The Author(s) BMC Health Services Research 2016, 16(Suppl 5):278

DOI 10.1186/s12913-016-1521-4

RESEARCH Open Access

Scoping review of health promotion and

disease prevention interventions addressed
to elderly people
Mariusz Duplaga*, Marcin Grysztar, Marcin Rodzinka and Agnieszka Kopec

Abstract
Background: The ageing of modern societies remains one of the greatest challenges for health and social systems.
To respond to this challenge, we need effective strategies assuring healthy active life for elderly people. Health
promotion and related activities are perceived as a key intervention, which can improve wellbeing in later life.
The main aim of this study is the identification and classification of such interventions addressed to older adults
and elderly. Therefore, the strategy based on the scoping review as a feasible tool for exploring this domain,
summarizing research findings and identifying gaps of evidence, was applied.
Methods: The scoping review relies on the analysis of previous reviews of interventions aimed at older adults
(55–64 years old) and elderly persons (65 years and above) assessed for their effectiveness in the framework of
a systematic review and/or meta-analysis. The search strategy was based on the identification of interventions
reported as health promotion, primary disease prevention, screening or social support. In the analysis, the reviews
published from January 2000 to April 2015 were included.
Results: The search strategy yielded 334 systematic reviews and/or meta-analyses addressed to target groups of
interest, 182 of them assessed interventions belonging to health promotion, 219 to primary prevention, 34 to
screening and 35 to social support. The studies focused on elderly (65 years and above) made up 40.4 % of all
retrieved reviews and those addressing population of 55 years and above accounted for 24.0 %.
Conclusions: Interventions focused on health maintenance and improvement in elderly and older adults represent
frequently combined health promotion and disease prevention actions. Many interventions of this type are not
addressed exclusively to elderly populations and/or older adults but are designed for the general population.
The most common types of interventions addressed to elderly and older adults in the area of health promotion
include health education, behavior modification and health communication.
Keywords: Elderly, Older adults, Health promotion, Primary disease prevention, Screening, Social support, Scoping
review, Systematic review

Background health among older groups remains a demanding task. It

Population ageing is perceived as one of the greatest is obvious that morbidity increases with age and multi-
challenges for modern societies both in terms of morbidity is more common in elderly populations [2].
economic burden and social demands. In 2010, people As a response to this challenge, many policies and
aged 65 years and over made up 15 % of the overall strategies on international, national or other levels have
population in Europe. Estimations indicate that in 2050 been formulated. On a general level, they are aimed at
this figure will reach at least 25 % [1]. Maintaining reaching goals related to affirmative concepts of ageing
formulated as ‘active ageing’ [3], ‘healthy ageing’ [4],
‘productive ageing’ [5] or ‘positive ageing’ [6, 7]. Accor-
* Correspondence: [email protected]
Department of Health Promotion, Institute of Public Health, Faculty of Health
ding to the Policy Framework issued by the World
Sciences, Jagiellonian University Medical College, Grzegorzecka Str. 20, Health Organization in 2002, the development of
31-531 Krakow, Poland

© 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
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the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
The Author(s) BMC Health Services Research 2016, 16(Suppl 5):278 Page 456 of 479

