Multi-dimensional Health Risk Appraisal for Older People: embedding promotion of health and well-being in practice

Lead Research Organisation: University College London
Department Name: Primary Care and Population Sciences

Abstract

Current policy emphasises tailored approaches to preventing ill-health, working in partnerships across health and local government, and local solutions to promoting wellbeing for older people. There is however limited evidence on the best approaches to meet these aims. This study will assess the feasibility and costs of a using a new self-assessment system to identify health, social, economic and environmental needs and promote well-being among older people. The system is called ?Multi-dimensional Risk Appraisal for Older people? (MRAO). It provides comprehensive assessment, tailored personalised feedback on individual?s needs and information on resources nationally and locally to meet these needs. Those with needs would be contacted by someone from NHS, social care or voluntary groups who could support them in meeting their need, if they wished. This might include, for example, healthy lifestyle advice, advice on help with benefits/finances or local social/educational groups for older people. The study involves forming local ?working groups? with older people, members from NHS (GPs, community nurses), local government (social care, transport, planning, housing/environment) and voluntary/community organisations. The combined anonymous results of MRAO assessments with older people will be presented to these groups, to use this information to recommend changes in services to more closely meet the needs of older people living locally.

This is a feasibility study, to see if this process can work in practice, with the potential to make positive changes in promoting well-being among older people. The MRAO system has already been developed but not implemented in ?real? settings. We will see if there are differences in needs, quality of life, disability and well-being among older people from before and 3 months after the MRAO assessments. We will find out how much setting up/running the MRAO and working groups costs. We will use information collected to design a future bigger trial of MRAO, to test if this is a cost-effective approach that can be recommended across the country. We will observe/interview working groups to evaluate how different sectors/agencies can work together to meet local needs using MRAO and provide guidance on best practice. We will interview older people who have taken part about their experiences; asking what helps and hinders them in sustaining well-being. The information from this study would potentially have a big impact on policy and practice in making sure that older people receive support to prevent problems getting worse and in enabling them to contribute to their communities.

Technical Summary

This project evaluates a Multi-dimensional Risk Assessment in Older people (MRAO) expert system that encompasses health, social, economic and environmental domains. It considers its effectiveness as a tool that promotes self care and fosters cross sector working to promote community well-being. It has relevance across Research Councils including the MRC, ESRC and EPSRC.

Study objectives are to:
1) Assess feasibility and costs of locally adapting/embedding the MRAO system
2) Identify factors helping/hindering older people and professionals from using MRAO recommendations that promote well-being
3) Evaluate areas of effective joint working across agencies (health, social care, housing/environment/transport, voluntary sector, social enterprises) based around meeting locally identified needs using MRAO.
4) Feasibility data for a future trial.

Design: Mixed method evaluation of the MRAO system
Setting: Two localities (urban London, rural Hertfordshire).
Intervention: This incorporates 3 stages:
1) Locally adapting/embedding the MRAO technology: Researchers will facilitate working groups including older people, General Practices/GP commisioners, Community Nursing, Social Care, Housing/Transport/Environment, Social Enterprises and Voluntary/Community Organisation to tailor the MRAO system for local needs and incoporate local strategies for responding to older people using MRAO.
2) MRAO assessments with older people: By postal questionnaires with a random sample of 1:3 older people at participating general practices. Participants receive automated tailored feedback based on responses to MRAO. Feedback includes information on resources to support self-care/promote well-being, with individualised reinforcement from primary care, social care or voluntary sector practitioners as locally agreed.
3) Utilising aggregate data to inform commissioning/service delivery: Aggregated data on patterns of local need are fed back to working groups which will make recommendations to local policymakers, commissioners and services.

