Exploring the economic implications of a group-based lifestyle intervention for middle-aged adults with chronic schizophrenia and co-morbid type 2 diabetes

Objective: People with schizophrenia are at elevated risk of having type 2 diabetes, compared to the general population. Although there is a growing body of literature on the effectiveness of behavioural interventions to improve physical activity levels and healthy eating habits, there are very few economic evaluations conducted for people with severe mental illness and physical health problems. The aim of this study is to explore the cost-effectiveness of group-based lifestyle interventions for middle-aged adults with enduring long-term schizophrenia and co-morbid type 2 diabetes. Methods: Deterministic decision analytical modelling techniques are applied to explore cost-effectiveness based on the findings from a systematic review on this population. The intervention refers to a group-based lifestyle intervention, which is a combination of exercise, diet and diabetes education over 6 months. The intervention costs are estimated to reflect the UK local context. Results: From the UK National Health Service perspective, the group-based lifestyle intervention is potentially cost-effective, relative to usual care. It costs £80 to achieve an additional unit of Body Mass Index (BMI) lost and the incremental cost-effectiveness ratio is just below £700 to gain an extra Quality Adjusted Life Year, which lies well within the conventionally acceptable threshold values in the UK. Conclusions: Group based life style intervention for this population is effective and can be cost-effective in reducing BMI and improving diabetes knowledge, at least in the short-term. More co-ordinated policies among relevant sectors are required to facilitate behavioural change and better maintain an improved lifestyle. An integrated approach is needed to make this more sustainable in the long-term

The impacts of intergenerational programmes on the physical health of older adults

Background: The ageing population is growing and the dependency ratio is increasing. It is vital to promote healthy ageing of older people to relieve pressure on society. The aim of this study is to explore the effects of community-based intergenerational programmes on older adults’ physical health in terms of their general self-rated health, level of physical activity and physical functioning. Methods: A rapid literature review was performed to identify studies of intergenerational programmes for community-dwelling older adults. The search included peer-reviewed articles published in English from 1986 to 2014 with no country restriction. However, interventions for older people with dementia, as well as for anyone living in residential care were excluded. Supplementary searches were performed and a narrative synthesis was conducted. Results: Seven studies met these inclusion criteria. Intergenerational activities, including volunteering and reminiscence components, have been associated with an overall positive trend in physical health outcomes. Individuals reported having better health, as well as decreased body aches and pain. In addition, participants reported a feeling of being “more active”, with improved energy consumption, increasing the numbers of streets walked and stairs climbed. For physical functioning, older volunteers tended to show less decline in hand grip strength but inconsistent results for walking speed. Conclusion: More studies with longer time horizons and sufficient statistical power are required to determine the optimal level of participation and to address potential barriers to maximising the benefits of intergenerational programmes for socially marginalised groups. More formal evaluations of the costs and benefits of programmes are needed, taking account of broader societal benefits to inform practice and policy for active ageing

Do intergenerational activities do any good for older adults well-being?: a brief review

Introduction: With the rapid growth in the oldest old segment of the population across the world, public policy interests tend to be more directed to quality of life than quantity of life for those of advanced age. Although there is a growing body of literature on the effects of psychosocial interventions for older adults, interventions from a crossgenerational viewpoint are under-researched. This article briefly reviews the impacts on the well-being of community dwelling older people of participation in non-kin related intergenerational activities. Method: A literature review was conducted to assess current research regarding intergenerational activities and outcomes among older adults. The search included English-language publications that reported original data from January 1986 to mid-2014. Studies were published in a peer-reviewed journal and without country restriction. Supplementary searched were performed and a narrative synthesis was conducted. Intergenerational interventions involving older people with dementia were excluded. Results: Overall positive benefits from the intergenerational programmes can be seen in terms of improved cognitive functioning, as well as in the emotional and social dimensions of well-being for older adults living in the community. Conclusion: More studies with larger sample sizes and longer-time horizons are needed to confirm the optimal levels of intensity and duration that would maximize the synergistic effects for all participating generations

Evidence on financing and budgeting mechanisms to support intersectoral actions between health, education, social welfare and labour sectors

Intersectoral collaboration between the health and the social welfare, education or labour sectors can help to influence the social determinants of health. Funding such collaboration can be difficult as these sectors may be subject to very different regulatory structures, incentives and goals. This review found 51 documents on the use of various financial mechanisms to facilitate intersectoral collaboration for health promotion, involving at least two of these sectors. A systematic search of the evidence identified the approaches used, including: discretionary earmarked funding, recurring delegated financing allocated to independent bodies and mechanisms for joint budgeting between two or more sectors. Many of these examples are implemented at a regional or local, rather than national, level and factors that influence their success include organizational structures, management, culture and trust. Potential facilitators include regulatory and legislative frameworks providing incentives, clear accountability for actions and the identification of specific benefits to all participating sectors

Modelling the economic impact of reducing loneliness in community dwelling older people in England

Loneliness has been associated with poor mental health and wellbeing. In England, a 2018 national strategy on loneliness was published, and public health guidelines recommend participation in social activities. In the absence of existing economic evidence, we modelled the potential cost effectiveness of a service that connects lonely older people to social activities against no-intervention. A 5-year Markov model was constructed from a health and social care perspective. Parameters were drawn from the literature, with the intervention structure based on an existing loneliness alleviation programme implemented in several settings across England. Univariate and probabilistic sensitivity analyses were undertaken. The total expected cost per participant in the intervention group is £ 7131 compared to £ 6783 in the usual care group with 0.45 loneliness free years (LFY) gained. The incremental cost per LFY gained is £ 768; in the probabilistic sensitivity analysis the intervention is cost saving in 3.5% of iterations. Potentially such interventions may be cost-effective but are unlikely to be cost-saving even allowing for sustained effects and cumulative adverse health and social care events averted. Empirical studies are needed to determine the cost-effectiveness of these interventions, ideally mapping changes in loneliness to the quality of life, in order to allow the key metric in health economic studies, cost per quality adjusted life year to be estimated

The use of complementary and alternative medicine by adults with allergies: a Czech national representative survey

Background: The prevalence rates of the use of Complementary and Alternative Medicine (CAM) in allergy patients range from 42% in the United States up to 50% in Europe. In the Czech Republic, no such data exists. Our aim was to examine patterns in CAM use in populations with self-reported allergies in the Czech Republic. Methods: A cross-sectional survey was conducted. A sample of citizens aged 15 years and older, sex, age, and region-stratified, was randomly selected from the 2014 voter registration lists (n = 8,395,132). Respondents with self-reported allergies were further analyzed. Results: Overall, 93% of the respondents with self-reported allergies reported the use of 1 or more CAM modalities during the past 30 days. Herbal teas, relaxation techniques, a detoxifying diet, dietary supplements (excluding vitamins and minerals), and reflexology were used in respondents with allergies. Females, under age 30, with higher education, higher income, and self-reported poor health, were significantly associated with the use of CAM among respondents with allergies. Conclusions: The prevalence of CAM use among people with self-reported allergies in the Czech Republic is higher compared to other countries, with determinants of CAM varying across specific CAM categories. More attention to existing use is needed to promote the healthy adoption of CAM by raising awareness of its safe and effective use, both for CAM users as well as for health care providers