Abstract
(Englisch)
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Overall objectives of the project:
The goal of the project is to change health risk behaviour in older persons with the longer-term aim of preventing disability and minimising unnecessary service utilisation. This is achieved by the development of a new intervention that could be integrated into primary care at relatively low cost and that could be used as a cross-national database for comparative evaluation on determinants of healthy ageing.
Experimental approach and working method:
The intervention is based on the use of information technology to identify modifiable risk factors for disability and to generate feed-back statements to older persons and health care providers (Health Risk Appraisal for Older People, HRA-O). The first project phase was devoted to the development and pilot-testing of HRA-O. In the second project phase, we are conducting three randomised controlled trials in Hamburg (N=3'326), Bern (N=4'038), and London (N=3'142). Study population: Older community-dwelling persons (London, Bern: age 65 years and older; Hamburg 60 years and older), registered in participating primary care practices. Randomisation: Two thirds of practices were allocated to additional physician training. Older persons of these practices were randomised to intervention group and control (usual care) group. Older persons of the remaining one third of practices (no additional physician training) serve as a second control group. Intervention: Persons in the intervention group get the HRA-O intervention (written feed-back with reinforcement in primary care practice over a one-year period). Outcomes: At one-year follow-up, HRA-O questionnaires and telephone follow-up will be administered to evaluate the effects on health behaviour. The third project phase will be devoted to follow-up and practice dissemination.
Achievements and results to date:
· successful completion of pilot field tests in Hamburg (N=164) and London (N=348): results show a high prevalence of modifiable risk factors for disability (e.g. low physical activity, 28% to 46%; high fat nutrition, 25% to 54%; vision problem, 17% to 38%; risk of social isolation, 3% to 27%), variable levels of preventive care uptake (e.g. no colon cancer screening, 48% to 94%; no influenza vaccination, 38% to 52%) and a high level of acceptance of the self-administered questionnaire (older persons said that the questionnaire was easy to complete, 83% to 96%);
· development of a regionally adapted, scientifically updated HRA-O system;
· successful recruitment and randomisation of older persons (N=10'506);
· successful implementation of regionally adapted intervention programs to reinforce the HRA-O approach (practice-nurse model, home-visit model, group sessions, general practitioner quality circle based on evidence-based intervention manual);
· ongoing dissemination activities: collaboration with groups in other member states (Austria, Denmark, Netherlands, Belgium) interested in future use and dissemination.
The most relevant publications emanating from the project:
Dapp U, Anders J, Lübke N, Meier-Baumgartner HP, Stuck AE. Disability Prevention. Zeitschr Geront Geriat 2000, Suppl. 2, 33:41.
Harari D, Iliffe S, Swift C, Kharicha K, Stuck AE. Self-reported preventive health care in community-living older people. British Geriatrics Society, May 2001
Seematter-Bagnoud L, Stuck AE, Büla C. Prévention et promotion de la santé chez la personne âgée. MédecineHygiène 2002; 60:S24-25.
Stuck AE, Egger M, Hammer A, Minder CE, Beck JC. Home visits to prevent nursing home admission and functional decline in the elderly: Systematic review and meta-regression analysis. JAMA 2002; 287:1022-8
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