appropriate policies and programs that enhance the those specific to ageing among older adults and elderly
health, participation and security of older citizens is people. For this purpose, the framework of a scoping
essential for meeting this challenge [3]. review was applied based on the analysis of systematic
Strategies, which broadly fall into the domain of health reviews and/or meta-analyses focused on the assessment
promotion and disease prevention, bring a promise of a of effectiveness of relevant interventions.
healthier and more productive life in advanced age. Health To authors’ knowledge, such review of secondary evi-
promotion is a relatively recent approach to improving dence on interventions promoting or adding to health of
the health of societies and individuals. To some extent, it elderly persons was not done before. It is also anticipated
has been developed as a response to the dissatisfaction that accumulated secondary evidence in this domain may
with ongoing efforts in health care during the 1970s. be used for formulating policy recommendations on the
During the First International Conference of Health effectiveness of interventions related to the maintenance
Promotion held in Ottawa, Canada, in 1985, health and improvement of health in these populations. The broad
promotion was defined as “the process of enabling people view of the domain should also reveal potential gaps in
to increase control over, and to improve, their health” [8]. secondary evidence and navigate researchers to these areas,
It was included in the Ottawa Charter perceived as one of which should be addressed in future systematic reviews.
the key documents establishing the basis for health The focus of the scoping review was on health promo-
promotion as a domain. The Charter also specifies the five tion addressed to elderly or older adults; however, a rigid
main action types for health promotion. They encompass extraction of health promotion interventions from other
building healthy public policies, creating supportive envi- related actions, especially disease prevention, could arti-
ronments, strengthening community actions, developing ficially limit the scope of efficient types of interventions
personal skills, and reorienting health services. focused on the maintenance of health and avoiding
In turn, disease prevention is usually perceived as a health risks in elderly people. To avoid this limitation
complementary term to health promotion, although its and taking into consideration the frequent combined use
definitions focus on the context of avoiding diseases or of the terms of health promotion and disease prevention
their consequences, and not on the concept of health. in effectiveness reports, a broad strategy of retrieving
According to the Health Promotion Glossary, disease secondary evidence has been established. It has been
prevention encompasses “measures not only to prevent deliberately extended to the three additional concepts
the occurrence of disease, such as risk factor reduction, including primary disease prevention, screening and
but also to arrest its progress and reduce its consequences social support to obtain a better view of actions aimed at
once established” [9]. Primary disease prevention is aimed improving health in elderly people.
at precluding the onset of disease. Secondary prevention The research question established for the scoping
should lead to controlling the disease before it manifests review was formulated as follows: “What types of inter-
clinically. Screening is an example of such measure. In ventions promoting the health of the elderly population
patients with a developed disease, tertiary prevention may have been assessed for their effectiveness in systematic
be undertaken in order to decrease its impact on the reviews and meta-analyses?” The review focuses on
patient’s life [10]. interventions addressed at healthy older adults and elderly
Although health promotion and disease prevention are people, or on interventions focusing on general health
treated as separate concepts, the difference is less visible issues of these groups even if they suffer from specific
when we consider practical applications. To some extent, disorders.
health promotion may be perceived as being aligned with Definitions of health promotion remain general or tend
positive definitions of health extending beyond the to favor selected types of interventions or outcomes.
absence of disease. Health promotion may be seen as a Although health is usually stated or regarded as the
broader concept supporting the achievement of wellbeing default aim, the instrumental objectives (following ele-
and happiness. In turn, disease prevention aims to avoid ments of the health promotion definition proposed by
or eliminate diseases. Health promotion does not need to Rootman in 2001 [12]), processes or actions are not stated
involve disease prevention, but disease prevention cannot systematically. As the definition proposed in the Ottawa
be achieved without health promotion [11]. A close Charter [8], repeated in the WHO glossary [9], is the most
relationship between health promotion and disease widely recognized, the review reported in this paper used
prevention may result in some difficulties in the classifi- it as a guiding statement. Nevertheless, for further classi-
cation of interventions focused on the maintenance and fication of possible interventions falling in the domain of
improvement of health. health promotion, the taxonomy described by McKenzie
The aim of this paper is the identification and classifi- et al. was used [13].
cation of health promotion and related types of inter- As a rule, the scoping review was focused on previous
ventions addressing general health issues as well as reviews of interventions aimed at general health issues
The Author(s) BMC Health Services Research 2016, 16(Suppl 5):278 Page 457 of 479

