Promoting independence, health and well-being for older people: a feasibility study of computer-aided health and social risk appraisal system in primary care.
BACKGROUND
With 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.


METHODS
Design: Feasibility study.


METHODS
Five General Practices in London (Ealing) and Hertfordshire, United Kingdom (UK) Participants: Random sample of patients aged 65 + years.


METHODS
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.


RESULTS
Feasibility of implementation; participant wellbeing, functional ability and quality of life; social needs, health risks, potential lifestyle changes; and costs of implementation.


RESULTS
Response 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.


CONCLUSIONS
A 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.
Department Primary Care & Population Health, University College London (UCL), Royal Free Campus, Rowland Hill St, London, NW3 2PF, UK. K.walters@ucl.ac.uk.
Kate
http://orcid.org/0000-0003-2173-2430
K
Walters
Department Primary Care & Population Health, University College London (UCL), Royal Free Campus, Rowland Hill St, London, NW3 2PF, UK.
Kalpa
K
Kharicha
Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, AL10 9AB, Hertfordshire, UK.
Claire
C
Goodman
Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, AL10 9AB, Hertfordshire, UK.
Melanie
M
Handley
Social Care Workforce Research Unit, King's College London, Strand, London, WC2B 4LL, UK.
Jill
J
Manthorpe
University of Northumbria, Sutherland Building Newcastle-upon-Tyne, Newcastle, NE1 8ST, UK.
Mima
M
Cattan
Department of Applied Health Research, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK.
Steve
S
Morris
Department Primary Care & Population Health, University College London (UCL), Royal Free Campus, Rowland Hill St, London, NW3 2PF, UK.
Caroline S
CS
Clarke
Department of Applied Health Research, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK.
Jeff
J
Round
Department Primary Care & Population Health, University College London (UCL), Royal Free Campus, Rowland Hill St, London, NW3 2PF, UK.
Steve
S
Iliffe
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D017076:Computer-Aided Design; D004185:Disability Evaluation; D015444:Exercise / Q000502:physiology; D005240:Feasibility Studies; D005260:Female; D015577:Geriatric Assessment; D006293:Health Promotion / Q000458:organization & administration*; D006304:Health Status; D006801:Humans; D057187:Independent Living / Q000523:psychology / Q000706:statistics & numerical data*; D008019:Life Style; D008297:Male; D011320:Primary Health Care / Q000458:organization & administration*; D011788:Quality of Life; D018570:Risk Assessment; D012424:Rural Population; D006113:United Kingdom; D014505:Urban Population
Ageing; Elderly; Health Promotion; Primary Care