Measurements/outcomes:
1) Quantitative evaluation:
a) Data on multi-dimensional needs, health behaviours, function/disability, distress, quality of life, social inclusion and well-being will be collected from older people at baseline and 3 months.
b) Cost of the intervention
c) Feasibility data: defining ?usual care?; method of randomisation/recruitment; uptake and recruitment rate; adherence; missing data; effect sizes and SDs of outcomes; major cost components, methods of collecting data on costs of service provision..
2) Qualitative evaluation:
a) Participant observation of working groups and in-depth interviews with participants. This will identify factors relevant to MRAO development, adaption and implementation, optimal use of aggregate data and multi-agency working to promote well-being.
b) In depth interviews with older people will explore experiences of undertaking the MRAO assessment and factors that facilitated/hindered them from engaging in actions to promote well-being.

Publications

10 25 50

 
Description HTA Disease Prevention Commissioning Panel
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
 
Description Inclusion in Strategic Plans for Local Authorities/ Clinical Commissioning Group
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Citation in other policy documents
 
Description HTA Commissioned Call 'Home Based Health Promotion for Vulnerable Older People'
Amount £442,408 (GBP)
Funding ID 12/192/10 
Organisation National Institute for Health Research 
Department Health Technology Assessment Programme (HTA)
Sector Public
Country United Kingdom
Start 09/2014 
End 03/2017
 
Description Innovation Grant
Amount £34,444 (GBP)
Organisation Parkinson's UK 
Sector Charity/Non Profit
Country United Kingdom
Start 04/2013 
End 03/2014
 
Description NIHR In Practice Fellowship
Amount £79,997 (GBP)
Funding ID 167572 
Organisation National Institute for Health Research 
Department NIHR Fellowship Programme
Sector Academic/University
Country United Kingdom
Start 09/2015 
End 08/2017
 
Description NIHR School of Primary Care Research - Round 7
Amount £62,361 (GBP)
Organisation National Institute for Health Research 
Department School for Primary Care Research
Sector Academic/University
Country United Kingdom
Start 04/2014 
End 07/2015
 
Description NIHR School of Primary Care Research FR11
Amount £37,173 (GBP)
Organisation National Institute for Health Research 
Department School for Primary Care Research
Sector Academic/University
Country United Kingdom
Start 10/2015 
End 09/2016
 
Description NIHR School of Public Health Research
Amount £3,024,209 (GBP)
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 04/2013 
End 03/2017
 
Description National School of Primary Care Research - Round 5
Amount £57,561 (GBP)
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 06/2012 
End 05/2014
 
Description Patient and Public Involvement Bursary Fund
Amount £1,995 (GBP)
Organisation National Institute for Health Research 
Department UCLH/UCL Biomedical Research Centre
Sector Public
Country United Kingdom
Start 02/2014 
End 01/2015
 
Description Research Grants Scheme
Amount £121,053 (GBP)
Funding ID R296/0513 
Organisation The Dunhill Medical Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 10/2013 
End 09/2015
 
Description Thomas Pocklington Trust Research Grants
Amount £33,345 (GBP)
Organisation Thomas Pocklington Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 04/2012 
End 03/2013
 
Title WISH database 
Description Database containing quantitative data and qualitative data collected in this LLHW MRC grant. Includes 52 semi-structured interviews with older people and stakeholder and prospective data on 456 older people participating. 
Type Of Material Database/Collection of data 
Year Produced 2014 
Provided To Others? Yes  
Impact The data from the semi-structured interviews has been used to inform the development of a new home-based health promotion service for older people with early frailty, in conjunction with further interviews conducted as part of an NIHR HTA grant (that was funded following this MRC grant as a further development). The data has also been used to promote cross-disciplinary collaboration within UCL for a Masters Degree research project. 
 