or primary prevention of conditions not yet diagnosed in services that contribute towards reducing the dimension
the target groups. However, it was also assumed that gen- of a problem or improving an unsatisfactory situation”
eral areas of interventions could be relevant for individuals [17], 2) the age of the target audience was at least 55 years
with diagnosed and treated medical conditions. old, or the target audience included subjects aged 55 years
and above, 3) publication period was from January 2000 to
Methods April 2015, 4) published in English. Interventions related
Study design to therapy, diagnostics or rehabilitation required for
The study was based on the methodology of scoping specific diseases were excluded from the analysis. Syste-
review designed in order to identify and review the matic reviews whose key audiences were elderly indivi-
secondary evidence on the effectiveness of interventions duals suffering from specific diseases were included in the
addressing older adults and elderly people in the domain scoping review providing that the interventions were
of health promotion and related areas. The research aimed at general health issues and not specific symptoms
question for the scoping review was introduced earlier in or consequences of diseases diagnosed in these audiences.
the Background section. The scoping review is defined as
“a process of mapping the existing literature or evidence Search strategy
base” [14]. According to Armstrong et al., it may be used The search strategy was developed in order to identify
to identify research gaps and summarize research findings, systematic reviews and/or meta-analyses assessing the
as well as to explore the extent of the literature in a effectiveness of health promotion and related interventions
particular domain, helping to identify appropriate parame- addressed to elderly and older adults. The search strategy
ters and defining a potential scope of a systematic review was based on the scheme derived from the classical PICO
and the associated costs [15]. In contrast to the systematic algorithm. The keywords included in the search are
review, the scoping review is generally characterized by presented in Table 1. The search was performed in the
broad research questions. following databases: MEDLINE, CINAHL, the Cochrane
The design applied in this study anticipated the analysis Library, EMBASE, INSPEC, PubPsych and ERIC.
of systematic reviews published between January 2000 and
April 2015. It is assumed that the results of this review Data extraction and assessment
would be explored further with the aim of identifying Systematic reviews identified in the process were de-
effective health promotion and related interventions scribed according to criteria including year of publication,
addressed to the elderly population and formulating age and sex of targeted audiences, general areas of inter-
recommendations on the policy level. ventions, targeted areas of interventions, and in the case
of interventions, classified as including health promotion
Inclusion criteria actions, according to McKenzie et al. [13]. Four general
The scoping review described in this paper was based on areas of interventions were established to classify the
the secondary analysis of available systematic reviews papers retrieved in the search strategy described earlier.
and/or meta-analyses. No other types of evidence were These areas encompassed health promotion, primary
included. The main rationale for such approach was the disease prevention, screening and social support.
attempt to obtain a view of interventions addressed to The search strategy assumed the retrieval of inter-
elderly people and older adults which underwent an ventions defined by authors in literature databases as
assessment as to their effectiveness. The term “interven- disease prevention, although the selection of secondary
tion” was applied in the meaning proposed by Rychetnik evidence was guided by a rule that only primary preven-
et al. as “an intervention comprises an action or program tion interventions were retrieved for the scoping review.
that aims to bring about identifiable outcomes” [16]. Screening is usually classified as a specific type of inter-
The systematic reviews and/or meta-analyses included vention belonging to secondary prevention [10]. As it is
in the scoping review met the following criteria: 1) the aimed at finding disease (or risk factors) at an early stage
study assessed the effectiveness of health promotion or in subjects who are not aware of their medical condition,
related interventions (primary prevention, screening, it was included in the scoping review. Actions addressed
social support); definitions of these areas are included in to the community or undertaken in the community are
the list contained in Additional file 1. The concept of of key importance for health promotion. It also seems
effectiveness was used in line with the definition proposed that the support from social services and social care is
by Wojtczak as “a measure of the extent to which a particularly pertinent to the needs and situations of
specific intervention, procedure, regimen, or service, when elderly people. Thus, interventions described as social
deployed in the field in routine circumstances, does what support were selected as another category of a general
it is intended to do for a specified population. In the area of interventions used for the classification of sys-
health field, it is a measure of output from those health tematic reviews.
The Author(s) BMC Health Services Research 2016, 16(Suppl 5):278 Page 458 of 479

