Promotion of health in older people: a randomised controlled trial of health risk appraisal in British general practice
1 Department of Ageing and Health, Guys and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London SE1 7EH, UK
2 Department of Primary-Care and Population Sciences, University College London, London NW3 2PF, UK
3 Department of Social and Preventive Medicine, University of Bern, CH-3012 Bern, Switzerland
4 Albertinen-Haus Geriatrics Centre, Sellhopsweg 18-22, D-22459 Hamburg, Germany
5 Langley Research Center, Los Angeles, CA 90272, USA
6 Department of Health Care of the Elderly, Kings College London, Clinical Age Research Unit, King's College Hospital, London SE5 9PJ, UK
7 Department of Geriatrics, University of Bern, Insel und Ziegler Hospital, Bern, CH-3001 Bern, Switzerland
Address correspondence to: Danielle Harari. Tel: 0207 188 2516; Fax: 0207 928 2339. Email: danielle.harari{at}kcl.ac.uk
Background: there is inadequate evidence to support currently formulated NHS strategies to achieve health promotion and preventative care in older people through broad-based screening and assessment in primary care. The most extensively evaluated delivery instrument for this purpose is Health Risk Appraisal (HRA). This article describes a trial using HRA to evaluate the effect on health behaviour and preventative-care uptake in older people in NHS primary care.
Methods: a randomised controlled trial was undertaken in three London primary care group practices.
Functionally independent community-dwelling patients older than 65 years (n = 2,503) received a self-administered Health Risk Appraisal for Older Persons (HRA-O) questionnaire leading to computer-generated individualised written feedback to participants and general practitioners (GPs), integrated into practice information-technology (IT) systems. All primary care staff received training in preventative health in older people. The main outcome measures were self-reported health behaviour and preventative care uptake at 1-year follow-up.
Results: of 2,503 individuals randomised, 2,006 respondents (80.1%) (intervention, n = 940, control n = 1,066) were available for analysis. Intervention group respondents reported slightly higher pneumococcal vaccination uptake and equivocal improvement in physical activity levels compared with controls. No significant differences were observed for any other categories of health behaviour or preventative care measures at 1-year follow-up.
Conclusions: HRA-O implemented in this way resulted in minimal improvement of health behaviour or uptake of preventative care measures in older people. Supplementary reinforcement involving contact by health professionals with patients over and above routine clinical encounters may be a prerequisite to the effectiveness of IT-based delivery systems for health promotion in older people.
Keywords: health risk appraisal, health promotion, older, primary care, elderly
Received 14 November 2007; accepted in revised form 29 February 2008.