Social prescribing programmes to prevent or delay frailty in community-dwelling older adults

The increasing incidence of frailty is a health and social care challenge. Social prescription is advocated as an important approach to allow health professionals to link patients with sources of support in the community. This study aimed to determine the current evidence on the effectiveness of social prescribing programmes to delay or reduce frailty in frail older adults living in the community. A systematic literature review of published (DARE, Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, NICE and SCIE, NHS Economic Evaluation Database) and unpublished databases (OpenGrey; WHO Clinical Trial Registry; ClinicalTrials.gov) were searched to July 2019. Studies were eligible if they reported health, social or economic outcomes on social prescribing, community referral, referral schemes, wellbeing programmes or interventions when a non-health link worker was the intervention provider to people who are frail living in the community. 1079 unique studies were screened for eligibility. No papers were eligible. There is therefore a paucity of evidence reporting the effectiveness of social prescribing programmes for frail older adults living in the community. Given that frailty is a clinical priority and social prescribing is considered a key future direction in the provision of community care, this is a major limitation

Crude associations between the 13 symptoms used in algorithm construction and a positive HAT test.

*<p>Significantly associated with being identified as a case, at p<0.05. Kerendel's sign (painful tibia) was present in 33.3% of cases and independently significantly associated with a positive test outcome (individual OR 5.9, p-value <0.001) but was combined with other more rare symptoms into the larger category ‘neurological problems’. There were no significant differences in demographic characteristics (age, sex, residency status, location) between cases and non-cases (data not shown). OR: Odds ratio. CI: Confidence interval.</p

Presenting symptom data collected and used in algorithm construction.

<p>Presenting symptom data collected and used in algorithm construction.</p

Receiver operating curve diagram of all candidate syndromic algorithms evaluated.

<p>Each point represents the sensitivity and 1-specificity of a single algorithm. Ideally, the highest performing algorithms would be located in the top left corner of the graph.</p

Performance of previously published syndromic algorithms.

<p>Performance of previously published syndromic algorithms.</p

Effectiveness of lifestyle and psychosocial interventions in reducing cognitive decline in older people: Systematic review

BackgroundObservational findings suggest that a third of dementia cases are attributable to modifiable risk factors (Livingston et al, 2017). However, we are still unclear on what non- pharmacological interventions should look like or what a manualised dementia prevention programme might include.MethodPubMed, EMBASE (Ovid), PsycINFO, CINAHL, Web of Science, and reference lists of included studies were systematically searched and screened by two independent reviewers. We included lifestyle and psychosocial interventions that aimed to reduce cognitive decline in healthy people aged 50+, and people of any age with Subjective Cognitive Decline or Mild Cognitive Impairment. We narratively synthesised evidence, prioritising results from studies rated at lower Risk of Bias (ROB) and used Centre for Evidence Based Medicine guidelines to grade levels of evidence. These findings were used to inform co- production of an internationally collaborated APPLE- Tree (Active Prevention in People at risk of dementia: Lifestyle, bEhaviour change and Technology to REducE cognitive and functional decline) programme.ResultA total of 64 studies were included describing psychosocial (n=12), multi- domain (n=10), exercise (n=36) and dietary (n=6) interventions. We found Grade A evidence that 4+ months of aerobic exercise twice weekly had a moderate effect on global cognition. With interventions that integrate, cognitive and motor challenges (e.ge. dance or dumb bell training) had small to moderate effects on memory or global cognition. We also found Grade B evidence that 4+ months of creative art or storytelling groups; 6 months of resistance training and a two- year, dietary, exercise, cognitive training and social intervention had small but positive effect on global cognition. Conflicting evidence was observed for interventions solely focusing on increasing Mediterranean diet adherence. With effects for some interventions remaining up to a year beyond facilitated sessions. Only two lower ROB studies measured impact of non- pharmacological interventions onto dementia incidence with neither finding significant effects.ConclusionBased on current published findings an evidence- based intervention strategy to improve global cognition, memory and executive functioning should include group therapy carried out for 4+ months, promoting engagement in regular (at least weekly) activity, involving aerobic or resistance exercise, and cognitively demanding (visuospatial/memory) or creative tasks.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163848/1/alz042843.pd