Table 1 Keywords used in the search for secondary evidence age categories were used: 1) 65 years of age or more –
Population Intervention/interest Comparison Outcome for interventions targeting exclusively elderly persons, 2)
Elderly Health promotion Systematic Effectiveness 55 years of age or more – for reviews analyzing inter-
and related areas review ventions targeting both older adults and elderly persons,
Elderly “Health “Health “Systematic Effectiveness 3) general population including elderly persons – for
Senior promotion” education” review” Efficacy reviews assessing interventions directed to general popu-
Senioral Prevention “Health literacy” “Meta Efficiency
Elders Intervention “Health analysis” Impact lations which could include elderly persons but without
Elder Interventions communication” “Meta- Evidence clear differentiation of results according to age catego-
“Senior Campaign “Health analysis” Outcomes ries, and finally 4) ‘other’ – for reviews which assessed
citizen” Campaigns advocacy” Metaanalysis
“Old age” “Health “Community interventions addressed to age groups addressed in other
“Old programme” advocacy” way but which included also elderly persons. The main
people” “Health “Social rationale for how the age categories were structured,
Seniors program” campaign”
“Advanced “Social “Social was related to an attempt of distinguishing interventions
age” support” campaigns” that were addressed specifically to elderly persons from
Geriatric “Social care” “Health these which were designed for broader age groups.
Aged “Social coaching”
Ageing intervention” “Environmental The classification process was conducted by two au-
Aging Screening change thors independently and divergent opinions were solved
Preventive strategies” on the consensus basis. If a consensus was not reached, a
Prophylaxis “Healthy
Nutrition environment” third author was referred to for final decision.
“Physical “Community The data collection tool used in this study was prepared
activity” mobilization” as a form available to authors describing the retrieved
Habits “Behaviour
Addiction modification” studies on the www.esurv.org website. The results of the
Prophylaxis descriptions were exported to an Excel file. A descriptive
Screening analysis of the data was performed with Statistica v.10 PL
“Primary
prevention” (StatSoft, Tulsa, OK, USA) after importing the data from
“Health the Excel file.
screening” We also provided the information about the quality of
“Support
groups” our review according to the PRISMA 2009 Checklist
“Social network” (see Additional file 2). Although this checklist was prima-
“Social rily designed for systematic review and/or meta-analysis,
gathering”
“Health at least part of enlisted criteria may be applied to the
changes” scoping review.

Results
For the classification of the target area of interven- Search results
tions, a list of areas was developed first, including The search performed in the literature databases gene-
general health issues such as physical activity or nutri- rated 13,145 papers, the verification based on the assess-
tion, and areas specifically related to older age, e.g. ment of titles resulted in 3449 papers, and the analysis of
frailty. This list was expanded with a few terms resulting abstracts limited the results to 886 papers selected for
from an initial analysis of papers retrieved. full-text assessment. The final stage, based on the analysis
The classification and description of secondary evidence of full texts, resulted in the selection of 334 systematic
was not made on the basis of its classification in literature reviews/meta-analyses for description and classification
databases or the keywords used for its selection, but it was (Additional file 3). The flow diagram showing the whole
carried out independently after the identification of search process is shown in Fig. 1.
feasible studies in the following process guided by existing
definitions (applied definitions with sources are included General area of intervention
in the Additional file 1). It means that even if the authors From 334 retrieved systematic reviews, 182 were related
of a specific systematic review declared it as focusing on to interventions classified as belonging to health promo-
one of four main areas, e.g. health promotion, it could be tion, 219 to primary disease prevention, 34 to screening,
re-classified by the authors of this scoping review accor- and 35 to social support. Systematic reviews exclusively
ding to definitions established for categories within classi- related to primary disease prevention interventions were
fication dimensions. the most numerous category of studies, making up
Retrieved reviews were also classified according to the 33.5 % (n = 112) of all systematic reviews. Studies related
age of audience targeted by analyzed interventions. Four to the analysis of the effectiveness of interventions
The Author(s) BMC Health Services Research 2016, 16(Suppl 5):278 Page 459 of 479

