What role can local and national supportive services play in supporting independent and healthy living in individuals 65 and over?

Windle, Karen (2015) What role can local and national supportive services play in supporting independent and healthy living in individuals 65 and over? Foresight, Government Office of Science . ISSN GS/15/24

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Executive summary
The UK population is ageing rapidly and the extent of comorbidities will continue to increase. This greater demand for support and care will need to be met within an environment of continued economic restraint. One policy response to mitigate such demand has been the reinvigorated focus on prevention and early intervention in health, social and third sector care. Prevention is broadly defined to include a wide range of services that promote independence; prevent or delay the deterioration of health and well-being resulting from ageing, illness or disability; and delay the need for more costly and intensive services. In exploring the existing evidence base around effective and cost-effective preventative services, our typology of prevention includes the accepted discourse of primary, second and tertiary prevention, while placing those ‘upstream’ well-being interventions at the core of any prevention strategy.

Well-being preventative services across the continuum
• In mitigating social isolation and loneliness, there is relatively good evidence that befriending interventions, social prescribing services, group activities and volunteer schemes can reduce loneliness and depressive symptomology, improve physical health, and result in differences in mortality.
• A range of exercise provision is able to improve balance, cognition, well-being, mobility, core strength and cardio-metabolic health, and reduce fall or fracture risk, depressive symptomology and cognitive decline. Physical activity can be supported through community-based interventions (e.g. walking for health groups, peer-supported exercise programmes), resulting in improved health-related quality of life and reductions in the use of secondary health care.
• Information, advice and signposting are seen as fundamental by individuals, as well as their families or carers, who need (or in the future may need), care and support to maintain independence. However, few studies concentrate on what works for older people, or whether timely and appropriate advice is able to maintain independence or improve quality of life. There is emerging evidence that care navigators (CNs) can provide effective practical and social support to older people, ensuring timely signposting to interventions and acting as a ‘link’ between community and statutory services.
• There is a range of low-level practical interventions that can support older people to remain at home, e.g. minor housing repairs, assisted gardening and shopping. While the link between such services and the use of higher-intensity provision is little discussed in the literature, a timely and trusted response can improve quality of life and reduce service use. Gardening has been shown to improve physical strength, fitness and cognitive ability and to reduce depression and anxiety.

Primary, secondary and tertiary prevention
Available primary and secondary preventative services (e.g. health screening, vaccinations, care management, day services, reablement) should be delivered holistically, i.e. ‘making every contact count’.
• Two national population health screening programmes – breast and bowel screening – demonstrate efficacy. In contrast, the level of uptake of the NHS Health Check has been lower than expected. While older people are more likely to attend, older individuals most likely to benefit (e.g. smokers, minority ethnic groups and those living in more deprived areas) seem less keen to engage.
• Day services for older people are a contested area, often perceived as part of the ‘one-size-fits-all’ welfarist agenda. Where the evidence is available, day services improve social care and quality of life for users and carers, reduce social isolation, may delay institutionalisation for people with dementia, and provide a sense of purpose for the individual, but are unlikely to reduce health service use.
• Care management, essential in supporting the individual to ‘age in place’, can reduce hospital admissions, lengths of stay and Accident and Emergency (A&E) attendances, although outcomes are dependent on the structure and processes adopted. Improved outcomes can be achieved by delivering well-being services alongside statutory provision.
• While reablement improves independence, health-related quality of life and service use, there are continuing process difficulties in appropriately involving or transferring older people to further service provision.
• In exploring tertiary prevention (minimising disability and deterioration from established diseases), the evidence base remains fragmented, with little clarity on the processes, structures or outcomes of, for example, rapid response teams (RRTs) or ambulatory emergency care (AEC) units.

Fragmented evidence base?
There is a wide range of available and effective well-being preventative services that can support older people to live independent and healthy lives. However, there are still gaps in the evidence base. Few evaluations explore whether reported changes in quality of life, service use, morbidity or mortality are maintained long term, with even fewer reporting cost-effectiveness. There is also little evidence that identifies the types of package of early interventions that should be provided, when these need to be offered, and to whom they would make the most difference. The evidence is non-existent on the structures and processes of effective preventative pathways.

The future role of services to 2030
If appropriate management of future pressures on the health and social care environment is to be delivered, the system needs to be rebalanced toward well-being interventions, and primary, secondary and tertiary prevention. However, the budget for such care is continually under threat. There is an urgent need to apply a single health and social care budget, incorporating housing and transport and delivered through a single commissioning point. Perhaps the main challenge in reorienting provision toward preventative care is that there first needs to be an accepted clarity from all partners across the health and social care environment as to what is being prevented – unnecessary hospital admissions or morbidity (ill health). The rhetoric of prevention needs to be embedded into service provision with appropriate care strategies, processes and structures able to support the promotion of well-being and health, rather than the management of disease.

Keywords:older people, prevention, early intervention, well-being, healthy ageing, JCOpen
Subjects:L Social studies > L430 Public Policy
Divisions:College of Social Science > School of Health & Social Care
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ID Code:18826
Deposited On:24 Sep 2015 06:37

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