Behaviour change to promote health and well-being in later life: a goal-setting intervention

Older people form an increasingly large group within our society. Living longer brings a greater risk of physical and mental decline and loneliness, and a greater need for care and support. There is also a greater risk of developing age-related diseases such as Alzheimer?s. Because of this, we urgently need to find ways of promoting good health in later life, and preventing, delaying or reducing the impact of age-related disability. This is essential if older people are to enjoy a good quality of life and remain independent for as long as possible. Lifestyle choices appear to influence well-being in old age. People who engage in plenty of mental, physical and social activity tend to have better well-being and remain independent for longer. Unfortunately, many older people are mentally and physically under-active and socially isolated. This suggests that we need to encourage lasting behaviour change. People are more likely to alter their behaviour if they have support from others and access to facilities and resources. We will establish a resource centre for over 50s that offers social contact and a range of relevant activities. Within this context, we will compare different approaches to encouraging increases in physical and mental activity. Everyone who attends will be invited to take part, and those who agree will be allocated randomly to have one of three types of interview. One will involve a general chat about the centre. The second will focus on goal-setting, working with the person to identify up to five areas where they would like to make changes and devising a plan to achieve these goals. The third will be similar to the second but participants will also receive a mentoring phone call every two months. After a year, we will find out how much the three groups have increased their levels of mental and physical activity, and compare the effects of the different types of interview. The findings will be used to inform policy makers and service providers about ways of improving well-being in later life. They will also provide a basis for developing a larger study in which we will follow up the participants for a number of years to find out whether changes in behaviour result in greater well-being and help to reduce the impact of age-related disability and disease.

Lifestyle factors including increased levels of cognitive and physical activity and social engagement are associated with maintenance of function and well-being, and reduction of health risks, in later life. It is now timely to establish the effects of interventions that aim to encourage sustainable behaviour change in these domains in order to promote good health and prevent, delay, or reduce the severity of age-related cognitive and physical disability. The proposed feasibility study forms the initial stage of a cross-disciplinary programme of work intended to lead to a full-scale randomised controlled trial (RCT) of a multi-component lifestyle intervention for over 50s, with longitudinal follow-up. We aim to establish the feasibility of an innovative approach to bringing about behaviour and lifestyle change among over 50s, based on social cognitive theory. We will develop a resource centre for over 50s to provide a context that supports behaviour change and encourages desired behaviours through provision of facilities, activities and social support. Within this context, we will conduct a preliminary RCT of a goal-setting intervention with all centre attendees willing to participate. Goal-setting will involve a structured interview in which up to five specific, realistic and achievable goals are identified in the domains of physical activity, cognitive activity, social engagement and health. Following initial assessment and health screening, we expect to randomise 75 individuals to one of three conditions: control (a general discussion encouraging participation in the centre), goal-setting, and goal-setting with mentoring (a goal-setting interview followed up with bi-monthly telephone mentoring). Reassessment after 12 months will examine changes in participation in physical, cognitive and social activity, and extent of goal attainment. Physical, cognitive, psychological and social functioning, health, and quality of life will also be assessed, together with factors that may influence participation and outcome. In-depth qualitative interviews with a subset of participants, analysed using a biographical narrative approach, will provide insights into motivations and expectations. The findings will allow us to assess the acceptability of the approach, identify the most appropriate outcome measures, and estimate the critical parameters for a large-scale RCT with long-term follow-up. The research will shape our understanding of how best to develop studies aimed at promoting well-being in ageing and preventing, reducing or delaying the onset of cognitive disability and disease, and will lead directly to a proposal for a full-scale RCT.