Fig. 1 Flow diagram of the search strategy and study selection process

combining health promotion and primary disease pre- represented 25.8 % (n = 47) (Table 3). In the reviews
vention actions were the second most numerous category addressing primary preventions, these percentages were
(n = 79, 23.7 %), with those focused on health promotion 42.9 % (n = 94) and 23.3 % (n = 51), respectively (Table 3).
interventions coming in third (n = 75, 22.5 %). Studies The overwhelming majority of the systematic reviews
analyzing other exclusive categories of interventions were analyzed interventions addressed to both sexes (90.1 %,
less numerous and made approximately 20 % in total. The n = 301); only 7.8 % (n = 26) were related to interven-
numbers of systematic reviews according to the exclusive tions targeting women and only 2.1 % (n = 7) were
categories of interventions (individual or combined) are focused on interventions specific to men. The percen-
presented in Table 2. tage of reviews targeting both sexes was nearly the same
in the studies related to health promotion and primary
Age categories and gender of targeted audiences prevention interventions (94.0 and 93.6 %, respectively;
The age group of subjects targeted by the interventions Table 3). There were no gender specific interventions in
assessed in the systematic reviews was another criterion the reviews classified in the category of social support.
used for the description of publications retrieved. The The greatest differentiation by sex was seen in syste-
reviews focused on interventions targeting the elderly matic reviews classified as including screening inter-
population (65 years and above) made 40.4 % (n = 135) ventions; only 44.1 % were focused on both sexes, with
of all papers, while those targeting the population of 44.1 % targeting women and 11.8 % men (Table 3).
55 years and above represented 24.0 % (n = 80). The
percentage of reviews assessing interventions addressed Year of publication
to the general population including older age groups The number of systematic reviews corresponding with the
was 26.3 % (n = 88), and those addressed to other age inclusion criteria increased steadily from 2000, reaching
groups encompassing subjects in older age comprised the highest values in 2013 and 2014. The number of
9.3 % (n = 31). From the reviews addressing health pro- records retrieved from 2015 is relatively low; however, this
motion interventions, exclusively or in combination with is due to the fact that the search only included the first
other types, those targeting elderly subjects made up 4 months of the year. The number of all systematic
36.3 % (n = 66), and older adults and elderly people reviews retrieved increased from 3 in 2000 to 48 in 2014.
The Author(s) BMC Health Services Research 2016, 16(Suppl 5):278 Page 460 of 479

Table 2 Number of systematic reviews retrieved according to could be assigned to several areas, the total exceeds the
exclusive categories of the general area of intervention number of reviews retrieved.
Category of intervention Number of studies % In the systematic reviews, the three most frequent
primary prevention 112 33.5 target areas of interventions were specific diseases
health promotion & primary prevention 79 23.7 (disease-oriented, n = 152), physical activity (n = 94) and
general health (n = 82). Other common target areas were
health promotion 75 22.5
quality of life (n = 71), frailty (n = 64), cognitive function
screening 22 6.6
(n = 51) and mental health (37). The highest number of
health promotion & primary prevention 14 4.2 systematic reviews addressing disease-oriented interven-
& social support
tions is related to the fact that 219 of the 334 reviews
health promotion & social support 9 2.7 addressed the general area of primary prevention. Details
primary prevention & screening 7 2.1 of the distribution of interventions according to key target
social support 6 1.8 problems with regard to the four general areas and con-
prevention & social support 5 1.5 sidering the exclusive categories established on the basis
health promotion & screening 3 0.9
of individual and combined areas are presented in Table 5.
From the 75 systematic reviews assessing the inter-
health promotion & primary 1 0.3
prevention & screening ventions classified exclusively to health promotion, the
most numerous target areas of interventions included
all 4 general areas 1 0.3
physical activity (n = 35), general health (n = 30) and
screening & social support 0 0.0
quality of life (n = 26). It should be stressed that health
health promotion & screening 0 0.0 promotion interventions were also undertaken relatively
& social support
frequently in relation to specific diseases (n = 16). Within
primary prevention & screening 0 0.0 the systematic reviews classified exclusively to primary
& social support
prevention (n = 112), more than half (n = 57) were focused
on disease-oriented interventions, 40 were related to
The trend was also observed for systematic reviews related frailty and 26 to physical activity as a preventive measure.
to general areas of intervention (Fig. 2). The distribution From 22 reviews focused exclusively on screening
of systematic reviews according to detailed categories of interventions, 21 were categorized as disease-oriented,
general areas of interventions and year of publication is which is understandable considering the main aim of such
presented in Table 4. measures.

