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No clear evidence that home-based programs to change behaviour improve health outcomes of frail old adults

Gardner B, Jovicic A, Belk C, et al.  Specifying the content of home-based health behaviour change interventions for older people with frailty or at risk of frailty: An exploratory systematic review BMJ Open. 2017 Feb; 7(2).

Review question

• How do home-based health programs for frail older adults help in behaviour change, and how do these changes promote better health outcomes among these adults?

Background

• Frailty is prevalent among a growing number of older people and is associated with a number of negative health outcomes such as disability and premature death.
• A number of home-delivered programs for frail adults exist, but there is a lack of understanding around which programs work, and what specific part of each program is effective in leading to behavioural changes that can help protect against the negative health outcomes associated with frailty.
• Understanding how home-delivered programs can best induce behavioural changes that can help improve health, and whether or not these changes improve health outcomes in frail older adults, is required to inform clinical practice.

How the review was done

• A detailed search of 15 electronic databases for studies published up to 2014 was conducted. Studies involving randomized controlled trials focusing on home-based behavioural change programs in older adults with, or at risk of, frailty were included in this review.
• A total of 25,617 articles were identified in searches, and 19 studies were included in the review after assessments for eligibility.
• The review was funded by the National Institute for Health Research Health Technology Assessment grant.

What the researchers found

• The review found that home-based programs to change behaviour commonly focused on medication management, promoting physical activity, or a healthier diet.
• Very few programs addressed the underlying theories of behaviour change, such as motivation, or provided feedback which could explain the mixed results of the many interventions looked at in this review.
• It is difficult to assess whether the programs included in this review failed to cause behavioural change, or whether that behavioural change was ineffective in improving health outcomes.

Conclusion

• This review found no evidence that home-based programs to change behaviour improved health outcomes in frail older adults. Since many programs did not adhere to theories underlying behavioural change, it may be beneficial to create future programs with the help of experts in behavioural change.