Maintaining independence in older people

Abstract

Appropriate social and medical interventions may help maintain independence in older people. Determinants of functional decline, disability and reduced independence are recognized and specific interventions target the treatment of clinical conditions, multiple health problems and geriatric conditions, prevention of falls and fractures, and maintenance of physical and cognitive function and social engagement.Preventive strategies to identify and treat diverse unmet needs of older people have been researched extensively. We reviewed systematically recent randomized controlled trials evaluating these 'complex' interventions and incorporated the findings of 21 studies into an established meta-analysis that included 108,838 people in 110 trials. There was an overall benefit of complex interventions in helping older people to live at home, explained by reduced nursing home admissions rather than death rates. Hospital admissions and falls were also reduced in intervention groups. Benefits were largely restricted to earlier studies, perhaps reflecting general improvements in health and social care for older people. The wealth of high-quality trial evidence endorses the value of preventive strategies to help maintain independence in older people.

The clinical effectiveness and cost-effectiveness of home-based, nurse-led health promotion for older people: a systematic review.

“…The reviews were not limited to nurse-led interventions and were not focused on the UK context. Three of these reviews 8,14,32 did not find a significant reduction in mortality. However, the results from the review by Elkan et al 10 concur with the findings of the meta-analyses presented here.…”

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT

“…[73][74][75][76] We also found evidence that targeted supervised home strength and balance exercise programmes plus walking practice, delivered by a trained health professional, can prevent falls. 77 Untargeted group exercise (particularly balance) may also prevent falls.…”

“…79 Exercise does not appear to have an effect on depressive symptoms. 80 From 16 reviews including 11-159 trials and one overview regarding falls prevention, [73][74][75][76]78,[80][81][82][83][84][85][86][87][88][89][90] we found that exercise programmes assessing risk for falls and managing this, anti-slip devices in shoes, home safety assessment and modification and training in walking aid use, may help prevent falls. The strongest evidence related to exercise, which reduces the risk and rate of falls in community-dwelling older adults, 73,75,78,[81][82][83][84][85] though some authors advocate caution with using exercise interventions in frailer older adults.…”

“…78,81 Falls risk assessment and management appears to be effective. 81,83 Falls prevention programmes may reduce falls risk by up to 10% and may also reduce the fear of falling and falls-related injuries; 75,76,80,85,[88][89][90] however, results are inconclusive in cognitively impaired older adults. 74 Walking aids should be correctly sized and adapted, recommended by a health professional and only used when necessary with training.…”

Promoting active ageing through a physical exercise program aimed at reducing frailty and risk of falling among older adults

“…Introduction: Risk of falling and frailty have been revealed as the most important conditions causing dependency among older people [1]. Older adults taking physical activity regularly can benefit of a proper maintenance of muscle strength and mass, which helps to retain function and independence, and to prevent falls and other injuries [2].…”