Classification of health promotion interventions

Targeted areas of interventions The systematic reviews which covered interventions clas-
An initial list of key target problems was established on sified in the domain of health promotion were also classi-
the basis of the areas targeted by health promotion and fied according to the typology described by McKenzie et
related interventions. It was further amended with issues al. [13]. The most frequent types of interventions in
identified in the systematic reviews. The numbers of this cluster of systematic reviews were health educa-
systematic reviews which could be assigned to specific tion (49.2 %, n = 91), behavior modification activities
areas are shown in Fig. 3. As a single systematic review (46.5 %, n = 86), and health communication (33.0 %,
n = 61) (Fig. 4). Less frequent types of interventions
Table 3 Number of systematic reviews retrieved by age and sex encompassed environmental changes related to services
categories according to the four general areas of intervention modification (19.5 %, n = 36), strategies focused on
General area of Age categories Sex categories services available in the community (19.5 %, n = 36),
intervention
general 55 65 other both sexes women men support groups (16.8 %, n = 31) and environmental changes
populationa + + related to the social context (14.1 %, n = 26). Other inter-
health 54 47 66 15 171 9 2 ventions occurred with a frequency below 10 %. No system-
promotionb
atic reviews were identified in the domain of health policy
primary 55 51 94 19 205 12 2 and environmental changes in relation to cultural aspects.
preventionb
screeningb 14 5 7 8 15 15 4
Discussion
b
social support 6 7 18 4 35 0 0 The scoping review reported in this paper was carried
a
b
on the condition that it encompassed the elderly population out with the aim of obtaining a view of the landscape of
systematic reviews addressing interventions which were classified as fulfilling
the criteria of at least one general area of intervention (either individually or
interventions undertaken within health promotion and
combined with other general area/s) related fields in relation to older adults and elderly
The Author(s) BMC Health Services Research 2016, 16(Suppl 5):278 Page 461 of 479

Fig. 2 Numbers of systematic reviews retrieved in consecutive years between 2000 and 2014 according to the general area of intervention

Table 4 Number of systematic reviews retrieved published between January 2000 and April 2015 according to exclusive categories
of interventions
Year HP PP SCR SS HP & PP HP & SS HP & SCR HP & PP & SS PP & SCR PP & SS HP & PP & SCR HP & PP & SCR & SS Total
2000 1 0 0 0 0 0 0 1 0 0 1 0 3
2001 0 1 1 0 2 0 0 1 0 0 0 0 5
2002 2 4 2 0 2 0 1 0 0 0 0 0 11
2003 2 2 1 0 1 0 0 1 3 0 0 0 10
2004 0 8 0 0 3 0 0 0 0 1 0 0 12
2005 1 5 0 0 5 0 0 1 0 0 0 1 13
2006 1 3 1 1 2 0 0 1 0 0 0 0 9
2007 1 2 0 1 4 0 0 1 1 1 0 0 11
2008 5 10 0 0 7 0 0 3 1 0 0 0 26
2009 2 8 3 1 5 1 0 0 0 0 0 0 20
2010 5 13 2 0 10 0 1 1 0 0 0 0 32
2011 8 8 3 1 8 0 0 2 0 2 0 0 32
2012 12 13 3 2 8 0 0 0 0 0 0 0 38
2013 11 19 4 0 10 5 1 1 2 0 0 0 53
2014 20 13 2 0 9 3 0 1 0 0 0 0 48
2015 4 3 0 0 3 0 0 0 0 1 0 0 11
Total 75 112 22 6 79 9 3 14 7 5 1 1 334
Abbreviations: HP health promotion, PP primary prevention, SCR screening, SS social support
The Author(s) BMC Health Services Research 2016, 16(Suppl 5):278 Page 462 of 479

Fig. 3 Numbers of systematic reviews retrieved classified by specific target areas of interventions

