Findings from the Trial
The future of early frailty prevention: lessons from a national clinical 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.
Infographic
You can download a copy of the infographic here: Link Infographic
Brief
A short summary of the trial findings, written to brief policymakers on key issues surrounding the study and why the data collected is important for future government policies. You can download a copy of the brief here:
The press release can also be read here: UCL News HomeHealth Press Release
Multiple Long-Term Conditions Sub-study
Many older people live with multiple long-term health conditions. We looked at how the symptoms (for example pain, breathlessness, fatigue) affected the progress towards priorities or goals and what could be done to make this easier. These findings are currently in the process of being published. We will then a share a video summarising our findings and provide links to the published papers.
HomeHealth Results Symposium
We hosted a launch event to outline our key findings from the HomeHealth trial. This covered the overall clinical effectiveness, the cost-effectiveness, and the process evaluation results.
The event featured presentations from the HomeHealth team, as well as a panel discussion and expert Q&A around implementation and challenges for delivering the HomeHealth service and similar services within these sectors and populations.
The event took place at the Wellcome Collection, London in November 2023. You can download the presentation content with detailed information of our findings, as well as watch the recorded videos from the event, here: