Recommendations for research
The guideline committee has made the following recommendations for research.
In the UK, which activity‑based interventions are most effective and cost effective at protecting older people who are at risk of a decline in their independence and mental wellbeing?
The evidence of effectiveness and cost effectiveness on interventions to help older people at risk is limited. At‑risk groups include those:
whose partner has recently died
who have recently separated or divorced
who have recently been made redundant or involuntarily retired
who are carers.
The only high quality cost effectiveness evidence available was on the benefits of singing, and this was not specific to any particular groups. A wide range of other activities could be explored.
It is also unclear which utility measures should be used in cost effectiveness studies of these interventions. Evidence of the most effective ways to measure the impact of interventions would inform future updates of the guideline.
In the UK, what are the most effective ways to identify older people who at risk of a decline in their independence and mental wellbeing?
In the UK, what are the key components of a local coordination role to ensure best value for money in promoting older people's independence and mental wellbeing?
The evidence base for recommendation 5.1.1 (to appoint a local coordinator) came mainly from expert testimony and a service mapping review (review 3). Pinpointing the elements of a local coordinator's role that make it a success and good value for money are needed to improve this recommendation. Studies would need to include relevant cost effectiveness data and measures of success.
In the UK, what are the most effective ways of involving older people in developing interventions to promote their independence and mental wellbeing?
There is no evidence on this. Studies would help providers to improve participation in interventions and that, in turn, would help more older people to maintain their independence and mental wellbeing. Evidence on effectiveness would also allow providers to better judge the levels of services needed and ensure enough places are available locally for these activities.
In the UK, which factors or processes in an intervention influence older people's mental wellbeing? How do these factors interact with one another and does the importance differ for different groups?
The evidence base is unclear. By understanding the factors or processes that influence mental wellbeing it will be possible to design more effective interventions. For example, it would be useful to determine whether the importance of these factors and processes varies according to ethnicity, long‑term disability, level of social deprivation, gender, sexuality or geography (urban or rural). Evidence is also needed on:
optimal duration or intensity of the intervention
duration of benefits following the intervention
relative effectiveness of interventions provided remotely (via telephone or internet) compared with face‑to‑face
impact of the interactions between factors (such as between gender and social deprivation) and the size of impact?
In the UK, which mid‑life groups are currently at most risk of losing their independence or experiencing poor mental wellbeing in later life? And which interventions are most effective and cost effective in preparing these people for later life?
Interventions that prevent or slow down a decline in independence and mental wellbeing in mid‑life may be more cost effective than later interventions. But there is a lack of UK‑based evidence on the effectiveness and cost effectiveness of a range of interventions for this age group.
Evidence on the most effective ways of measuring the impact of these interventions could also help commissioners and providers to evaluate their services, and inform guideline updates.