Table 5 Frequencies of interventions targeted at key problems classified according to the general areas
Target area HPa PPa SCRa SSa HPb PPb SCRb SSb HP & HP & HP & PP & PP & HP & PP & HP & PP & HP & PP & SCR
PP SCR SS SCR SS SCR SS & SS
disease oriented 65 106 29 15 16 57 21 2 35 3 4 4 3 1 6 0
physical activity 68 59 2 3 35 26 0 0 29 0 0 0 0 1 2 1
general health 71 47 2 12 30 9 0 1 30 0 4 0 1 1 5 1
quality of life 60 37 3 15 26 8 1 2 20 0 5 0 0 1 7 1
frailty 21 54 2 3 7 40 1 1 12 0 1 1 0 0 1 0
cognitive function 36 35 0 5 14 14 0 0 18 0 2 0 1 0 2 0
mental health 20 24 5 6 10 11 1 2 6 0 0 2 1 1 2 1
nutrition 14 7 0 3 6 1 0 0 5 0 2 0 0 0 1 0
disability 5 4 1 2 2 1 1 1 2 0 0 0 0 0 1 0
independence 5 5 0 1 1 2 0 0 3 0 1 0 0 0 0 0
sleep quality 5 3 0 0 2 0 0 0 3 0 0 0 0 0 0 0
psychosocial 3 3 0 4 0 1 0 1 0 0 1 0 0 0 2 0
functioning
addiction 3 1 0 0 2 0 0 0 1 0 0 0 0 0 0 0
Categories: SCR&SS, HP&SCR&SS and PP&SCR&SS were not included in the table due to 0 frequencies
Abbreviations: HP health promotion, PP primary prevention, SCR screening, SS social support
a
systematic reviews addressing interventions which were classified as fulfilling the criteria of at least one general area of intervention
(either individually or combined with other general area/s)
b
systematic reviews addressing interventions which were classified exclusively as belonging to one general area of intervention
The Author(s) BMC Health Services Research 2016, 16(Suppl 5):278 Page 463 of 479

Fig. 4 Numbers of systematic reviews retrieved analyzing health promotion interventions classified according to the McKenzie et al. taxonomy

audiences. Aside from obtaining a broader view of the Of the general areas of interventions, primary preven-
domain, the results of the scoping review may be further tion was analyzed the most frequently in the systematic
used to guide efforts to identify the types of health reviews retrieved (65.6 %). The interventions, which
promotion interventions, which are actually effective in could be classified as health promotion activities, were
these specific groups. Finally, the results obtained may less frequent (54.5 %). Social support and screening
be of service for identifying gaps in secondary evidence interventions were significantly less frequent than the
and future areas of analysis. This study is one of the first two first areas of interventions and occurred with a
efforts aimed at describing the spectrum of health similar frequency (10.2 and 10.5 %, respectively). The
promotion and related interventions targeting health of classification of general areas of interventions was
elderly persons and older adults. challenging due to the fact that as many as 35.6 % of the
The number of systematic reviews retrieved for con- systematic reviews were related to interventions stem-
secutive years in the period included in the study ming from two or more areas. As distinguishing the four
increased steadily from 2000. It is understandable when general areas of interventions was an arbitrary decision
we consider the maturation of the evidence-based public originating from the attempt to describe the scope of
health (EBPH) approach during the recent decades actions aimed at the maintenance and improvement of
[18, 19]. The original definitions of EBPH were formulated the health of older adults and elderly populations, the
in the late 1990s [20–22]. As well as accepting the need interpretation of the proportions between these areas is
for the evidence-based approach to public health inter- rather difficult. However, it should be stressed that
ventions, it also meant that earlier methods used in although systematic reviews analyzing isolated primary
evidence-based medicine could be applied to some extent prevention interventions were the most frequent cat-
in public health. A clear formulation of recommendations egory (33.5 %), combined health promotion and primary
for systematic reviews in the areas of public health and prevention activities were the second (23.7 %) and iso-
health promotion was published in 2007 [23]. lated health promotion interventions were the third
The Author(s) BMC Health Services Research 2016, 16(Suppl 5):278 Page 464 of 479

