Does a social prescribing ‘holistic’ link-worker for older people with complex, multimorbidity improve well-being and frailty and reduce health and social care use and costs? A 12-month before-and-after evaluation
Open accessAbstract
Aim: To evaluate the impact of ‘holistic’ link-workers on service users’ well-being, activation and frailty, and their use of health and social care services and the associated costs. Background: UK policy is encouraging social prescribing (SP) as a means to improve well-being, self-care and reduce demand on the NHS and social services. However, the evidence to support this policy is generally weak and poorly conceptualised, particularly in relation to frail, older people and patient activation. Torbay and South Devon NHS Foundation Trust, an integrated care organisation, commissioned a Well-being Co-ordinator service to support older adults (≥50 years) with complex health needs (≥2 long-term conditions), as part of its service redesign. Methods: A before-and-after study measuring health and social well-being, activation and frailty at 12 weeks and primary, community and secondary care service use and cost at 12 months prior and after intervention. Findings: Most of the 86 participants achieved their goals (85%). On average health and well-being, patient activation and frailty showed a statistically significant improvement in mean score. Mean activity increased for all services (some changes were statistically significant). Forty-four per cent of participants saw a decrease in service use or no change. Thirteen high-cost users (>£5000 change in costs) accounted for 59% of the overall cost increase. This was largely due to significant, rapid escalation in morbidity and frailty. Co-ordinators played a valuable key-worker role, improving the continuity of care, reducing isolation and supporting carers. No entry-level participant characteristic was associated with change in well-being or service use. Larger, better conceptualised, controlled studies are needed to strengthen claims of causality and develop national policy in this area.
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Of the nine mindfulness-based education studies with control groups, six implemented a waitlist style control.
“of these, six37 38 40 41 50 60 implemented a waitlist style control”
From Workplace interventions to improve well-being and reduce burnout for nurses, physicians and allied healthcare professionals: a systematic review. (2023) · cites this paper as [40]
The Discussion (Strengths and limitations of study; page unavailable) explicitly says this study lacked a control group. It therefore could not be one of the cited studies that implemented a waitlist control; the paper evaluates a social-prescribing link-worker, not mindfulness-based education. (LLM, conf=0.88)
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Experimental — accuracy not yet measuredSchroeder et al and Colgan et al both reported improvements in resiliency levels using the Brief Resilience Scale for participants following the mindfulness-based education sessions compared with the control groups.
“Schroeder et al38 and Colgan et al40 both reported improvements in resiliency levels using the Brief Resilience Scale for participants following the MBE sessions compared with the control groups.”
From Workplace interventions to improve well-being and reduce burnout for nurses, physicians and allied healthcare professionals: a systematic review. (2023) · cites this paper as [40]
The Findings (Health outcomes; page not provided) report changes in well-being and frailty after a social-prescribing intervention. The Discussion (Strengths and limitations; page not provided) says this study had no control group. Searches for Schroeder, Colgan, the Brief Resilience Scale, and mindfulness-based education found no passage addressing the attributed comparison. (LLM, conf=0.77)
Experimental — accuracy not yet measuredColgan et al reported a substantial increase in resiliency levels following the intervention.
“A substantial increase in resiliency levels was reported by Colgan et al40 following the intervention”
From Workplace interventions to improve well-being and reduce burnout for nurses, physicians and allied healthcare professionals: a systematic review. (2023) · cites this paper as [40]
The Methods (Intervention; page unavailable) describe resilience-focused coaching, but the Findings (Health outcomes; page unavailable) report changes in well-being, patient activation and frailty—not resiliency levels. A search for resiliency levels and Colgan found no passage reporting the claimed increase. The cited paper is by Elston et al., not Colgan et al. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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“For metric and interval outcomes (WEMWBS, Wellbeing Star and PAM), a paired t-test was used to test for significance, if the Shapiro–Wilk test for normality was not significant (Ghasemi and Zahediasl, 2012).”
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Flagged first, then by citations
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Cohen, C., Pignata, S., Bezak, E., Tie, M., & Childs, J. (2023) · BMJ open · doi:10.1136/bmjopen-2022-071203 · Cited by 514 · see citing works
- Authors
- Elston, J., Gradinger, F., Asthana, S., Lilley-Woolnough, C., Wroe, S., Harman, H., & Byng, R.
- Affiliations
- Torbay and South Devon NHS Foundation Trust (GB)
- University of Plymouth (GB)
- Age UK (GB)
- Corresponding author
- Elston, Julian
- Venue
- Primary Health Care Research & Development
- Publisher
- Cambridge University Press (CUP)
- Published
- 2019
- Volume
- 20
- Pages
- e135-e135
- ISSN
- 1463-4236 (ISSN-L)
- 1477-1128
- PMC
- PMC6764188
- OpenAlex
- W2966735423
- Cited by
- 78
- References
- 3
- Citations by year
- 2026: 8 · 2025: 16 · 2024: 7 · 2023: 18 · 2022: 16 · 2021: 8 · 2020: 4 · 2019: 1
- FWCI
- 74.59
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Primary Health Care Research & Development (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PEARL (University of Plymouth) (submittedVersion)
- Funders
- Torbay Medical Research Fund
- National Institute for Health and Care Research
- Department of Health and Social Care
- Age UK
- Topics
- Social Sciences › Arts and Humanities › Conservation › Art Therapy and Mental Health
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Keywords
- social prescribing, link workers, older adults, multimorbidity, frailty, well-being, patient activation, health care costs, care coordination, caregiver support, integrated care, chronic disease
- MeSH terms
- Aged, Chronic Disease, Female, United Kingdom, Health Policy, Health Services for the Aged, Health Services Research, Humans, Male, Middle Aged, Social Support, Social Welfare, State Medicine, Utilization Review, Comorbidity, Frail Elderly
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