Social prescribing for people living with dementia (PLWD) and their carers: what works, for whom, under what circumstances and why – protocol for a complex intervention systematic review

\ua9 Author(s) (or their employer(s)) 2024.Introduction Dementia is a complex medical condition that poses significant challenges to healthcare systems and support services. People living with dementia (PLWD) and their carers experience complex needs often exacerbated by social isolation and challenges in accessing support. Social prescribing (SP) seeks to enable PLWD and their carers to access community and voluntary sector resources to support them address such needs. Existing research, however, does not describe what SP interventions are currently in place in dementia care. Little is known about the needs these interventions are designed to address, the reasons that lead PLWD and their carers to participate in them, their effectiveness and the extent to which they could increase positive health outcomes if adopted and how. Methods and analysis A complex intervention systematic review of SP for PLWD and/or their carers will be conducted using an iterative logic model approach. Six electronic (MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus and Cochrane/CENTRAL) and two grey literature databases (EThOS and CORE) were searched for publications between 1 January 2003 and June 2023, supplemented by handsearching of reference lists of included studies. Study selection, data extraction and risk of bias assessment, using Gough’s Weight of Evidence Framework, will be independently performed by two reviewers. A narrative approach will be employed to synthesise and report quantitative and qualitative data. Reporting will be informed by the Preferred Reporting Items for Systematic Review and Meta-Analysis Complex Interventions extension statement and checklist. Ethics and dissemination No ethical approval is required due to this systematic review operating only with secondary sources. Findings will be disseminated through peer-reviewed publications, conference presentations and meetings with key stakeholders including healthcare professionals, patient and carer groups, community organisations (eg, the Social Prescribing Network and the Evidence Collaborative at the National Academy for Social Prescribing), policymakers and funding bodies. PROSPERO registration number CRD42023428625

Reimagining Dementia Care: A Complex Intervention Systematic Review on Optimising Social Prescribing (SP) for People Living with Dementia (PLWD) in the UK

Introduction: Dementia is a complex medical condition that poses significant challenges to healthcare systems and support services. People living with dementia (PLWD) often face complex needs, exacerbated by social isolation and difficulty accessing support. Social prescribing (SP) has been increasingly integrated into the UK’s National Health Service (NHS) as a means to connect individuals with non-clinical services to address these challenges. However, current research provides limited detail on specific SP interventions tailored to dementia care, leaving gaps in understanding the targeted needs, participation drivers, effectiveness, and potential benefits for PLWD. Methods: A complex intervention systematic review of SP in dementia care was performed in the UK using an iterative logic model approach. Six databases and grey literature were searched supplemented by handsearching of reference lists of included studies. Results were screened in a two-step process, followed by data extraction. Risk of bias was assessed using Gough’s Evidence of Framework. Reporting was informed by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA-CI) extension statement and checklist.Results: Forty-nine studies, reporting on PLWD, met the inclusion criteria. Findings indicate that SP for PLWD in the UK is varied and lacks focus, reflecting the diverse demographics involved. Interventions encompass cognitive, educational, psychosocial, physical, community, and complementary therapies, of inconsistent classification, with some being umbrella interventions and others standalone services. Provided by the NHS, charities, and integrated services, SP involves a range of referrers and connectors. Finally, individual outcomes show benefits such as increased independence and improved mood, but challenges pertaining to suitability and logistical issues whereas systemic outcomes include cost savings and better service delivery, despite high implementation costs.Conclusion: SP pathways for PLWD are varied, with success relying heavily on adequately resourced and trained connectors. While benefits extend beyond health improvements, further research is needed to assess long-term impacts, refine mechanisms, and standardise evaluation metrics for SP effectiveness in dementia care

Reimagining dementia care: A complex intervention systematic review on optimising social prescribing (SP) for carers of people living with dementia (PLWD) in the United Kingdom

Introduction: Carers of people living with dementia (PLWD) face a range of complex needs, including medical, emotional, social and practical challenges, often exacerbated by social isolation and barriers to accessing support. Social prescribing (SP) addresses these needs by increasing access to non-clinical support and services. However, existing research lacks detailed descriptions of SP interventions for carers of PLWD, with limited understanding of the needs they target, the reasons for participation, their effectiveness and their potential to improve outcomes for carers of PLWD. Methods: A complex intervention systematic review of SP for carers of PLWD was undertaken using iterative logic modelling and reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA-CI) extension statement and checklist. Six databases and grey literature were searched, supplemented by hand searching reference lists of included studies. Results were screened in a two-step process, followed by data extraction. Gough's Weight of Evidence Framework was used to assess the risk of bias in the included studies. Results: Fifty-two studies were included. Findings indicated SP for carers of PLWD in the United Kingdom is varied and operates in a largely uncoordinated process involving initiation by diverse stakeholders and institutions across multiple sectors. The classification of SP interventions for carers of PLWD is inconsistent, and participation is often opportunistic. Positive outcomes included improved carer mood, social connections, practical support, quality of life and better PLWD–carer relationships. However, negative outcomes were associated with intervention suitability, emotional impact, relevance and strained PLWD–carer relationships. Discussion: While the evidence suggests SP is a promising intervention for carers of PLWD, its long-term impacts, challenges of tailoring prescriptions to carers' needs and overcoming logistical issues remain. Additionally, further research is required to evaluate long-term impact, investigate specific mechanisms to tailor SP to specific carer needs and explore in greater detail the PLWD–carer relationship and its effects on SP uptake and maintenance. Patient and Public Contributions: A PPI advisory group was involved in the review, including providing insights into review questions, the logic model, findings and results. The group consisted of one person living with dementia and a caregiver