Development, feasibility and performance of a health risk appraisal questionnaire for older persons

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Abstract

Background

Health risk appraisal is a promising method for health promotion and prevention in older persons. The Health Risk Appraisal for the Elderly (HRA-E) developed in the U.S. has unique features but has not been tested outside the United States.

Methods

Based on the original HRA-E, we developed a scientifically updated and regionally adapted multilingual Health Risk Appraisal for Older Persons (HRA-O) instrument consisting of a self-administered questionnaire and software-generated feed-back reports. We evaluated the practicability and performance of the questionnaire in non-disabled community-dwelling older persons in London (U.K.) (N = 1090), Hamburg (Germany) (N = 804), and Solothurn (Switzerland) (N = 748) in a sub-sample of an international randomised controlled study.

Results

Over eighty percent of invited older persons returned the self-administered HRA-O questionnaire. Fair or poor self-perceived health status and older age were correlated with higher rates of non-return of the questionnaire. Older participants and those with lower educational levels reported more difficulty in completing the HRA-O questionnaire as compared to younger and higher educated persons. However, even among older participants and those with low educational level, more than 80% rated the questionnaire as easy to complete. Prevalence rates of risks for functional decline or problems were between 2% and 91% for the 19 HRA-O domains. Participants' intention to change health behaviour suggested that for some risk factors participants were in a pre-contemplation phase, having no short- or medium-term plans for change. Many participants perceived their health behaviour or preventative care uptake as optimal, despite indications of deficits according to the HRA-O based evaluation.

Conclusion

The HRA-O questionnaire was highly accepted by a broad range of community-dwelling non-disabled persons. It identified a high number of risks and problems, and provided information on participants' intention to change health behaviour.

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Most cited references 32

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Risk factors for falls among elderly persons living in the community.

Mary E. Tinetti, Mark Speechley, Sandra F. Ginter (1988)

To study risk factors for falling, we conducted a one-year prospective investigation, using a sample of 336 persons at least 75 years of age who were living in the community. All subjects underwent detailed clinical evaluation, including standardized measures of mental status, strength, reflexes, balance, and gait; in addition, we inspected their homes for environmental hazards. Falls and their circumstances were identified during bimonthly telephone calls. During one year of follow-up, 108 subjects (32 percent) fell at least once; 24 percent of those who fell had serious injuries and 6 percent had fractures. Predisposing factors for falls were identified in linear-logistic models. The adjusted odds ratio for sedative use was 28.3; for cognitive impairment, 5.0; for disability of the lower extremities, 3.8; for palmomental reflex, 3.0; for abnormalities of balance and gait, 1.9; and for foot problems, 1.8; the lower bounds of the 95 percent confidence intervals were 1 or more for all variables. The risk of falling increased linearly with the number of risk factors, from 8 percent with none to 78 percent with four or more risk factors (P less than 0.0001). About 10 percent of the falls occurred during acute illness, 5 percent during hazardous activity, and 44 percent in the presence of environmental hazards. We conclude that falls among older persons living in the community are common and that a simple clinical assessment can identify the elderly persons who are at the greatest risk of falling.

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The MOS social support survey.

C Sherbourne, A Stewart (1991)

This paper describes the development and evaluation of a brief, multidimensional, self-administered, social support survey that was developed for patients in the Medical Outcomes Study (MOS), a two-year study of patients with chronic conditions. This survey was designed to be comprehensive in terms of recent thinking about the various dimensions of social support. In addition, it was designed to be distinct from other related measures. We present a summary of the major conceptual issues considered when choosing items for the social support battery, describe the items, and present findings based on data from 2987 patients (ages 18 and older). Multitrait scaling analyses supported the dimensionality of four functional support scales (emotional/informational, tangible, affectionate, and positive social interaction) and the construction of an overall functional social support index. These support measures are distinct from structural measures of social support and from related health measures. They are reliable (all Alphas greater than 0.91), and are fairly stable over time. Selected construct validity hypotheses were supported.

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The Physical Activity Scale for the Elderly (PASE): development and evaluation.

C G Janney, Cicely A. Jette, George W Smith … (1993)

A Physical Activity Scale for the Elderly (PASE) was evaluated in a sample of community-dwelling, older adults. Respondents were randomly assigned to complete the PASE by mail or telephone before or after a home visit assessment. Item weights for the PASE were derived by regressing a physical activity principal component score on responses to the PASE. The component score was based on 3-day motion sensor counts, a 3-day physical activity dairy and a global activity self-assessment. Test-retest reliability, assessed over a 3-7 week interval, was 0.75 (95% CI = 0.69-0.80). Reliability for mail administration (r = 0.84) was higher than for telephone administration (r = 0.68). Construct validity was established by correlating PASE scores with health status and physiologic measures. As hypothesized, PASE scores were positively associated with grip strength (r = 0.37), static balance (r = +0.33), leg strength (r = 0.25) and negatively correlated with resting heart rate (r = -0.13), age (r = -0.34) and perceived health status (r = -0.34); and overall Sickness Impact Profile score (r = -0.42). The PASE is a brief, easily scored, reliable and valid instrument for the assessment of physical activity in epidemiologic studies of older people.

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Author and article information

Journal

Journal ID (nlm-ta): BMC Med Res Methodol

Title: BMC Medical Research Methodology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2288

Publication date Collection: 2007

Publication date (Electronic): 11 January 2007

Volume: 7

Page: 1

Affiliations

[1 ]Department of Geriatrics, University of Bern, Spital Bern-Ziegler, Morillonstrasse 75-91, CH-3001 Bern, Switzerland

[2 ]Division of Geriatrics, Department of General Internal Medicine, Insel University of Bern Hospital, CH-3010 Bern, Switzerland

[3 ]Department of Primary Care and Population Sciences, University College London, Hampstead Campus, Rowland Hill Street, London NW3 2PF, UK

[4 ]Albertinen-Haus Geriatrics Centre, University of Hamburg, Sellhopsweg 18-22, D-22459 Hamburg, Germany

[5 ]Department of Ageing and Health, Guys and St Thomas' NHS Foundation Trust, 9th Floor North Wing, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK

[6 ]Department of Health Care of the Elderly, Kings College London, Clinical Age Research Unit, King's College Hospital, Bessemer Road, London SE5 9PJ, UK

[7 ]Department of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, CH-3012 Bern, Switzerland

[8 ]Department of Emergency Medicine, University of California, Los Angeles, California, USA

[9 ]School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave. 32-144, Los Angeles CA-90024-1687, USA

Article

Publisher ID: 1471-2288-7-1

DOI: 10.1186/1471-2288-7-1

PMC ID: 1783663

PubMed ID: 17217545

SO-VID: de611450-4d02-4ae5-a813-f81606894949

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Development, feasibility and performance of a health risk appraisal questionnaire for older persons

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Abstract

Background

Methods

Results

Conclusion

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Most cited references 32

Risk factors for falls among elderly persons living in the community.

The MOS social support survey.

The Physical Activity Scale for the Elderly (PASE): development and evaluation.

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