised care, and reducing non-medical resource use in the primary care setting. The purpose of this systematic review was to synthesise the effect of social prescribing for older adults within primary care.DesignWe followed standard systematic review guidelines, including protocol registration, screening studies (title/abstract and full text) and assessing the study quality.Eligibility and information sourcesWe searched multiple online databases for studies that included older adults 60+ years (group mean age), an intervention defined and called social prescribing (or social prescription) via health provider referrals to non-medical services, and quantitative physical and psychosocial outcomes and/or health resource use. We included experimental and observational studies from all years and languages and conducted a narrative synthesis. The date of the last search was 24 March 2022.ResultsWe screened 406 citations (after removing duplicates) and included seven studies. All studies except one were before–after design without a control group, and all except one study was conducted in the UK. Studies included 12–159 participants (baseline), there were more women than men, the group mean (SD) age was 76.1 (4.0) years and data collection (baseline to final) occurred on average 19.4 (14.0) weeks apart. Social prescribing referrals came from health and social providers. Studies had considerable risk of bias, programme implementation details were missing, and for studies that reported data (n=6) on average only 66% of participants completed studies (per-protocol). There were some positive effects of social prescribing on physical and psychosocial outcomes (eg, social participation, well-being). Findings varied for health resource use. These results may change with new evidence.ConclusionsThere were few peer-reviewed studies available for social prescribing and older adults. Next steps for social prescribing should include co-creating initiatives with providers, older people and communities to identify meaningful outcomes, and feasible and robust methods for uptake of the prescription and community programmes. This should be considered in advance or in parallel with determining its effectiveness for meaningful outcomes at multiple levels (person, provider and programme).

Effectiveness of social prescribing for chronic disease prevention in adults: a systematic review and meta-analysis of randomised controlled trials

“…Our study resonates with preceding SP reviews regarding the limitations in the available evidence and the need for further high-quality research 23 24 26 29 34 76–78. As we envisioned, there is limited development and evaluation of SP interventions to address the chronic disease risk factors in adults.…”

“…A key strength of this systematic review is that it provides the first evidence of SP in addressing the determinants of chronic diseases by comprehensively synthesising the available data and applying the methodologically rigorous standards of conduct and reporting. It is recommended that this study should be interpreted together with other prior reviews to understand the impact of SP on the person (ie, physical, mental and social well-being), community groups and the healthcare system 23–36. A further strength was performing meta-analyses separately at two assessment points.…”

“…However, some reviews concluded that there was little to no impact on loneliness, health and well-being measures 23 29 31. Additionally, some studies gathered evidence around the effectiveness of SP on community/system levels31 32 and cost-effectiveness,31 or for specific populations such as migrants, older adults, people with diabetes and autism spectrum disorder 33–36. More importantly, these reviews emphasised that evidence was mostly mixed with very low certainty, resulting in largely inconclusive findings.…”

Establishing internationally accepted conceptual and operational definitions of social prescribing through expert consensus: a Delphi study

“…Despite these developments in the social prescribing movement, an agreed definition of social prescribing has yet to emerge 1 9 13–34. The reality is that the definition of social prescribing varies across and within countries 1.…”

Establishing Internationally Accepted Conceptual and Operational Definitions of Social Prescribing Through Expert Consensus: A Delphi Study

“…[35] A conceptual definition outlines what a concept means but it does not explain how to measure it, whereas an operational definition outlines how to measure a concept but it does not explain what it means. Since there is a lack of agreement on both the conceptualization and operationalization of social prescribing, [14,33,34] agreement on both types of definitions is needed. The aim of this study was to establish internationally accepted conceptual and operational definitions of social prescribing.…”