Health risk assessments may benefit elderly

When healthy elderly people fill out health risk questionnaires and get personalized counseling, they have better health behaviors and use more preventive care, according to a new study.

Eighteen percent of firms ask working-age employees to complete health risk assessments, but the use of these tools in older persons is relatively new, said lead author Andreas E. Stuck of University Hospital Bern in Switzerland.

The personal health risk assessments covered multiple potential risk factors relevant in old age, and participants received individualized feedback and health counseling, lasting two years, Stuck said.

“Thus, prevention in old age is likely effective, but only if risk assessment is combined with individualized counseling over an extended period of time,” Stuck told Reuters Health by email.

In his team’s study, conducted in Switzerland between 2000 and 2002, 874 healthy adults over age 65 filled out questionnaires and received individualized computer-generated feedback reports, which were also sent to their doctors.

Additionally, for two years, nurse counselors visited patients at home and called them every three to six months to reinforce what health behaviors they should be pursuing or preventive care they should be obtaining based on their individualized reports.

About 85 percent of those assigned to the health risk assessment group returned their questionnaires, the researchers reported in PLoS Medicine.

Counselors identified the most important risk factors for each person, and the interaction between risk factors was taken into account. For example, for a person with low physical activity who was having pain, the first step was to intervene on management of pain, then on physical activity, Stuck said.

At the end of two years, the researchers compared the risk assessment group to another 1,000 similar adults who did not get the questionnaires or counseling.

Seventy percent of those who completed the health-risk assessments were physically active and 66 percent had received a seasonal flu vaccine, compared to 62 percent and 59 percent of the comparison group, respectively.

Long-term outcomes like nursing home admission or functional status were not available, but the researchers estimated that almost 78 percent of the adults in the health risk assessment group were still alive after eight years, compared to almost 73 percent in the comparison group.

The health assessment, data entry and individualized feedback report takes patients about one hour to do and costs about $30, Stuck said, not including the cost of individualized counseling by the nurse counselor or a primary care physician.

Health risk assessment should be offered to all older people starting between age 60 and 65, he said.

“The authors report promising evidence that a complex intervention might improve longevity and functioning in older adults,” said Evan Mayo-Wilson of the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, who was not part of the new study.

“The team provided many services in addition to standard care, and we cannot tell if all of those services were important or if only certain activities would be necessary to achieve good outcomes,” Mayo-Wilson told Reuters Health by email.

But only half of the people assessed for the trial were enrolled, while many weren’t eligible or refused, and some who were assigned to the health risk assessments didn’t return their questionnaires or otherwise didn’t engage with the program, he noted.

“We should be cautious in interpreting the results of this study because previous studies found inconsistent effects of mortality and other health outcomes,” Mayo-Wilson said.