Prevention and self-care
What is prevention and how does it work?
The positive impact of assistive products goes far beyond improving the health, well-being, participation and inclusion of individual users – families and societies also benefit. In addition to policy requirements, economic and social benefits make the case for health and welfare systems to invest in assistive products and related services.
WHO 2022
If physical activity were a drug, we would refer to it as a miracle cure, due to the great many illnesses it can prevent and help treat.
Chief Medical Officers, quoted in Public Health England 2020
Preventative approaches seek to promote people’s independence, delay, or avoid people’s wellbeing deteriorating due to illness, disability and / or ageing, and reduce the likelihood of people from experiencing crises in their health and / or social situation. Along with improving people’s wellbeing, preventative support has the potential to reduce demands on health and care services including hospital admissions and long-term residential care. Prevention can apply to people’s mental health as well as their physical health. Self-care refers to individuals, families and communities having the skills and capacity to promote their own wellbeing and to manage aspects of a long-term illness or disability.
Prevention services can potentially incorporate a wide range of both targeted and generic activities. These include: facilitating access to information, skills, and self-care resources; creating safe and enabling living environments through adapted housing and physical aids; using digital technologies to support self-management of conditions and maintain independence; and developing a physical and social environment through which people can access community-based resources and support and engage in wider society.
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Video transcript Open
Prevention and self-care. What is this and how does it work?
One of the goals of integrated care is to enable people to maintain or regain independence and improve their quality of life. Prevention and self-care are as essential to meeting this goal as is the coordination of health and social care services.
With prevention support, people can make informed decisions about their care and wellbeing.
How does prevention support integrated care?
An individual's prevention goals and interventions should be identified as part of the joint needs assessment and care planning process. Prevention then becomes integrated to care coordination and provision.
Supporting people to live healthy lives and preventing or delaying the deterioration of their conditions requires a broad spectrum of interventions. Interventions might include:
- health education and coaching for self-care
- social prescribing
- information and advice services
- telehealth
- telecare.
This expands the range of services that can be used to support individuals' needs. Examples include the coordination of care with a housing association or the local fire service to provide a falls prevention service.
Who are prevention interventions aimed at?
Simply anyone who has deteriorating health or a growing dependency on Health and Social Care. There are great benefits to having services that add to more traditional health and social care.
What do preventive interventions need to succeed?
Strategies include improving people's skills and education, providing an easily navigated service environment, encouraging participation and others.
What is the evidence for outcomes and impact?
There is a growing body of evidence for prevention interventions although their outcomes and impact are varied. With older adults, interventions that support self care effectively increase self-rated health and wellbeing. And research around health coaching programs indicates that they lead to improved self-management and confidence, healthier behaviours and better health outcomes.
By supporting people's understanding of their conditions, encouraging activation and improving overall health outcomes, preventive and self-care programs may result in a reduction in demand for hospital care.
Explore prevention and self-care
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Policy guidance Open
- Global report on assistive technology (World Health Organization 2022)
- Improving health and wellbeing through housing: a High Impact Change Model (Local Government Association 2022)
- A window of opportunity: delivering prevention in an ageing world (International Longevity Centre UK 2022)
- Strengthening the right to independent living: briefing paper (Equality and Human Rights Commission 2021)
- Priorities for local government: transforming later lives (Centre for Ageing Better 2021)
- Health matters: physical activity-prevention and management of long-term conditions (Public Health England 2020)
- Supported self-management: summary guide (NHS England and NHS Improvement 2020)
- Technology and innovation for long-term health conditions (King's Fund 2020)
- Reaching out: guide to helping principal and local councils tackle loneliness (Local Government Association 2019)
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Practice examples Open
- Innovations in social prescribing: the role of housing (HACT 2022)
- Greater Manchester falls prevention: delivering integration and reconditioning (University of Manchester 2022)
- Smarter homes for independent living: putting people in control of their lives (Policy Connect 2022)
- Leeds Neighbourhood Networks report (Centre for Ageing Better 2022)
- Supporting older people to live safely at home - findings from thirteen case studies on integrated care across Europe (International Journal of Integrated Care 2020)
- Bristol Ageing Better Community Navigators Service: final evaluation report of a social prescribing initiative addressing loneliness and social isolation amongst older people (University of the West of England 2020)
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Measuring success Open
- Methods to evaluate perspectives of safety, independence, activity, and participation in older persons using welfare technology. A systematic review (Disability and Rehabilitation: Assistive Technology 2019)
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Research Open
- Evidence review of home adaptations in the UK and other OECD countries: a tripartite framework (UK Collaborative Centre for Housing Evidence 2022)
- Towards a contemporary social care ‘prevention narrative’ of principled complexity: An integrative literature review (Health & Social Care in the Community 2022)
- Exploring the experience of reablement: A systematic review and qualitative evidence synthesis of older people's and carers' views (Health & Social Care in the Community 2022)
- A systematic scoping review of community-based interventions for the prevention of mental ill-health and the promotion of mental health in older adults in the UK (Health and Social Care in the Community 2022)
- A collaborative, multi-sectoral approach to implementing a social prescribing initiative to alleviate social isolation and enhance well-being amongst older people (Journal of Integrated Care 2021) (behind paywall)
- Pros and cons of pet ownership in sustaining independence in community-dwelling older adults: a scoping review (Ageing and Society 2019) (behind paywall)
- New horizons in supporting older people's health and wellbeing: is social prescribing a way forward? (Age and Ageing 2020)
- Arts on prescription for community‐dwelling older people with a range of health and wellness needs (Health and Social Care in the Community 2019)
- Long-term exercise programmes reduce falls and injuries in older adults (National Institute for Health Research 2019)
- Help-at-home for older people: economic evidence (London School of Economics and Political Science 2019)
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Latest evidence Open
No recent resources found for this topic.
