Effects of social prescribing for older adults: An evidence and gap map

BACKGROUND: Many factors such as declining physical function, low socioeconomic status and unemployment play a role in the complex health and social needs of older adults. While healthcare providers can assist in treating health conditions, non-clinical interventions are most likely needed to meet their social needs and improve wellbeing. Social prescribing has been introduced to help primary care providers and other connectors meet patient's social needs that contribute to poor health and inequalities. With the increasing recognition of these complex challenges, decision-makers need to know which social prescribing interventions or social prescriptions are effective for older adults. 

OBJECTIVES: To map the available evidence on the effectiveness of social prescribing interventions and social prescriptions addressing a non-medical health-related need for older adults in clinical and community settings. 

SEARCH METHODS: We searched the following databases from inception until November 14, 2023, with no language restrictions: Ovid MEDLINE, Embase, EBM Reviews, Elsevier Scopus, Epistemonikos, CABI CAB Direct, NIHR PROSPERO, WHO Global Index Medicus, Clarivate Web of Science Social Sciences Citation Index (SSCI), Conference Proceedings, Clarivate Korean Citation Index (KCI), Clarivate SciELO Citation Index and Google Scholar via Harzing Publish or Perish. 

SELECTION CRITERIA: Titles and abstracts and full text of potentially eligible articles were independently screened in duplicate for systematic reviews and studies with concurrent control groups assessing the effectiveness of social prescribing and social prescription interventions on the wellbeing of older adults. Conflicts were resolved through consensus. 

DATA COLLECTION AND ANALYSIS: We developed and pilot-tested a data collection form in EPPI-Reviewer. Data was extracted and coded individually by reviewers based on an intervention-outcome framework which was also used to define the dimensions of the evidence and gap map. Data extraction was validated by a second reviewer for 20%. We assessed the quality of reviews using the AMSTAR2 tool. The quality of primary studies was not assessed. 

MAIN RESULTS: We included 662 articles (430 primary studies, 232 reviews) that assessed the effectiveness of social prescribing interventions or social prescriptions targeting non-medical health-related social needs of older adults to improve their health and wellbeing. Over 65% of the articles were published in 2019 or later. AMSTAR2 quality was rated as critically low for 55%, low for 31%, moderate for 6% and high for only 4% of systematic reviews. Of the included primary studies, 48% were randomized controlled trials and 52% were non-randomized studies.Most of the evidence was from high-income countries (78% of reviews and 93% of primary studies), few from upper-middle (25% of reviews and 5% of primary studies), and lower-middle (9% of reviews and 3% of primary studies) countries, and none from low-income countries (0%). The most common intervention types identified were psychosocial (e.g. social and emotional support interventions), with 81% of reviews and 63% of primary studies including these interventions, lifestyle (exercise on prescription) with 45% of reviews and 30% of primary studies including these interventions, and arts-based (museums, galleries, arts & crafts), with 29% of reviews and 20% of primary studies including these interventions. These were followed by material support in 13% of reviews and 7% of primary studies, and nature-based interventions in 10% of reviews and 4% of primary studies. Ninety-eight percent of the reviews and 95% of the primary studies focused on assessing the impact on individual outcomes (e.g. participant wellbeing/quality of life), with 41% of reviews and 47% of primary studies assessing process outcomes (e.g. participant satisfaction), and 27% of both reviews and primary studies looking at health system outcomes (e.g. health/social service use). Eleven percent of reviews and primary studies looked at adverse effects, and no studies assessed health equity as a community outcome.Key characteristics of social prescribing interventions or social prescriptions were described in few included articles; codesign of the interventions in 6% of reviews and 15% of primary studies, while participant empowerment was described in 24% of reviews and 19% of primary studies.Most articles focused on a population at risk of or experiencing inequity (91% of reviews and 96% of primary studies). Less than 10% of both reviews and primary studies conducted any equity analysis to assess differential effects for populations experiencing inequities across factors such as age, gender or ethnicity. 

AUTHORS’ CONCLUSIONS: Most of the available evidence on social prescribing and social prescription was on psychosocial and health system interventions; there is limited research on material support and nature-based interventions. Furthermore, despite the aims of social prescribing or social prescription to empower communities and reduce health inequalities, there are few studies that assess community-level outcomes or adverse effects. There is a need for more research in low-middle-income countries and for high-quality reviews. This map can help identify priorities for further research and promote the use of existing evidence in policy and practice.