Background Mental health in older adults is often overlooked, or pathologised into dementias and brain diseases. Yet, the spectrum of mental health is as varied as at other life stages, with additional risks to mental health presented by physical decline, onset of ill health, reducing income, social isolation and bereavement. Community interventions can reduce the impact of these, potentially protecting mental health and promoting wellbeing. There is a need to understand: what kind of interventions, for which stressors, prevail in the UK setting; which demonstrate effectiveness, for whom, and how; and, where there may be intervention gaps or need for focused research.
We conducted a scoping review of community-based interventions in the UK, to improve the mental health and wellbeing of older adults, with a focus on psychosocial adversity.
Methods We searched electronic databases to identify academic studies of community interventions which aim to improve mental health and wellbeing outcomes for older adults, extracted data, and conducted a narrative synthesis. Community interventions were broadly defined as any non-clinical intervention that aimed to improve psychosocial aspects of participants lives, and extended to social prescribing and asset-oriented initiatives. This could cover a range of programmes and initiatives from providing mental health-related information, support and advice, broader community engagement, building social connections, mobilising resources.
Results From the 902 studies returned from database searches and 5 studies identified through manual bibliography searching, 889 full-text articles were assessed for eligibility and 56 included in the final data synthesis. Thirteen initial categories of community-based intervention were identified, including: befriending; peer support; group support; creative/cultural activities; welfare advice; social prescribing and asset-based community interventions.
Conclusion The evidence base for effective and cost-effective community public mental health interventions for older adults is mixed and relatively weak. Evidence can be found. e.g. in favour of befriending and in cultural activities, though not always backed by a good understanding of who precisely benefits, and for how long. As a whole, and even within category, strong conclusions are hampered by inconsistent outcome measures, small samples, and lack of follow up. Useful insights in implementation are however presented by interventions with an ‘upstream’ and very localised approach, reflecting more recent directions in policy and practice.
We argue both for greater consistency in concept and outcome measurement, and for inclusion of theory and systems-based approaches to evaluating effectiveness to reflect the complexity of community-based interventions and strategies and goals of reducing inequalities.
This study/project is funded by the National Institute for Health Research (NIHR) School for Public Health Research (Grant Reference Number PD-SPH-2015). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
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