Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis.
BACKGROUND
In old age, reduction in physical function leads to loss of independence, the need for hospital and long-term nursing-home care, and premature death. We did a systematic review to assess the effectiveness of community-based complex interventions in preservation of physical function and independence in elderly people.


METHODS
We searched systematically for randomised controlled trials assessing community-based multifactorial interventions in elderly people (mean age at least 65 years) living at home with at least 6 months of follow-up. Outcomes studied were living at home, death, nursing-home and hospital admissions, falls, and physical function. We did a meta-analysis of the extracted data.


RESULTS
We identified 89 trials including 97 984 people. Interventions reduced the risk of not living at home (relative risk [RR] 0.95, 95% CI 0.93-0.97). Interventions reduced nursing-home admissions (0.87, 0.83-0.90), but not death (1.00, 0.97-1.02). Risk of hospital admissions (0.94, 0.91-0.97) and falls (0.90, 0.86-0.95) were reduced, and physical function (standardised mean difference -0.08, -0.11 to -0.06) was better in the intervention groups than in other groups. Benefit for any specific type or intensity of intervention was not noted. In populations with increased death rates, interventions were associated with reduced nursing-home admission. Benefit in trials was particularly evident in studies started before 1993.


CONCLUSIONS
Complex interventions can help elderly people to live safely and independently, and could be tailored to meet individuals' needs and preferences.
Beswick
Andrew D
AD
Department of Social Medicine, University of Bristol, Bristol, UK. andy.beswick@bristol.ac.uk
Rees
Karen
K
Dieppe
Paul
P
Ayis
Salma
S
Gooberman-Hill
Rachael
R
Horwood
Jeremy
J
Ebrahim
Shah
S
D000203:Activities of Daily Living / Q000145:classification*; D000368:Aged; D019058:Community Networks / Q000458:organization & administration / Q000706:statistics & numerical data*; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods* / Q000706:statistics & numerical data; D006304:Health Status; D016852:Housing for the Elderly / Q000706:statistics & numerical data*; D006801:Humans; D009026:Mortality; D010351:Patient Discharge; D016032:Randomized Controlled Trials as Topic; D012306:Risk