Abstract
BackgroundWith population ageing, research is needed into new low-cost, scalable methods of effective promotion of health and wellbeing for older people. We aimed to assess feasibility, reach and costs of implementing a new tailored computer-aided health and social risk appraisal system in primary care.MethodsDesign: Feasibility study.Setting: Five General Practices in London (Ealing) and Hertfordshire, United Kingdom (UK)Participants: Random sample of patients aged 65 + years.Intervention: The Multi-dimensional Risk Appraisal for Older people (MRA-O) system includes: 1) Postal questionnaire including health, lifestyle, social and environmental domains; 2) Software system generating a personalised feedback report with advice on health and wellbeing; 3) Follow-up of people with new concerning or complex needs by GPs or practice nurses.Evaluation: Feasibility of implementation; participant wellbeing, functional ability and quality of life; social needs, health risks, potential lifestyle changes; and costs of implementation.ResultsResponse rates to initial postal invitations were low (526/1550, 34%). Of these, 454/526 (86%) completed MRA-O assessments. Compared to local UK Census data on older people, participants were younger, more were owner-occupiers and fewer were from ethnic minority groups than expected. A range of problems was identified by participants, including pain in last week (269/438, 61.4%), low physical activity (173/453, 38.2%), sedentary lifestyle (174/447, 38.3%), falls (117/439, 26.7%), incontinence (111/441 25.2%), impaired vision 116/451 (25.7%), impaired hearing (145/431, 33.6%), depressed mood (71/451, 15.7%), impaired memory (44/444 9.9%), social isolation (46/449, 10.2%) and loneliness (31/442, 7.0%). Self-rated health was good/excellent in 312/437 (71.4%), and quality of life and well-being were slightly above age-specific population norms. Implementation costs were low. Practices reviewed medical records of 143/454 (31.5%) of participants as a consequence of their responses, and actively followed up 110/454 (24.2%) of their patients.ConclusionsA computer-aided risk appraisal system was feasible for General Practices to implement, yields useful information about health and social problems, and identifies individual needs. Participation rates were however low, particularly for the oldest old, the poorest, and ethnic minority groups, and this type of intervention may increase inequalities in access. Widespread implementation of this approach would require work to address potential inequalities.
Highlights
With population ageing, research is needed into new low-cost, scalable methods of effective promotion of health and wellbeing for older people
In the United Kingdom (UK) the majority of older people are registered with a General Practitioner (GP), and primary care is one of the few services that has the ability to reach the general population of older people
We have combined the standard HRAO with the new questions from the SWISH study to create a new broader assessment tool, the Multi-dimensional Risk Appraisal for Older people (MRA-O) system. This experience raised two questions: 1) Can a multifaceted intervention with local embedding and reenforcement of tailored recommendations be integrated into routine primary care? 2) Are there added benefits to broadening primary care based health risk appraisal to include social, economic and environmental domains? The aims of this study were to test the feasibility and costs of using Health Risk Appraisal for Older people (HRA-O) and SWISH tools combined into a Multi-dimensional Risk Appraisal system for Older people (MRA-O), including local embedding and reenforcement of use in routine primary care
Summary
Research is needed into new low-cost, scalable methods of effective promotion of health and wellbeing for older people. There is a lack of evidence for effective primary care led population approaches to improving health and wellbeing in later life, and initiatives such as an annual over 75 years health check, generally an invitation to a face to face assessment with a nurse or physician for all people aged 75 and over, have had limited effectiveness [6], with no evidence on whether they might be cost-effective. This approach is potentially burdensome for primary care, in the context of a rising older-old population. It may miss opportunities for health promotion in younger age groups, such as those aged 65 – 74 years around the retirement window
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