Implementation of a collaborative care model among community-dwelling older people using a health risk assessment instrument resulted in better health behaviors and increased use of preventative care, according to a study published this week in PLOS Medicine. The trial, conducted by Andreas Stuck from the University Hospital Bern and University of Bern, Switzerland, and colleagues, demonstrated improved 8-year survival among recipients of the intervention.
In almost every country, the over-60 age group is growing faster than any other age group. Programs that encourage a healthy lifestyle and the uptake of preventative care among older people are a health policy priority. In this pragmatic trial, Stuck and colleagues found that health risk assessment by self-administered questionnaire combined with two years of personal reinforcement by specially trained counselors was effective in reducing the average participant's number of risk factors and preventative care deficits. For example, at the 2-year follow-up, 70% of the intervention group were physically active compared to 62% of the control group (Odds Ratio 1.43 (95% CI 1.16-1.77, p = 0.001), and 66% of the intervention group had had an influenza vaccination that year compared to 59% of the control group (OR 1.35 (95% CI 1.09-1.66, p = 0.005)). Over the 8-year follow-up, the mortality rate was 3.16 (95% CI 2.74-3.63) per 100 person-years in the intervention group, as compared to 3.97 (95% CI 3.59-4.39) in the control group (Hazard Ratio 0.79 (95% CI 0.66-0.94, p = 0.009). Stuck and colleagues calculated that, to avert one death over eight years, 21 individuals would need to receive the intervention.
Certain aspects of the trial design may limit the interpretation of these findings. Some participants may have given socially desirable answers on questionnaires, the study was undertaken at a single site, and long-term follow-up information was limited to survival. Overall, however, these findings suggest that the use of regionally adapted approaches for health risk assessment combined with individual counseling might be an effective and relatively low-cost way to improve health and survival among non-disabled older people. The authors state, "Our study may also serve as a model for low- and middle-income countries, given the importance of the demographic challenge of rapidly growing populations of older individuals in these countries."
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Research Article
Funding:
European Union (QLK6-CT-1999-02205) (AS SI CS); the Federal Education and Science Ministry (Bern, Switzerland, BBW 990311.1) (AS); the Swiss National Science Foundation (32-52804.97) (AS); the Swiss National Science Foundation Swiss National Cohort (projects 0071, 3347CO-108806, 33CS30_134273 and 33CS30_148415) (ME); the Swiss Foundation for Health Promotion (Project No. 398) (AS); the Velux Foundation (AS); the Langley Research Institute (JCB). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests:
The authors have declared that no competing interests exist.
Citation:
Stuck AE, Moser A, Morf U, Wirz U, Wyser J, Gillmann G, et al. (2015) Effect of Health Risk Assessment and Counselling on Health Behaviour and Survival in Older People: A Pragmatic Randomised Trial. PLoS Med 12(10): e1001889. doi:10.1371/journal.pmed.1001889
Author Affiliations:
Department of Geriatrics, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
Institute of Primary Care, University of Bern, Bern, Switzerland
Research Department of Primary Care and Population Health, University College London, London, United Kingdom
Department of Ageing and Health, St. Thomas' Hospital, London, United Kingdom
Clinical Age Research Unit, King's College London, London, United Kingdom
University of California, Los Angeles, California, United States of America
Langley Research Institute, Los Angeles, California, United States of America
Contact:
Andreas E. Stuck, MD
University Hospital Bern and University of Bern
Department of Geriatrics
C.L. Lory-Haus, 3. OG
Bern, CH-3010
SWITZERLAND
0041763632338
andreas.stuck@insel.ch
North American Contact
John C. Beck, MD
Professor of Medicine
1562 Casale Road
Pacific Palisades, CA 90272
U.S.A.
+1 310 459 5927
egebjcb@ucla.edu
Journal
PLoS Medicine