What is the impact on health and wellbeing of interventions that foster respect and social inclusion in community-residing older adults? A systematic review of quantitative and qualitative studies

Abstract

Background: Many interventions have been developed to promote respect and social inclusion among older people, but the evidence on their impacts on health has not been synthesised. This systematic review aims to appraise the state of the evidence across the quantitative and qualitative literature.

Methods: Eligible studies published between 1990 and 2015 were identified by scanning seven bibliographic databases using a pre-piloted strategy, searching grey literature and contacting experts. Studies were included if they assessed the impact (quantitatively) and/or perceived impact (qualitatively) of an intervention promoting respect and social inclusion on the physical or mental health of community-residing people aged 60 years and older. Titles and abstracts were screened for eligibility by one reviewer. A second reviewer independently screened a 10% random sample. Full texts were screened for eligibility by one reviewer, with verification by another reviewer. Risk of bias was assessed using standardised tools. Findings were summarised using narrative synthesis, harvest plots and logic models to depict the potential pathways to health outcomes.

Results: Of the 27,354 records retrieved, 40 studies (23 quantitative, 6 qualitative, 11 mixed methods) were included. All studies were conducted in high and upper middle-income countries. Interventions involved mentoring, intergenerational and multi-activity programmes, dancing, music and singing, art and culture and information-communication technology. Most studies (n = 24) were at high or moderate risk of bias. Music and singing, intergenerational interventions, art and culture and multi-activity interventions were associated with an overall positive impact on health outcomes. This included depression (n = 3), wellbeing (n = 3), subjective health (n = 2), quality of life (n = 2), perceived stress and mental health (n = 2) and physical health (n = 2). Qualitative studies offered explanations for mediating factors (e.g. improved self-esteem) that may lead to improved health outcomes and contributed to the assessment of causation.

Conclusions: Whilst this review suggests that some interventions may positively impact on the health outcomes of older people, and identified mediating factors to health outcomes, the evidence is based on studies with heterogeneous methodologies. Many of the interventions were delivered as projects to selected groups, raising important questions about the feasibility of wider implementation and the potential for population-wide benefits.

Systematic review registration: PROSPERO registration number CRD42014010107.

Keywords: Age-friendly environments; Ageing; Health impact; Older people; Social inclusion; Systematic review.

Fig. 1

PRISMA flow diagram of the study selection process

Fig. 2

Quantitative and qualitative studies stratified by intervention category

Fig. 3

The logic model shows some possible outcomes and mediating factors based on scoping work. OP refers to older people; black dashed arrow represents a relationship/impact; ↓ decrease; ↑ increase; (?) symbol means neutral/do not know

Fig. 4

In bold are the mediating factors and outcomes that have been studied by the quantitative and/or qualitative studies. In blue are the additional mediating factors and outcomes identified in this review. OP refers to older people; black dashed lines represent a relationship; ↓ decrease; ↑ increase; (?) symbol means neutral/do not know/evidence is inconsistent

Fig. 5

This diagram shows an overview of the outcomes (depression, mental health, subjective health, physical health, quality of life and wellbeing) that have been studied by the qualitative and quantitative studies (including number of studies), the effect for quantitative studies and the possible mechanisms for these effects as suggested by the qualitative evidence. The dashed arrows that go from the mediating factors to the outcomes indicate solely that according to some participants’ narratives, these factors may contribute to an improvement in health outcomes. See Additional files 4 and 5 for a summary of the studies, and the harvest plot (Table 1), which graphically represents the overall summary of the quantity, direction and strength of the quantitative evidence for the various health outcomes

Fig. 6

This diagram shows an overview of the outcomes (depression, mental health, subjective health, physical health, wellbeing, quality of life, falls and chronic pain) that have been studied by the qualitative and quantitative studies (including number of studies), the effect for quantitative studies and the possible mechanisms for these effects as suggested by the qualitative evidence. The dashed arrows that go from the mediating factors to the outcomes indicate solely that according to some participants’ narratives, these factors may contribute to an improvement in health outcomes. See Additional files 4 and 5 for a summary of the studies, and the harvest plot (Table 1), which graphically represents the overall summary of the quantity, direction and strength of the quantitative evidence for the various health outcomes

Fig. 7

This diagram shows an overview of the outcomes (depression, subjective health, wellbeing, falls and physical health) that have been studied by the qualitative and quantitative studies (including number of studies), the effect for quantitative studies and the possible mechanisms for these effects as suggested by the qualitative evidence. The dashed arrows that go from the mediating factors to the outcomes indicate solely that according to some participants’ narratives, these factors may contribute to an improvement in health outcomes. See Additional files 4 and 5 for a summary of the studies, and the harvest plot (Table 1), which graphically represents the overall summary of the quantity, direction and strength of the quantitative evidence for the various health outcomes

Fig. 8

This diagram shows an overview of the outcomes (depression, anxiety, perceived stress, mental health, physical health, wellbeing, quality of life and falls) that have been studied by the qualitative and quantitative studies (including number of studies), the effect for quantitative studies and the possible mechanisms for these effects as suggested by the qualitative evidence. The dashed arrows that go from the mediating factors to the outcomes indicate solely that according to some participants’ narratives, these factors may contribute to an improvement in health outcomes. See Additional files 4 and 5 for a summary of the studies, and the harvest plot (Table 1), which graphically represents the overall summary of the quantity, direction and strength of the quantitative evidence for the various health outcomes

Fig. 9

This diagram shows an overview of the outcomes (depression, anxiety, mental health, quality of life and wellbeing) that have been studied by the qualitative and quantitative studies (including number of studies), the effect for quantitative studies and the possible mechanisms for these effects as suggested by the qualitative evidence. The dashed arrows that go from the mediating factors to the outcomes indicate solely that according to some participants’ narratives, these factors may contribute to an improvement in health outcomes. See Additional files 4 and 5 for a summary of the studies, and the harvest plot (Table 1), which graphically represents the overall summary of the quantity, direction and strength of the quantitative evidence for the various health outcomes

Fig. 10

This diagram shows an overview of the outcomes (depression, anxiety, perceived stress, mental health, subjective health, physical health, wellbeing, quality of life, falls and chronic pain) that have been studied by the qualitative and quantitative studies (including number of studies), the effect for quantitative studies and the possible mechanisms for these effects as suggested by the qualitative evidence. The dashed arrows that go from the mediating factors to the outcomes indicate solely that according to some participants’ narratives, these factors may contribute to an improvement in health outcomes. See Additional files 4 and 5 for a summary of the studies, and the harvest plot (Table 1), which graphically represents the overall summary of the quantity, direction and strength of the quantitative evidence for the various health outcomes

Fig. 11

This diagram shows an overview of the outcomes (depression, perceived stress, mental health, physical health, subjective health, wellbeing and quality of life) that have been studied by the qualitative and quantitative studies (including number of studies), the effect for quantitative studies and the possible mechanisms for these effects as suggested by the qualitative evidence. The dashed arrows that go from the mediating factors to the outcomes indicate solely that according to some participants’ narratives, these factors may contribute to an improvement in health outcomes. See Additional files 4 and 5 for a summary of the studies, and the harvest plot (Table 1), which graphically represents the overall summary of the quantity, direction and strength of the quantitative evidence for the various health outcomes