Background Potentially avoidable risk factors continue to cause unnecessary disability and

Background Potentially avoidable risk factors continue to cause unnecessary disability and premature death in older people. primary care physician (PCP) practices in a mixed rural and urban area in Switzerland. From November 2000 to January 2002, 874 participants were randomly allocated to the intervention and 1,410 to usual care. The intervention consisted of HRA based on self-administered questionnaires and individualised computer-generated feedback reports, combined with nurse and PCP counselling over a 2-y period. Primary outcomes were health behaviours and preventive care use at 2 y and all-cause mortality at 8 y. At baseline, participants in the intervention group had a mean standard deviation of 6.9 3.7 risk factors (including unfavourable health behaviours, health and functional impairments, and social risk factors) and 4.3 1.8 deficits in recommended preventive care. At 2 y, favourable health behaviours and use of preventive care were more frequent in the intervention than in the control group (based on = 0.001), and 66% compared to 59% had influenza vaccinations in the past year (odds ratio 1.35, 95% CI 1.09C1.66, = 0.005). At 8 y, based on an intention-to-treat analysis, the estimated proportion alive was 77.9% in the intervention and 72.8% in the control group, for an absolute mortality difference of 4.9% (95% CI 1.3%C8.5%, = 0.009; based on = 0.009; based on Wald test from Cox regression model), 64862-96-0 supplier and the number needed to receive the intervention to prevent one death was 21 (95% CI 12C79). The main limitations of the study include the single-site study design, the use of a brief self-administered questionnaire for 2-y outcome data collection, the unavailability of other long-term outcome data (e.g., functional status, nursing home admissions), and the availability of long-term follow-up data on mortality for analysis only in 2014. Conclusions This is the first trial to our knowledge demonstrating that a collaborative care model of HRA in community-dwelling older people not only results in better health behaviours and increased use of recommended preventive care interventions, but also improves survival. The intervention tested in our study may serve as a model of how to implement a relatively low-cost but effective programme of disease prevention and health promotion in older individuals. Trial Registration International Standard Randomized Controlled Trial Number: ISRCTN 28458424 Introduction An increasing number of older individuals are affected by multiple risks and morbidities, leading to functional impairment, nursing home admissions, or premature death, with enormous social and economic costs to society [1]. These adverse outcomes might at least in part be avoidable. For example, recent studies demonstrate a continued high prevalence of unhealthy behaviours and preventive care deficits in older individuals despite evidence supporting the importance of healthy lifestyles and optimal preventive care in later life [2]. Also, early identification of, and intervention for, previously unknown health and functional deficits may contribute to better outcomes in older people [3]. The search for, and the implementation of, multimodal programmes for cost-effective disease prevention and health promotion has therefore become a top health policy priority worldwide. It has been shown that multimodal interventions may substantially improve health status and reduce mortality for frail or disabled older individuals. For example, one randomised controlled trial found that chronically ill older adults who were offered a community-based nurse intervention had a 25% 64862-96-0 supplier lower risk of death as compared to control group individuals with usual care [4]. However, for nondisabled older individuals, previous studies have revealed inconsistent findings. 64862-96-0 supplier For example, a meta-analysis of trials of systematic health checks for general adult populations concluded that these interventions did not have favourable effects on mortality, perhaps since these programmes were organised in parallel to, and not aligned with, primary care [5]. Moreover, systematic analyses 64862-96-0 supplier of multimodal preventive care home visit programmes found no consistent effects on mortality and other outcomes, although some studies found that these programmes significantly reduced or delayed nursing home admissions in older individuals [6]. Health risk assessment (HRA) has recently received attention as a 64862-96-0 supplier method for multidimensional preventive care intervention among older individuals [7,8]. Originally developed for workforce health promotion, HRA is based on self-reports to guide risk factor interventions, with subsequent individualised feedback Ppia to participants on their health status and on how to promote health, maintain function, or prevent disease [9,10]. HRA is a potentially promising approach for use in older individuals, with scientific evidence for favourable effects on intermediate outcomes such as health behaviours and use of preventive care [7,8,11]. However, studies have found that HRA-based interventions were effective for intermediate outcomes only if older individuals received HRA combined with some form of personal reinforcement [7,8,11]. For example, this was confirmed by the findings of two recent randomised controlled trials funded by the European Union [12,13]. One trial conducted in London (UK) tested the effects of a single HRA. This HRA was combined with an electronic health.