Findings from the Trial

Summary of Findings

Why?

Frailty is being less able to recover after a health problem. It is common in people over 65 and increases disability, hospitalisations and care needs. We designed the HomeHealth service to help people with mild frailty maintain their independence.

The HomeHealth Service

The service consisted of six personalised home-based visits from a support worker. The service was tailored to each person, identifying what they wanted to do to stay well and independent. It could include home exercise programmes, nutritional support to improve energy levels, improving mental well-being and increasing social connections.

What did we do?

The study evaluated the effect and cost-effectiveness of the service with 388 people who were over 65 years old and assessed as having ‘mild frailty’ across 3 areas of the UK. 195 people were randomly allocated to receive the service, the other 193 received their usual care (no additional support). Everyone taking part in the study had three assessments with a researcher – at the beginning, 6 months and 12 months later. At these assessments we gathered information about many areas of life, including frailty, independence, mental wellbeing,  and use of health and social care services. 

What did we find?

People who received the service had a 1/3 fewer unplanned hospital admissions. This saved the NHS £586 per person over the year of the study. The HomeHealth service only cost £294 per person. In our assessments we found no improvement in independence in self-care in the group that received the service. There were, however, small improvements in well-being, psychological distress and frailty score. The other things we measured did not have significant differences between the groups. Care costs & associated time were lower in the group who received the service, but differences were not significant.

Behaviour change is possible in a mildly frail population. On average, participants made moderate progress towards their goals. However, this varied a lot between people.

Upon interviewing some of the people who received the service, we found that:

• Barriers to behaviour change included: understanding the service’s aims and process, intrinsic motivation to make changes and the physical ability to make the desired progress.
• Positive factors included: being open to trying new behaviours, independently identifying things to work on and perseverance when facing difficulties.
• A case-management/empathic listening approach was valued by all participants.
• Improving mobility was the most popular goal.
• People liked that the service was tailored to their needs and abilities.

Why do we think this happened?

The service helped participants to access other existing health and social care services, and fewer people had low physical activity levels – this may have helped reduce unplanned hospital admissions. Covid-19 meant almost all group-based activities (including exercise groups) were shut down. The original service enabled people to attend group exercise classes, however this had be to changed to largely home-based exercises. Missing this component might be an important reason that we did not see more improvements in independence.