Promoting health and wellbeing for older people in primary care: a feasibility study

Abstract

BackgroundThere is a need for research into effective approaches to promote health and wellbeing for older people in primary care, particularly using technologies. These interventions may, however, generate inequalities in access. We aimed to assess the implementation in UK primary care of the multidimensional risk appraisal in older people (MRAO). The objectives were to (1) assess feasibility and costs of embedding the MRAO system; (2) identify sociodemographic characteristics of older people who choose to take part in a health promotion intervention; (3) identify factors helping or hindering older people and professionals from using recommendations to promote health and wellbeing; and (4) assess the utility of the MRAO to promote working across health, local government, and voluntary sectors. MethodsWe completed a mixed-methods feasibility study in five general practices in London and Hertfordshire. A random sample of people aged at least 65 years were included. People living in nursing or care homes and those with severe dementia or terminal illness were excluded. The MRAO intervention was a software system that analysed responses to a multidimensional questionnaire covering health, lifestyle, and social and environmental domains and generated tailored advice about health services, behaviour change, and local resources. Participants and practices received copies of the report and followed up those with new or complex problems. Four locality cross-sector working groups considered commissioning and service recommendations from local profiles of needs generated. We undertook quantitative and qualitative assessments. Quantitative analyses consisted of feasibility (uptake, attrition, process), wellbeing, needs or health risks, lifestyle, quality of life, service use, and costs at baseline and 6 months of follow-up. Qualitative analyses consisted of thematic analysis of four cross-sector working group meetings and in-depth qualitative interviews with 22 working group participants and 30 older people. Ethics approval was granted by the London-East REC (11/LO/1814). Written informed consent was obtained before enrolment. Findings527 of 1550 (34·0%) people responded and 454 of 527 (86·1%) returned completed questionnaires. There were differences across sites, with 283 of 770 (36·8%) returned in Hertfordshire and 171 of 780 (21·9%) in London. Median age of participants was 73·2 years (IQR 68·9–78·9), 240 (52·9%) were women, 378 (83·3%) were white British, 400 (88·1%) lived in owner-occupied accommodation, 271 (59·7%) had no post-16 education, and 122 (26·9%) received only the state pension. Compared with local UK Census 2011 data, participants were younger, more were owner occupiers, and fewer were from ethnic minority groups than expected. A range of needs were identified at baseline, including pain (300 of 454 [66·1%]), low physical activity levels (211 [46·5%]), deteriorating mobility (change in last 12 months in walking in 131 [28·9%] or climbing stairs in 170 [37·4%]), falls (117 [25·8%]), urinary incontinence (111 [24·4%]), vision (116 [25·6%]), hearing (106 [23·3%]), depression (71 [15·6%]), impaired memory (44 [9·7%]), social isolation (46 [10·1%]), and loneliness (31 [6·8%]). Recent life events were common (182 [40·1%]). Baseline self-rated health was good or excellent in 312 (68·7%) and wellbeing was slightly above median age-specific population norms (median score Warwick–Edinburgh mental wellbeing scale 55·0, IQR 49·0–61·0). Preliminary analysis of 52 in-depth interviews and four working groups suggests the process was feasible to implement and of value to practices in identifying previously unknown needs. Multidisciplinary working groups seemed to find it difficult to interpret and act on findings. We will present findings on costs, behaviour changes, health service utilisation, wellbeing and quality of life at follow-up, and qualitative data on context, mechanisms, and effect. InterpretationBaseline findings suggest the MRAO system is feasible to implement in primary care. Practices can use it to identify individual needs and inform commissioning. However, participation rates are low, particularly for older age (at least 85 years), lower socioeconomic status, and ethnic minority groups. FundingMedical Research Council LLHW G1001822/1.