Maintaining independence in older adults

Maintaining independence (“ageing in place”) is a priority for older adults, their care providers, and healthcare systems.1 Many community based interventions are being implemented to support this goal. They are typically complex, involving multiple components targeting multiple known or hypothesised determinants of independent living such as individualised care plans, medication reviews, exercise, and nutrition.2

Previous evidence syntheses have either “lumped” all complex interventions together or focused on a specific combination of interventions (or their component parts) and compared them with “usual care” (defined, if at all, quite variably across primary studies), providing some evidence of effectiveness, albeit with small overall effects and wide variation.23456 Decision makers planning a complex intervention would likely want to know not just that a complex intervention is better than none but how one complex intervention compares with another.

Crocker and colleagues (doi:10.1136/bmj-2023-077764) attempt to fill this gap through their systematic review and network meta-analysis.7 Although …