Appendix D: Gaps in the evidence
Few rigorous assessments of the effectiveness and cost effectiveness of interventions to promote mental wellbeing in people aged 65 and older have taken place in the UK. Future studies should be sufficiently powered to detect changes in mental wellbeing (for example, maintenance, improvement or worsening of mental wellbeing). In addition, the outcome measures used should be appropriate to detect change across different groups of older people and consistent across studies. PHIAC identified a number of gaps in the evidence relating to the interventions under examination, based on an assessment of the evidence. These gaps are set out below.
1. There was no UK evidence that evaluated the effectiveness of mental wellbeing interventions across different groups of older people, whether by age, cultural background or sexual orientation; nor were any identified that targeted alleviating poverty or living on a reduced income.
2. There were few evaluations that determined which interventions were most effective or whether interventions that focused directly on mental wellbeing (for example, maintaining quality of life or self-esteem) were more effective than those that focused on improving independence and ability to do day-to-day tasks.
3. No evaluations were found of the effect on mental wellbeing of environmental interventions (for example, adaptive equipment or assistive technologies).
4. No evaluations were found of the effect on mental wellbeing of community interventions to improve the physical and social environment (for example, street lighting) that were specifically aimed at older people. No evaluations were found of the impact of access to community facilities and services (such as benefits advice or educational and volunteering opportunities) on the mental wellbeing of older people.
5. No evaluations were found that compared the effectiveness of different practitioners working in different settings to deliver interventions (for example, studies comparing the effectiveness of trained health promotion specialists with community practitioners or specialist exercise personnel with fitness instructors, or comparing delivery in private sector residential homes with day-care centres based in hospitals).
6. There was little evaluation of the specific component of an intervention that would ensure continued effectiveness (for example, disaggregating the effect of social interactions from physical exercise).
7. Generally, evaluations did not report on factors which make particular at-risk groups vulnerable (for example, black and minority ethnic groups, older people in communal or private residential settings, those who live alone, who are homeless, who live in rural settings or who have language or learning difficulties).
8. There was little or no evidence on the characteristics of the provider of an effective intervention (for example, whether effectiveness of interventions depends on the status or characteristics of those delivering the intervention), on the involvement of older people in their design and delivery, or on the involvement of family members and/or carers.
9. There was a lack of long-term evidence for effectiveness and cost effectiveness.
10. In many cases better quality research is required before the wider applicability of the interventions can be determined.
11. There was a lack of evidence of the association between standardised measures of quality of life or emotional and social wellbeing and those used to measure QALYs.
12. There was limited evidence of the cost effectiveness of interventions. As a result, it was not possible to extrapolate the outcomes from many of the studies identified in the effectiveness review to allow a cost–utility analysis.
The Committee made five recommendations for research.