A systematic review and network meta-analysis stratified by frailty
Objectives and brief methodology
The number of older people in the UK is increasing. Older people, particularly those with long-term health problems and frailty, are core users of NHS and social care services. It is expected that use of health and social care services by the growing older population will increase over the next ten years.
The UK government have recently published the NHS Long Term Plan. This sets out how the NHS will change over the next ten years to meet the needs of the population. A key focus of the NHS Long Term Plan is to enable older people to age well, and provide community services that improve independence and wellbeing. However, an important problem is that we do not have good evidence for how community services for older people, including people living with frailty, should be organised and provided.
In this project we plan to review findings from previous research studies (clinical trials) that have tested different community services for older people living at home, including people living with frailty. We will combine information from the previous research studies to find out which community services are most effective. This will include new information on how services should be organised, which is crucial information for people who develop and provide services. This will help people who run the NHS and social care to decide precisely which services should be offered and who should get them. In turn this should help older people to live longer in their own homes with fewer problems.
We will use a method called network meta-analysis to allow us to compare different kinds of services for older people with each other. This will include key information such as which staff should be involved in a service, how long the service should last for, and whether services are effective when provided in group settings or in people’s homes. This is a major improvement on previous reviews, where usually we only find out if each service is better than not having the service at all. We will also find out if some services are better suited to people with frailty and others are better suited to the general older population.
We will be looking at which service is most effective at helping people to stay living at home. We will also be looking at how different services improve independence and mental health. We will find out if different services can reduce falls, hospital admission and nursing home admissions for older people. We will also look at how much different services cost and if they are cost-effective.
This work will provide important and robust information to providers of services so they can deliver the NHS Long Term Plan and improve health and wellbeing in later life.
To synthesise evidence on the effectiveness of community-based complex interventions to sustain independence for older people, including the effect of frailty and pre-frailty, and group interventions to identify the best configurations.
- Do community-based complex interventions for older people increase living at home, independence and health-related quality of life?
- Do community-based complex interventions for older people reduce home care requirement, depression, loneliness, falls, hospitalisation, care home admission, costs and mortality?
- How should interventions be grouped for network meta-analysis (NMA)?
- What is the optimal configuration of community-based complex interventions for older people?
- Do intervention effects differ by frailty level (not frail; pre-frailty; frailty)?
Systematic review with NMA, following Cochrane methods, GRADE NMA guidance to evaluate quality of evidence, and PRISMA NMA reporting guidance.
Eligible studies are randomised controlled trials (RCTs) and cluster RCTs of community-based complex interventions for older people living at home (mean age 65+), compared with usual care or another complex intervention. The primary outcome is living at home.
Interventions will be grouped in a three-stage process: summarising using TIDieR, content analysis, and nominal group consensus process with expert reference panel.
In addition, meta-analysis results will be presented by different levels of frailty (not frail; pre-frailty; frailty), and by extending the standard and network meta-analyses to a meta-regression.
Impact and dissemination:
Potential for major impact, supporting delivery of the NHS Long Term Plan, with dissemination to policymakers, commissioners, health/social care professionals, older people and researchers.
Partners & Collaborators
Prof Andrew Clegg, Dr Tom Crocker, Dr Joie Ensor, Prof Anne Forster, Prof John Gladman, Prof Richard Riley
Bradford Institute for Health Research, Keele University, University of Leeds, University of Nottingham
Our established Frailty Oversight Group (FOG), made up of patients and public, will work with us to produce plain English summaries and press releases. Members of our FOG will support us to share our work in public meetings, where we will invite feedback on our findings and how they might be best put to use.
01/12/2019 to 31/09/2021