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Results for 'systematic reviews'

Results 1 - 10 of 30

Systematic review of community business related approaches to health and social care

McCLEAN Stuart, et al
2019

This systematic review identifies evidence in relation to the impact of community business-related approaches to health and social care on outcomes for its users. In particular, the report asks how effective community businesses are in delivering outcomes for their users. In recent years community businesses which are rooted in a local area and led by the local community have emerged in the wider health and social care market to address factors in local communities that may benefit or harm health and wellbeing. The report demonstrates that the available evidence of varying quality and more research is needed. However, it found that community businesses related approaches such as ‘men’s sheds’ initiatives, village models for older people and community farms impact on a range of health and wellbeing outcomes, These include outcomes for social connectedness, self-esteem, physical health, mental wellbeing and quality of life. It concludes that community businesses deliver benefits for users that could be at least as effective as traditional models of health and social care but more research is needed to provide robust and evidence-based comparisons.

A systematic review to investigate dramatherapy group work with working age adults who have a mental health problem

BOURNE Jane, ANDERSEN-WARREN Madeline, HACKETT Simon
2018

This study investigated the effects of dramatherapy group work with adults between the ages of 18 and 65 years, who have mental health problems. A systematic review was undertaken using a meta-ethnography to synthesise the existing relevant research. Database searches identified 111 records, from which 12 were included in the review. There was a combined total of n = 194 participants from eleven of the studies; plus one study that did not give exact participant numbers. The included studies were either qualitative or mixed method, with a variety of designs: case studies, interviews, focus groups, observations, questionnaires, evaluations, and use of a variety of measurement tools. There was a range of populations, including: adults with intellectual disabilities, adult offenders, community service users, and in-patients. Participants were from a number of different settings. Overall findings were encouraging and included; improvements in social interaction, improved self- awareness, empowerment and social interaction. No negative effects were reported.

The (cost‐)effectiveness of preventive, integrated care for community‐dwelling frail older people: a systematic review

LOOMAN Wilhelmina Mijntje, HUIJSMAN Robbert, FABBRICOTTI Isabelle Natalina
2019

Integrated care is increasingly promoted as an effective and cost‐effective way to organise care for community‐dwelling frail older people with complex problems but the question remains whether high expectations are justified. Our study aims to systematically review the empirical evidence for the effectiveness and cost‐effectiveness of preventive, integrated care for community‐dwelling frail older people and close attention is paid to the elements and levels of integration of the interventions. We searched nine databases for eligible studies until May 2016 with a comparison group and reporting at least one outcome regarding effectiveness or cost‐effectiveness. We identified 2,998 unique records and, after exclusions, selected 46 studies on 29 interventions. We assessed the quality of the included studies with the Effective Practice and Organization of Care risk‐of‐bias tool. The interventions were described following Rainbow Model of Integrated Care framework by Valentijn. Our systematic review reveals that the majority of the reported outcomes in the studies on preventive, integrated care show no effects. In terms of health outcomes, effectiveness is demonstrated most often for seldom‐reported outcomes such as well‐being. Outcomes regarding informal caregivers and professionals are rarely considered and negligible. Most promising are the care process outcomes that did improve for preventive, integrated care interventions as compared to usual care. Healthcare utilisation was the most reported outcome but we found mixed results. Evidence for cost‐effectiveness is limited. High expectations should be tempered given this limited and fragmented evidence for the effectiveness and cost‐effectiveness of preventive, integrated care for frail older people. Future research should focus on unravelling the heterogeneity of frailty and on exploring what outcomes among frail older people may realistically be expected.

Economic evaluations of falls prevention programs for older adults: a systematic review

