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British Journal of General Practice

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A scoping review of community holistic interventions for older people with multimorbidity

Timothy Smith, Tahera Patel, Asangaedem Akpan, Andrew Clegg, Dame Caroline Watkins, Catherine Elizabeth Lightbody and Umesh Chauhan
British Journal of General Practice 2020; 70 (suppl 1): bjgp20X711509. DOI: https://doi.org/10.3399/bjgp20X711509
Timothy Smith
University of Central Lancashire
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Tahera Patel
University of Central Lancashire
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Asangaedem Akpan
University of Liverpool
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Andrew Clegg
University of Central Lancashire
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Dame Caroline Watkins
University of Central Lancashire
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Catherine Elizabeth Lightbody
University of Central Lancashire
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Umesh Chauhan
University of Central Lancashire
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Abstract

Background In many areas, new regional community-based services have been established to provide holistic care to patients with high physical, mental and social needs. Older people represent a group with multimorbidity and high healthcare needs that may benefit from holistic care, although uncertainty remains whether such an approach is effective.

Aim To review evidence for community holistic interventions in older people with multimorbidity.

Method The authors screened studies referenced by an earlier Cochrane Review and Academy of Medical Sciences report, both of which looked at interventions and populations more broadly, and their own searches of Medline, EMBASE, trial registration databases and hand-searching of journals since 2015. The authors included controlled community-based studies of holistic interventions with data for people aged at least 60 years.

Results Studies found (five published, two ongoing) were heterogeneous. The only significant improvement relating to physical or mental outcomes occurred in self-rated health scores, seen in two studies. One consisting entirely of diabetics showed developing a self-management plan improved self-rated health (P = 0.023), and Mental Component Summary (P = 0.03). The other used a multidisciplinary-team-guided personal care plan and found self-rated overall health improved (P = 0.02). Three studies looked at service usage, only one seeing a benefit, and only in the second year.

Conclusion Community-based holistic interventions for people with multimorbidity tended to focus on disease management or medication modification, and resulted in few significant benefits, almost entirely in self-rated health measures. Research into interventions focused on those with the highest needs, for example, multimorbidity with frailty; high number of comorbidities may be more likely to demonstrate meaningful benefits.

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British Journal of General Practice: 70 (suppl 1)
British Journal of General Practice
Vol. 70, Issue suppl 1
June 2020
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A scoping review of community holistic interventions for older people with multimorbidity
Timothy Smith, Tahera Patel, Asangaedem Akpan, Andrew Clegg, Dame Caroline Watkins, Catherine Elizabeth Lightbody, Umesh Chauhan
British Journal of General Practice 2020; 70 (suppl 1): bjgp20X711509. DOI: 10.3399/bjgp20X711509

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A scoping review of community holistic interventions for older people with multimorbidity
Timothy Smith, Tahera Patel, Asangaedem Akpan, Andrew Clegg, Dame Caroline Watkins, Catherine Elizabeth Lightbody, Umesh Chauhan
British Journal of General Practice 2020; 70 (suppl 1): bjgp20X711509. DOI: 10.3399/bjgp20X711509
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Print ISSN: 0960-1643
Online ISSN: 1478-5242