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Supporting self-care in community-dwelling older adults using complex interventions can increase self-rated health and quality of life, and reduce the occurrence of falls

Wong K, Wong F, Yeung W, et al.  The effect of complex interventions on supporting self-care among community-dwelling older adults: A systematic review and meta-analysis  Age and Ageing. 2018; 47(2): 185-193.

Review question

• What are the effects of community-based, complex self-care interventions on maintaining activities of daily living, instrumental activities of daily living and quality of life, and on preventing falls, fear of falling and subsequent hospitalization, in comparison with usual care among community-dwelling older adults?

Background

• Self-care techniques are critical for community-dwelling older adults to maintain a good health and remain independent. Outcomes of increased self-care practices include decreased psychological distress, disability and hospitalization.
• Complex interventions to support self-care in older adults are defined as interventions that contain a combination of several interacting components that support self-care through identification of physical, psychosocial and environmental needs.
• The aim of this systematic review is to identify the effects of community-based complex interventions on the lifestyle of older, community-dwelling adults as compared to usual care strategies.

How the review was done

• A detailed search of a number of electronic databases was conducted to identify studies published between January 2006 and October 2016. Randomized controlled trials examining complex interventions to support self-care among community-dwelling older adults in comparison with usual care were included in the review.
• A total of 22,132 studies were identified in searches, and 22 were included in the review after assessments for eligibility.
• This review was funded by the General Research Fund of the Research Grants Council of Hong Kong. 

What the researchers found

• The studies included in the review identified an overall positive benefit of complex interventions to improve the quality of life of older adults. However, there was no significant improvement for older adults in maintaining activities of daily living, fear of falling, reduction in health service utilization, or depression.
• Complex interventions did, however, reduce the number of falls for older adult participants by 40%, and improved self-rated health status, which can be associated with functional decline.

Conclusion

• The findings of this review identified the strengths of complex interventions encouraging self-care practices as decreased incidence of falls, as well as an improvement in self-rated health and quality of life. The meta-analysis revealed no significant evidence of effectiveness in improving activities of daily living, hospital admissions or depression.
• The review is unique as it addresses the care needs of relatively healthy older adults. Limitations to this review include a high level of inconsistency and heterogeneity across studies.