Doctoral thesis pooling homecare data from six countries links moderate-to-higher physical activity to better function, health outcomes and mortality in older homecare recipients
Synopsis
This doctoral thesis, conducted within the EU-funded I-CARE4OLD project, first maps the definition and use of non-pharmacological interventions (NPIs)—a systematic review shows highly heterogeneous and predominantly negatively framed definitions, and data from six countries show underuse of interventions with proven benefits (physical therapy, occupational therapy, psychosocial interventions, social participation) alongside relatively frequent use of physical restraints in some countries—and second, using longitudinal real-world data from the Netherlands and Ontario, Canada, with propensity-based methods, generalized estimating equations, and target trial emulation with causal machine learning, finds that moderate and higher levels of physical activity are associated with beneficial effect
Interpretation
The thesis proposes a structured set of characteristics—type of intervention, target, goals, and requirements—as building blocks for a future consensus definition of NPIs, after showing that definitions in the older-adult literature are highly heterogeneous and predominantly negatively framed. Prior work lacked a systematic mapping of NPI definitions in older adults; this review consolidates scattered and inconsistent definitions into an operational set of characteristics. A systematic review of NPI literature in older adults; it is a qualitative synthesis, and the abstract reports no number of included studies or heterogeneity statistics.
NPI use among homecare recipients varies across six countries, with underuse of interventions that have proven benefits—physical therapy, occupational therapy, psychosocial interventions, and social participation—while physical restraints are used relatively frequently in some countries. It extends the picture of NPI use from single-country descriptions to a cross-country comparison of six European countries, showing that underuse of beneficial interventions coexists with comparatively frequent restraint use. Cross-sectional prevalence description of homecare recipients in six countries; the abstract reports no specific proportions or magnitudes of cross-country differences.
In longitudinal real-world data from the Netherlands and Ontario, Canada, moderate and higher levels of physical activity are associated with beneficial effects on functional status, health-related outcomes, and mortality among older homecare recipients. It evaluates the effects of physical activity, a key NPI, in the relatively understudied homecare setting, combining propensity-based methods, generalized estimating equations, and target trial emulation with causal machine learning. Observational longitudinal real-world data with causal-inference methods, which can strengthen control of confounding, but the abstract reports no effect sizes, confidence intervals, or sample sizes, and association is not the same as causation established by randomized trials.
Taken together, the thesis argues for better defining, deploying, and evaluating NPIs to improve functioning and quality of life in ageing populations receiving homecare. It links conceptual work on definitions, descriptive evidence on current use, and effect estimation for physical activity into a single path from concept to clinical impact. A thesis-level synthesis supported jointly by the review, the cross-sectional description, and the longitudinal analyses.
Perspective
The thesis addresses older adults with complex chronic conditions receiving homecare, and the clinical and policy audiences who plan their care. Part 1 provides the protocol and methodological framework of the I-CARE4OLD project and a baseline picture of NPI definitions and use across six countries; Part 2 analyzes homecare populations in the Netherlands and Ontario, Canada. Its value lies in offering a reusable rationale and evidence base for building a consensus NPI definition, deploying interventions such as physical activity more systematically in homecare, and evaluating intervention effects with real-world data.
What is available here is the thesis abstract and bibliographic record, without chapter-level effect sizes, sample sizes, confidence intervals, follow-up durations, or the number of studies included in the systematic review. It is therefore not possible to judge the magnitude or robustness of the physical activity effects, or the size of the cross-country differences in use. In addition, the physical activity findings rest on observational real-world data; even with causal-inference methods, randomized trials or further replication would be needed for confirmation. The proposed NPI definition remains a set of characteristics rather than a widely accepted consensus. Readers who need specific numbers or methodological detail should consult the full thesis.