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Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis
Open accessAbstract
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.Findings 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.Interpretation Complex interventions can help elderly people to live safely and independently, and could be tailored to meet individuals' needs and preferences.
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Metadata
- Authors
- Beswick, A. D., Rees, K., Dieppe, P., Ayis, S., Gooberman-Hill, R., Horwood, J., & Ebrahim, S.
- Affiliations
- University of Bristol (GB)
- Corresponding author
- Beswick, Andrew D
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2008-03
- Volume
- 371
- Issue
- 9614
- Pages
- 725-735
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC2262920
- OpenAlex
- W2123193855
- Cited by
- 780
- References
- 118
- Citations by year
- 2026: 10 · 2025: 25 · 2024: 33 · 2023: 21 · 2022: 22 · 2021: 53 · 2020: 44 · 2019: 60 · 2018: 59 · 2017: 60 · 2016: 65 · 2015: 57 · 2014: 52 · 2013: 57 · 2012: 48
- FWCI
- 3.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- The Lancet (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- BIBSYS Brage (BIBSYS (Norway)) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- Bristol Research (University of Bristol) (submittedVersion)
- Funders
- Medical Research Council
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Keywords
- complex interventions, multifactorial intervention, physical function, independent living, older adults, community-based intervention, nursing home admission, hospitalization, falls, mortality
- MeSH terms
- Activities of Daily Living, Aged, Health Status, Humans, Mortality, Patient Discharge, Risk, Geriatric Assessment, Randomized Controlled Trials as Topic, Frail Elderly, Housing for the Elderly, Community Networks
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