OLIJ Branko F., et al
2018

Objectives: To provide a comprehensive overview of economic evaluations of falls prevention programs and to evaluate the methodology and quality of these studies. Design: Systematic review of economic evaluations on falls prevention programs. Setting: Studies (N=31) of community‐dwelling older adults (n=25), of older adults living in residential care facilities (n=3), and of both populations (n=3) published before May 2017. Participants: Adults aged 60 and older. Measurements: Information on study characteristics and health economics was collected. Study quality was appraised using the 20‐item Consensus on Health Economic Criteria. Results: Economic evaluations of falls prevention through exercise (n = 9), home assessment (n = 6), medication adjustment (n = 4), multifactorial programs (n = 11), and various other programs (n = 13) were identified. Approximately two‐thirds of all reported incremental cost‐effectiveness ratios (ICERs) with quality‐adjusted life‐years (QALYs) as outcome were below the willingness‐to‐pay threshold of $50,000 per QALY. All studies on home assessment and medication adjustment programs reported favorable ICERs, whereas the results of studies on exercise and multifactorial programs were inconsistent. The overall methodological quality of the studies was good, although there was variation between studies. Conclusion: The majority of the reported ICERs indicated that falls prevention programs were cost‐effective, but methodological differences between studies hampered direct comparison of the cost‐effectiveness of program types. The results imply that investing in falls prevention programs for adults aged 60 and older is cost‐effective. Home assessment programs (ICERs < $40,000/QALY) were the most cost‐effective type of program for community‐dwelling older adults, and medication adjustment programs (ICERs < $13,000/QALY) were the most cost‐effective type of program for older adults living in a residential care facility.

Occupational therapy fall prevention interventions for community-dwelling older adults: a systematic review

ELLIOTT Sharon, LELAND Natalie E.
2018

Objective: Accidental falls among community-dwelling older adults are preventable and increase the risk of morbidity, hospitalization, and institutionalization. We updated and broadened a 2008 systematic review examining the evidence for the effectiveness of fall prevention interventions in improving fall-related outcomes, occupational performance, quality of life, and health care facility readmissions for community-dwelling older adults., Method: Literature published from 2008 to 2015 from five electronic databases was searched and analysed, Results: Fifty articles met the inclusion criteria and were critically appraised and synthesized-37 provided Level I; 5, Level II; and 8, Level III evidence. Analysis was organized into four intervention themes: single component, multicomponent, multifactorial, and population based. Mixed evidence was found for single-component and multifactorial interventions, strong evidence was found for multicomponent interventions, and moderate evidence was found for population-based interventions., Conclusion: These findings can inform the delivery and integration of fall prevention interventions from acute care to community discharge.

Tackling loneliness: briefing

WHAT WORKS CENTRE FOR WELLBEING
2018

Based on a systematic review of evidence reviews, this briefing summarises the evidence on what works in alleviating loneliness in people aged 55 years and older. A total of 364 reviews were identified and 28 were included in the final review. The review found there is a need for greater clarity on the concept of loneliness and how it differs from social isolation, for both researchers and practitioners. Other key findings show that there is no one-size fits-all approach to alleviating loneliness in older population groups and that tailored approaches are more likely to reduce loneliness. A number of different approaches are being used to alleviate loneliness in older adults. These include: leisure activities; therapies; social and community interventions; educational approaches; befriending; and system-wide activities, such as changing the cultures of care. There was no evidence of approaches doing any harm, however there was a suggestion that some technology-based approaches are not suitable for everyone and could reinforce a sense of social isolation. Suggestions are made on how to improve the evidence-based on interventions for loneliness. The briefing also provides a case study of Community Webs, a project to reduce loneliness and social isolation of patients presenting to GP practices by mobilising community assets.

An overview of reviews: the effectiveness of interventions to address loneliness at all stages of the life-course

VICTOR Christina, et al
2018

This systematic review of reviews examines the effectiveness of interventions to alleviate loneliness. Searches retrieved 364 evidence reviews for screening. The final review provides a synthesis of 14 reviews and 14 reports identified from the grey literature, focused on assessing interventions to alleviate loneliness. The material included is International and from within the UK. All published and grey literature studies included focus on older people. Key findings show that there is no one-size fits-all approach to alleviating loneliness in older population groups and that tailored approaches are more likely to reduce loneliness. A number of different approaches are being used to alleviate loneliness in older adults. These include: leisure activities; therapies; social and community interventions; educational approaches; befriending; and system-wide activities, such as changing the cultures of care. There was no evidence of approaches doing any harm, however there was a suggestion that some technology-based approaches are not suitable for everyone and could reinforce a sense of social isolation. A wide variety of loneliness measures were used, and the concept of loneliness was not clearly defined, with the terms loneliness and social isolation often used interchangeably. The results from controlled study designs in community settings and care homes showed no effect of interventions on loneliness. However, the review notes that loneliness is seldom reported as a primary outcome in the published literature. The review makes a number of recommendations for policy.

