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

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 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.