Lifestyle Matters

The Challenges

Current national Guidance from the National Institute for Care and Clinical Excellence promotes the introduction of services and community based initiatives to enable older people to retain health and wellbeing and avoid mental ill health which is frequently associated with later life. The Guidance is informed by evidence, which demonstrates the relationship between extent of social activity and maintenance of health in the extended lifespan and the importance of participation in meaningful activities for mental well-being. More evidence is required to determine ascertain how mental well-being can be promoted in later life and particularly in those at risk of decline.

An occupation-based intervention designed in the United States to promote continued participation and engagement (Lifestyle Redesign) was shown to be effective in improving the mental well-being of older adults through two randomised controlled trials. The aim of the Lifestyle Matters randomised cotrolled trial was to test whether an intervention modelled on Lifestyle Redesign and adapted for a UK population could also demonstrate similar benefits with community living older people.

The Research

288 independently living adults aged 65 years or over, with no cognitive impairment were recruited from two sites in the UK between December 2011 and November 2015. Participants were randomised to either receive the Lifestyle Matters intervention, or ‘treatment as usual.’ Lifestyle Matters is a National Institute for Health and Care Excellence recommended multi-component preventive programme designed to improve the mental well-being of community living older people at risk of decline. It involves weekly group sessions over 4 months and monthly one to one sessions. The primary outcome for the study was mental well-being at 6 months following entry into the study using the mental health dimension of quality of life on the SF-36 outcome measure. Secondary outcomes included physical health dimensions of quality of life (also measured by the SF-36), existence of depression (measured by the PHQ-9), quality of life for health economic analysis (measured by the EQ-5D), self efficacy measured by the General Self Efficacy scale and perceived loneliness (measured by the de Jong Gierveld Loneliness Scale). All those who took part in the study completed these measures when they first entered the study and again 6 and 24 months later. A small number of participants were also interviewed at 6 and 24 months after entry into the study to explore their experiences during this time and for those who had taken part in Lifestyle Matters, whether they thought it had had any impact upon their lives.

The Results

Analysis of data collected from use of all the measures described above showed that participants who took part in Lifestyle Matters did not have a significantly different quality of life from those who did not take part. One measure of loneliness showed that those who took part in Lifestyle Matters may have reduced perceptions of loneliness. Interviews with participants showed that those who took part in Lifestyle Matters considered that they had derived some benefit but only the groups, and gained some benefit, but only two of the 13 people who had taken part in Lifestyle Matters and who were interviewed 24 months after joining the study talked about experiencing “major” benefit.
Therefore the results of the Lifestyle Matters trial were neutral; not showing that participation in Lifestyle Matters has an impact upon mental wellbeing as measured on the SF36. However we also know that the study population recruited to participate in this particular study were not on the cusp of mental decline. Currently preventive health services are not readily available in the UK and so identifying these individuals is very challenging.

The Impact

The impact of the Lifestyle Matters programme continues to be realised despite the neutral results. The intervention continues to be recommended by the National Institute for Health and Clinical Excellence.
Gail Mountain and Claire Craig receive a constant stream of enquiries from practitioners and students (particularly from occupational therapists) working in the UK, Europe and globally regarding implementation of Lifestyle Matters. A few of the many examples of implementation include programmes delivered by occupational therapists in Yorkshire and Derbyshire, in Brighton, in Scandanavian countries and in Puerto Rico.

A programme of dissemination led to presentations at the UK and US Occupational therapy congresses and also the World Congress of Healthy Ageing in South Africa.

The Lifestyle Matters programme of research enabled the study team to examine the appropriateness of the intervention for other groups of older people with specific health challenges.

A fidelity study of a version of the programme for people with early stage dementia proved promising and led to further funding from the NIHR Health Technology Programme for a randomised controlled trial, which is currently on-going. http://www.bradford.ac.uk/health/dementia/research/journeying-through-dementia/

It worth noting that the majority of existing Lifestyle Matters programmes are customised versions for particular groups of people; for example people with dementia, with depression, following stroke. The impact of the programme as a preventive strategy is yet to be realised due to the absence of preventive health services for older people.

Publications

Chatters R, Roberts J, Mountain G, et al
The long-term (24-month) effect on health and well-being of the Lifestyle Matters community-based intervention in people aged 65 years and over: a qualitative study. BMJ Open 2017;7:e016711. doi: 10.1136/bmjopen-2017-016711 http://bmjopen.bmj.com/content/7/9/e016711

Kirsty Sprange, Gail A Mountain, John Brazier, Sarah P Cook, Claire Craig,Daniel Hind, Stephen J Walters, Gill Windle, Robert Woods, Anju D Keetharuth, Tim Chater and Kath Horner. Lifestyle Matters for maintenance of health and wellbeing in people aged 65 years and over: study protocol for a randomised controlled trial. Trials 2013; 14:302.

Gail Mountain, Gill Windle, Daniel Hind, Stephen Walters, Anju Keertharuth, Robin Chatters, Kirsty Sprange, Claire Craig, Sarah Cook, Ellen Lee, Tim Chater, R. Woods, Louise Newbould, Lauren Powell, Katy Shortland, Jennifer Roberts; A preventative lifestyle intervention for older adults (lifestyle matters): a randomised controlled trial. Age Ageing 2017 1-8. doi: 10.1093/ageing/afx021

Sprange K, Mountain GA, Shortland K, Craig C, Blackburn D, Bowie P, Harkness K & Spencer M (2015) Journeying through Dementia, a community-based self-management intervention for people aged 65 years and over: a feasibility study to inform a future trial. Pilot and Feasibility Studies 20151:42 DOI: 10.1186/s40814-015-0039-6

Project Staff:

Name Site Telephone number Email

Prof Gail Mountain

Chief Investigator

ScHARR

University of Sheffield

+44 (0)114 222 2982 g.a.mountain@sheffield.ac.uk

Robin Chatters

Trial Manager

ScHARR

University of Sheffield

+44 (0)114 222 2969 r.chatters@sheffield.ac.uk

Dr Danny Hind

Trial Advisor

ScHARR

University of Sheffield

+44 (0)114 222 0707 d.hind@sheffield.ac.uk

Lauren O'Hara

Trial Support Officer

ScHARR

University of Sheffield

+44 (0)114 222 0880 l.e.ohara@sheffield.ac.uk

Prof Stephen Walters

Trial Statistician

ScHARR

University of Sheffield

+44 (0)114 222 0730 s.j.walters@sheffield.ac.uk

Prof John Brazier

Health Economist

ScHARR

University of Sheffield

+44 (0)114 222 0726 j.e.brazier@sheffield.ac.uk

Tim Chater

Data Management

ScHARR

University of Sheffield

+44 (0)114 222 0876 t.chater@sheffield.ac.uk

Dr Gill Windle

Principal Investigator

Bangor University +44 (0)1248 383968 g.windle@bangor.ac.uk

Prof Bob Woods

Clinical Psychology

Bangor University +44 (0)1248 382463 b.woods@bangor.ac.uk

Dr Sarah Cook

Fidelity Lead

Sheffield Hallam University +44 (0)114 225 5672 s.p.cook@shu.ac.uk

Claire Craig

Occuopational Therapy

Sheffield Hallam University +44 (0)114 225 2586 c.craig@shu.ac.uk

Kath Horner

Health Improvement Principle

NHS Sheffield +44 (0)114 305 1049 Kath.horner@nhs.net

Louise Newbould

Research Assistant

University of Sheffield +44 (0)114 222 8277 l.newbould@sheffield.ac.uk

Iona Strom

Trial Support

Bangor University +44 (0)1248 383050 i.strom@bangor.ac.uk