most frequent category (22.5 %). The high number of All these assumptions may be seen as being oversimpli-
systematic reviews related to the combined health pro- fied, especially when considering the potential difficulties
motion and primary prevention activities reflects the with indicating health promotion interventions which are
difficulties with the conceptual separation of both do- not specific to medical conditions occurring in the target
mains [24]. audiences of elderly people or older adults.
The scoping review aimed to identify health promo- Another issue which may be perceived as a limitation
tion and related interventions addressed to older adults in this study is the arbitrary assumption of a set of defi-
and elderly populations. As a consequence, interventions nitions used to describe and classify the papers identified
addressed to the general or other populations, which also in the search (Additional file 1). The choice or formula-
included these age groups, were also included in the tion of the definitions was mainly guided by the aim to
search strategy. Finally, 40.4 % of the studies were provide a clear differentiation between existing concepts
focused on elderly individuals only (65 years and above) and categories. The process was carried out on the basis
and 24.0 % on populations aged at least 55 years. The of existing literature and a consensus was sought within
remaining 35.6 % of the reviews were focused on inter- the authors’ team.
ventions not addressed specifically to older adults or Finally, on a general level, using secondary evidence
elderly people, but to population which include them. available as systematic reviews and/or meta-analyses of
The study reported in this paper suffered from several the effectiveness of interventions belonging to the areas
limitations, which were either related to problems with of interest may be a limitation on obtaining a broader
defining specific areas of interventions or to simpli- view of the domain. Although further evidence may be
fications and rigid assumptions accepted from the start available in other sources, its extraction is likely to be
for pragmatic reasons. First of all, it should be under- demanding and may not even be possible within the
lined that the scoping review did not include the analysis framework of this scoping review. In this stage, the aim
of the effectiveness of types of interventions differen- of defining interventions assessed for their effectiveness
tiated in the classification process. The aim of the in specific age groups justified such strategy.
assessment of the effectiveness was treated as a criterion
for inclusion of systematic reviews and/or meta-analyses
in the scoping review. So, the results presented here Conclusions
provide a view of the domain but cannot yet be used for Primary prevention measures, used alone or in combi-
formulating policy recommendations for health promo- nation with health promotion interventions, prevail
tion and related types of interventions which are feasible among interventions analyzed in systematic reviews for
in elderly persons and older adults. Further analysis is their effectiveness in populations of elderly people and
required, supposedly according to the dimensions of older adults or general audiences encompassing these
interventions’ classification described in this paper. age groups. Combined interventions constitute at least
Furthermore, the authors assumed that classifications one third of all interventions identified in the search.
made in databases searched and the proposed keywords A considerable part of interventions belonging to the
may be a potential source of ambiguity in the interpre- four general areas were addressed to general or other
tation of the search results. Thus, after applying the populations encompassing older adults and/or elderly
search strategy, the systematic reviews were classified individuals. Finally, of the types of health promotion
from the beginning on the basis of definitions developed interventions, those classified as health education, beha-
and accepted in the study. vior modification and health communication were the
Four general areas of interventions were selected arbi- most frequently analyzed in systematic reviews retrieved.
trarily based on the general approach aiming to analyze
the effectiveness of interventions addressed to healthy or
presumably healthy subjects in target audiences. This Additional files
resulted in the exclusion of papers which reported the
Additional file 1: Definitions and relevant references used by the
effectiveness of therapeutic, rehabilitation or interven- authors to describe the studies retrieved. (DOCX 19 kb)
tions higher than the primary level of disease prevention. Additional file 2: PRISMA Checklist for systematic reviews. (DOCX 27 kb)
The only exemption from this rule was the inclusion of Additional file 3: List of systematic reviews and/or meta-analyses
screening procedures. included in the scoping review with the classification results.
Additionally, the study included systematic reviews (DOCX 60 kb)

which analyzed interventions belonging to the four gen-

eral areas and addressing patients with specific medical
Abbreviations
conditions, but not aimed at these conditions as such EBPH, evidence-based public health; HP, health promotion; PP, primary
but rather at the patient’s general health status. prevention; SCR, screening; SS, social support
The Author(s) BMC Health Services Research 2016, 16(Suppl 5):278 Page 465 of 479

Acknowledgements 6. Ministry of Social Development. New Zealand Positive Ageing Strategy.

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