Strategies employed by older people to manage loneliness: systematic review of qualitative studies and model development

KHARICHA Kalpa, et al
2018

Objectives: To (i) systematically identify and review strategies employed by community dwelling lonely older people to manage their loneliness and (ii) develop a model for managing loneliness. Methods: A narrative synthesis review of English-language qualitative evidence, following Economic and Social Research Council guidance. Seven electronic databases were searched (1990–January 2017). The narrative synthesis included tabulation, thematic analysis, and conceptual model development. All co-authors assessed eligibility of final papers and reached a consensus on analytic themes. Results: From 3,043 records, 11 studies were eligible including a total of 502 older people. Strategies employed to manage loneliness can be described by a model with two overarching dimensions, one related to the context of coping (alone or with/in reference to others), the other related to strategy type (prevention/action or acceptance/endurance of loneliness). The dynamic and subjective nature of loneliness is reflected in the variety of coping mechanisms, drawing on individual coping styles and highlighting considerable efforts in managing time, contacting others, and keeping loneliness hidden. Cognitive strategies were used to re-frame negative feelings, to make them more manageable or to shift the focus from the present or themselves. Few unsuccessful strategies were described. Conclusion: Strategies to manage loneliness vary from prevention/action through to acceptance and endurance. There are distinct preferences to cope alone or involve others; only those in the latter category are likely to engage with services and social activities. Older people who deal with their loneliness privately may find it difficult to articulate an inability to cope.

A systematic review of outdoor recreation (in green space and blue space) for families to promote subjective wellbeing

MANSFIELD Lousie, et al
2018

This systematic review looks at the wellbeing outcomes when taking part in outdoor activities with family. Although there is existing evidence on the benefits being outdoors has for our wellbeing, there is less evidence of the wellbeing benefits when the time is spent with family. The review included empirical research assessing the relationship between outdoor recreation interventions for families and subjective wellbeing, published from 1997 - October 2017 and grey literature published from 2007-2017. The review reports on fifteen studies in total, including two quantitative, one mixed methods (RCT and interviews), and ten qualitative studies. Overall the review found the evidence base was limited with the number of studies and quality, especially for quantitative studies. The evidence from quantitative studies indicates that taking part in outdoor recreation with families has no significant effect on children's quality of life, and has no significant effect on self-esteem and other measures of psychological wellbeing. Initial evidence findings from qualitative studies showed more positive impacts when taking part in outdoor recreation with families, showing improved self-competence learning and identity; improved wellbeing via escapism, relaxation and sensory experience; and improved social bonding as a family. Analysis of survey data found that people's enjoyment of the outdoors is enhanced when they are spending time with family and friends, and in particular with partners.

Yoga-based exercise improves health-related quality of life and mental well-being in older people: a systematic review of randomised controlled trials

TULLOCH Alice, et al
2018

Objective: health-related quality of life (HRQOL) and mental well-being are associated with healthy ageing. Physical activity positively impacts both HRQOL and mental well-being. Yoga is a physical activity that can be modified to suits the needs of older people and is growing in popularity. A systematic review was conducted with meta-analysis to determine the impact of yoga-based exercise on HRQOL and mental well-being in people aged 60+. Methods: searches were conducted for relevant trials in the following electronic databases; MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, Allied and Complementary Medicine Database, PsycINFO and the Physiotherapy Evidence Database (PEDro) from inception to January 2017. Trials that evaluated the effect of physical yoga on HRQOL and/or on mental well-being in people aged 60+ years were included. Data on HRQOL and mental well-being were extracted. Standardised mean differences and 95% confidence intervals (CI) were calculated using random effects models. Methodological quality of trials was assessed using the PEDro scale. Results: twelve trials of high methodological quality (mean PEDro score 6.1), totalling 752 participants, were identified and provided data for the meta-analysis. Yoga produced a medium effect on HRQOL (Hedges’ g = 0.51, 95% CI 0.25–0.76, 12 trials) and a small effect on mental well-being (Hedges’ g = 0.38, 95% CI 0.15–0.62, 12 trials). Conclusion: yoga interventions resulted in small to moderate improvements in both HRQOL and mental well-being in people aged 60+ years. Further, research is needed to determine the optimal dose of yoga to maximise health impact.

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