Effects of participating in community assets on quality of life and costs of care: longitudinal cohort study of older people in England

Abstract

Objectives: Improving outcomes for older people with long-term conditions and multimorbidity is a priority. Current policy commits to substantial expansion of social prescribing to community assets, such as charity, voluntary or community groups. We use longitudinal data to add to the limited evidence on whether this is associated with better quality of life or lower costs of care.

Design: Prospective 18-month cohort survey of self-reported participation in community assets and quality of life linked to administrative care records. Effects of starting and stopping participation estimated using double-robust estimation.

Setting: Participation in community asset facilities. Costs of primary and secondary care.

Participants: 4377 older people with long-term conditions.

Intervention: Participation in community assets.

Primary and secondary outcome measures: Quality-adjusted life years (QALYs), healthcare costs and social value estimated using net benefits.

Results: Starting to participate in community assets was associated with a 0.017 (95% CI 0.002 to 0.032) gain in QALYs after 6 months, 0.030 (95% CI 0.005 to 0.054) after 12 months and 0.056 (95% CI 0.017 to 0.094) after 18 months. Cumulative effects on care costs were negative in each time period: £-96 (95% CI £-512 to £321) at 6 months; £-283 (95% CI £-926 to £359) at 12 months; and £-453 (95% CI £-1366 to £461) at 18 months. The net benefit of starting to participate was £1956 (95% CI £209 to £3703) per participant at 18 months. Stopping participation was associated with larger negative impacts of -0.102 (95% CI -0.173 to -0.031) QALYs and £1335.33 (95% CI £112.85 to £2557.81) higher costs after 18 months.

Conclusions: Participation in community assets by older people with long-term conditions is associated with improved quality of life and reduced costs of care. Sustaining that participation is important because there are considerable health changes associated with stopping. The results support the inclusion of community assets as part of an integrated care model for older patients.

Keywords: administrative health care costs; community assets; long-term conditions; multimorbidity; social prescribing; societal net-benefit.