How does prevention support integrated care?
Support for self-management is part of the shift in relationship between health and care professionals and people represented by personalised care. This means a person not being seen as a patient with symptoms or different conditions that need treating, but rather as a whole person with skills, strengths, and attributes, as well as needs that need to be met.
NHS England and NHS Improvement 2020
Loneliness can often be associated with older people who live on their own, but it is not just about social isolation or older people; we recognise that being lonely can have an impact irrespective of age and circumstance. Frequent loneliness can also ramp up pressure on public services, increase referrals to adult social care and trigger multiple attendances at GP surgeries.
Local Government Association 2019
Prevention helps individuals and families to maintain as much control as possible over their lives through avoiding or delaying deterioration in their abilities and recovering from a crisis in their health or social situation. It encourages health and social care professionals to support people to take as much responsibility as possible for their own and family’s wellbeing and to feel confident in making decisions over their lives and care. Embedding prevention within a health and social care system facilitates collaboration with broader public services and the voluntary and community sector including those relating to transport, housing, money and finance, and the physical environment.
Who are prevention interventions aimed at?
Preventive interventions and the promotion of self-care are suitable for anyone receiving integrated care, based on personal needs, skills and preferences. Anyone who is at risk of deteriorating health or greater dependency on health and care services would benefit from having access to services that augment or complement more traditional health and social care.
What does prevention need to succeed?
Reablement is generally well-received by older people and their informal carers. However, poor engagement from older people did occur when they had a poor understanding of their role in reablement and when they had not been fully consulted regarding their reablement goals.
Health & Social Care in the Community 2022
Collaborative design involving technology entrepreneurs, health care professionals and patients from the start is an important component of an innovation process.
King's Fund 2020
In the past, prevention orientated services have often struggled to compete for investment with direct health and care services. Integrated care systems must build upon their understanding of the needs of local populations and co-production with people with lived experience and communities to identify and invest sufficiently in the most promising local opportunities for prevention and self-care. Commissioners should take an outcomes-based approach which provides an opportunity for providers to work flexibly within an overall model of support and, in which, monitoring is not based solely on activity levels. Collaboration with wider partners, including private business and the voluntary sector, helps to lever new opportunities and technologies. Alongside commissioning of specific services, the practice of wider health and social care professionals must also seek to promote independence, choice, and wellbeing in their interactions with individuals and families.
What is the evidence for outcomes and impact?
While improvements of functional performance and safety as the primary focus of adaptations studies have been documented in greater depth following RCT studies, health gains and economic benefits were relatively weakly evidenced.
UK Collaborative Centre for Housing Evidence 2022
Older people who participate in year-long exercise programmes fall less and are less likely to be injured if they do fall. Exercise does not increase or decrease their risk of hospitalisation.
National Institute for Health Research 2019
Findings from the economic evaluation presented in this case summary showed positive changes in social care-related quality of life measured with the Adult Social Care Outcomes Toolkit. This included improvements in home cleanliness, dignity, occupation, and usual activities. However, changes were small and not statistically significant.
London School of Economics and Political Science 2019
Prevention is a difficult aspect of health and social care practice to research as it is challenging to accurately predict what would have happened if a support had not been provided and to quantify the contribution of an intervention alongside other factors which could have improved or deteriorated someone’s wellbeing. There is though growing evidence that a range of preventative measures, if well designed and implemented, can result in people reporting better health and wellbeing, being less prone to risks such as falls, being able to manage their long-term conditions, and to remain connected with informal networks and community resources. The impact of preventative approaches on a population's overall use of health and care services, including admissions to hospital, has not yet been formally established through research.