Description Collaboration with University of Bern 
Organisation University of Bern
Department Geriatrics/Medicine of Ageing
Country Germany 
Sector Academic/University 
PI Contribution In the context of MRC Grant G1001822 we have developed a collaboration with Professor Andreas Stuck and Dr Stephan Born at the University of Bern, Switzerland. They have developed and hold the copyright to the HRAO (Health Risk Appraisal for Older People) software, and with them we have translated and modified this for the UK context and added new sections to broaden from health and psychological and include social and environmental domains. This modified software is being feasibility tested within the research.
Collaborator Contribution They have updated their software to produce a modified UK version of the HRAO, for use in our study.
Impact The collaboration is multi-disciplinary including primary care academics, social policy and health services researchers (in the UK), and software specialists and geriatricians (in Bern).
Start Year 2012
 
Title Home based health promotion service for older people 
Description New service has been developed and currently undergoing a feasibility RCT, funded by the NIHR HTA. 
Type Preventative Intervention - Behavioural risk modification
Current Stage Of Development Early clinical assessment
Year Development Stage Completed 2015
Development Status Under active development/distribution
Impact N/A (Not yet) The products from the development process are currently being prepared for dissemination. 
 
Description Plenary Presentation at European General Practice Research Network, World Organisation of Family Doctors (WONCA), Barcelona 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Geographic Reach International
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact I was invited to give the conference opening plenary presentation of the findings of this MRC LLHW award, and what the implications are for practice. This generated a very lively discussion of the value different approaches to health promotion across different countries in Europe.

I have been invited to collaborate further with GP colleagues doing similar work in Sweden and Spain. As a result we have a team from the University of Lund, Sweden visiting my unit in November 2014, and we are applying for a joint grant together next year.
Year(s) Of Engagement Activity 2014
 
Description Presentation at Public Health Science National Conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Conference participants attended, which resulted in questions and discussion.

Further requests for information.
Year(s) Of Engagement Activity 2014
 
Description Presentation at RCGP Annual Conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Presented at RCGP Annual Conference, Harrowgate October 2013. This is attended primarily by practicing GPs and is well covered in the media.
"Promoting health and well-being for older people: the feasibility, impact and utility of a new system for primary care." Walters K, Kharicha K, Iliffe S, Goodman C, Handley M, Manthorpe J, Cattan M, Morris S.
There was some lively debate following the presentation on health promotion for vulnerable older people in primary care.

The feedback/discussion has been integrated into some of our other dissemination activities that will shortly occur (2 conferences presentations in November, and we are hosting 2 stakeholder conferences in our study localities for commissioners/policy makers in November).
Year(s) Of Engagement Activity 2013
 
Description RCGP Anticipatory care for Older People Workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? Yes
Type Of Presentation Keynote/Invited Speaker
Geographic Reach National
Primary Audience Health professionals
Results and Impact A virtual network has been formed, that has remained in regular contact, and has been lobbying for an increased profile of this topic within the RCGP and outside.

As above.
Year(s) Of Engagement Activity 2012
 
Description RCGP Dementia invited speaker 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach National
Primary Audience Health professionals
Results and Impact I was invited to give a talk for the Royal College of General Practitioners on the assessment of subjective memory impairment.

There was positive feedback from participants, and I was invited to give the same talk to regional groups of GPs.
Year(s) Of Engagement Activity 2012
 
Description SMF Think Tank expert round table 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact I was invited to attend an expert panel for the Social Market Foundation (SMF) Cross-Party Think Tank, who are preparing a report on the early diagnosis of Dementia. I was invited to provide a primary care perspective. A number of experts in the field attended, and a useful and animated discussion resulted in how to move the field forward in promoting early diagnosis in dementia. This will form part of the report for the SMF.

I was invited to join the GP expert reference group for the Alzheimer's Society (who were also in attendance). The SMF will be submitting a report to the Department of Health.
Year(s) Of Engagement Activity 2012
 
Description invited expert round table panel Alzheimers Society 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Expert panel was to inform the policy of Alzhemiers Society (and their related lobbying activities with the Department of Health) on the role of primary care in the early or timely diagnosis of dementia.

Alzheimers Society are currently having a major review of their policy
Year(s) Of Engagement Activity 2014