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.
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.
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

Alsaeed D
(2016)
Older people's priorities in health and social care research and practice: a public engagement workshop.
in Research involvement and engagement


Ford JA
(2017)
Service use of older people who participate in primary care health promotion: a latent class analysis.
in BMC health services research

Frost R
(2018)
Identifying acceptable components for home-based health promotion services for older people with mild frailty: A qualitative study.
in Health & social care in the community

Iliffe S
(2017)
Health and well-being promotion strategies for 'hard to reach' older people in England: a mapping exercise.
in Primary health care research & development

Jovicic A
(2015)
Identifying the content of home-based health behaviour change interventions for frail older people: a systematic review protocol.
in Systematic reviews

Kharicha K
(2021)
Managing loneliness: a qualitative study of older people's views.
in Aging & mental health

Kharicha K
(2017)
What do older people experiencing loneliness think about primary care or community based interventions to reduce loneliness? A qualitative study in England.
in Health & social care in the community

Liljas AEM
(2017)
Strategies to improve engagement of 'hard to reach' older people in research on health promotion: a systematic review.
in BMC public health

Liljas AEM
(2019)
Engaging 'hard to reach' groups in health promotion: the views of older people and professionals from a qualitative study in England.
in BMC public health
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 | 08/2014 |
End | 03/2017 |
Description | Innovation Grant |
Amount | £34,444 (GBP) |
Organisation | Parkinson's UK |
Sector | Charity/Non Profit |
Country | United Kingdom |
Start | 03/2013 |
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 | Public |
Country | United Kingdom |
Start | 08/2015 |
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 | 03/2014 |
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 | 09/2015 |
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 | 03/2013 |
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 | 05/2012 |
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 | Academic/University |
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 | 09/2013 |
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 | 03/2012 |
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 | Switzerland |
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 had a feasibility RCT, funded by the NIHR HTA. This has now progressed to a successfully funded definitive RCT |
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 |