About this guideline

What does this guideline cover?

The Department of Health (DH) asked the National Institute for Health and Care Excellence (NICE) to produce this guideline on dementia, disability and frailty in later life – mid‑life approaches to delay or prevent the onset of these conditions (see the scope).

This guideline does not provide detail on the diagnosis of, or cover treatments for dementia, disability and frailty (see related NICE guidance for other recommendations that may be relevant to the delay or prevention of dementia, disability and frailty).

The absence of any recommendations on interventions that fall within the scope of this guideline is a result of lack of evidence. It should not be taken as a judgement on whether they are cost effective.

How was this guideline developed?

The recommendations are based on the best available evidence. They were developed by the Public Health Advisory Committee (PHAC).

Members of the PHAC are listed in membership of the Public Health Advisory Committee and the NICE project team.

For information on how NICE public health guidelines are developed, see the NICE public health guideline process and methods guides.

What evidence is the guideline based on?

The evidence that the PHAC considered included:

  • Evidence reviews:

    • Review 1 'Issues that prevent or limit the uptake and maintenance of healthy behaviours by people in mid‑life (barriers and facilitators)' was carried out by Cambridge Institute of Public Health, University of Cambridge. The principal authors were: Louise Lafortune, Sarah Kelly, Steven Martin, Isla Kuhn, Andy Cowan, Carol Brayne.

    • Review 2 'Behavioural risk factors in midlife associated with successful ageing and the primary prevention or delay of disability, dementia, frailty, and non‑communicable chronic conditions' was carried out by Cambridge Institute of Public Health, University of Cambridge. The principal authors were: Louise Lafortune, Sarah Kelly, Steven Martin, Olivia Remes, Isla Kuhn, Andy Cowan, Carol Brayne.

    • Review 3 'Effectiveness and cost‑effectiveness of midlife interventions for increasing the uptake and maintenance of healthy lifestyle behaviours and to what extent do the different health behaviours prevent or delay dementia, disability, frailty and non‑communicable chronic diseases related to modifiable lifestyle risk factors' was carried out by Cambridge Institute of Public Health, University of Cambridge. The principal authors were: Louise Lafortune, Sarah Kelly, Steven Martin, Isla Kuhn, Andy Cowan, Carol Brayne.

    • Review 4 'Models of delivery of programmes that aim to increase the uptake and maintenance of healthy lifestyle behaviours in mid‑life' was carried out by the Centre for Public Health, NICE. The principal author was Claire McLeod.

  • Economic modelling 'Cost‑effectiveness of interventions aimed at increasing physical activity to prevent the onset of dementia' was carried out by The Institute for Health Policy and Management, Erasmus University, Rotterdam. The principal authors were: Pieter van Baal, Martine Hoogendoorn.

  • Expert papers

    • Expert paper 1, by Oliver Mytton, UK Health Forum, London

    • Expert paper 2, by Ian Gilmore, Royal Liverpool University Hospitals; Honorary Professor, Department of Medicine, University of Liverpool

    • Expert paper 3, by Linda Bauld, Institute for Social Marketing University of Stirling

    • Expert paper 4, by Adrian Williams, Guys & St Thomas Hospital, London

    • Expert paper 5, by Simon Capewell, Institute of Psychology, Health and Society, University of Liverpool

    • Expert paper 6, by Colin Mitchell, Centre for Health, Law and Emerging Technologies, Nuffield Department of Population Health, University of Oxford

    • Expert paper 7, by Carol Brayne, Institute of Public Health, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge

    • Expert paper 8, by Jamie Waterall, Public Health England

    • Expert paper 9, by Oliver Mytton, UK Health Forum, London

    • Expert paper 10, by Deborah Hall, NIHR Nottingham Hearing Biomedical Research Unit, Nottingham

Note: the views expressed in the expert papers above are the views of the authors and not those of NICE.

In some cases the evidence was insufficient and the PHAC has made recommendations for future research. For the research recommendations and gaps in research, see recommendations for research and gaps in the evidence.

Status of this guideline

The draft guideline, including the recommendations, was released for consultation in July 2014. At its meeting in October 2014, the PHAC amended the guideline in light of comments from stakeholders. The guideline was signed off by the NICE Guidance Executive in December 2014.

The guideline will complement but not replace NICE's guideline on dementia: supporting people with dementia and their carers in health and social care. (For further details, see related NICE guidance).

All healthcare professionals should ensure people have a high quality experience of the NHS by following NICE's recommendations in patient experience in adult NHS services.

All health and social care providers working with people using adult NHS mental health services should follow NICE's recommendations in service user experience in adult mental health.

The recommendations should be read in conjunction with existing NICE guidance unless explicitly stated otherwise. They should be implemented in light of duties set out in the Equality Act 2010.

The guideline is available on NICE's website. The recommendations are also available in a pathway for professionals whose remit includes public health and for interested members of the public.

NICE produces guidance, standards and information on commissioning and providing high‑quality healthcare, social care, and public health services. We have agreements to provide certain NICE services to Wales, Scotland and Northern Ireland. Decisions on how NICE guidance and other products apply in those countries are made by ministers in the Welsh government, Scottish government, and Northern Ireland Executive. NICE guidance or other products may include references to organisations or people responsible for commissioning or providing care that may be relevant only to England.

Implementation

NICE guidelines can help:

NICE has developed tools to help organisations put this guideline into practice.

Updating the recommendations

This guideline will be reviewed 3 years after publication to determine whether all or part of it should be updated. Information on the progress of any update will be posted on the NICE website.

ISBN: 978‑1‑4731‑1382‑4

  • National Institute for Health and Care Excellence (NICE)