Healthy Ageing - an Interdisciplinary Randomised Study of Health Dialogues in Primary Care

BACKGROUND: The world faces a demographic shift with an aging population and increasing numbers of older adults experiencing frailty and complex care needs. Effective preventive strategies are requested from many stakeholders . Health dialogues have been introduced in several Swedish regions to promote healthier aging, yet evidence for their effectiveness and cost-efficiency remains limited. While systematic reviews have not confirmed significant effects on morbidity or mortality, some cohort studies suggest benefits in cardiovascular outcomes and a few primary preventive interventions have been directed at older individuals. The results are disputed, and several authors argue that health dialogues and health checks tend to reach individuals with lower cardiovascular risk rather than those at highest risk [4]. There is a lack of studies linking the outcomes of health dialogues to different risk levels.

One strategy to identify individuals in the population at highest risk of morbidity is to use risk assessment instruments. In primary care populations, Adjusted Clinical Groups (ACG) and Charlson Comorbidity Index (CCI) are the most studied. In recent years, several predictive instruments/models using existing health and medical data have been developed to identify older individuals at risk of future functional decline and morbidity. However, the relatively moderate precision of these instruments limits their clinical usefulness. Digital motion analysis using the SAT (Skeleton Avatar Technology) technique has shown potential in assessing physical activity levels, mobility, and balance in older individuals. Still, data from broader populations of older individuals with a wide range of diseases and functional levels are lacking, and the method has not been tested for its predictive ability regarding functional decline and extensive care needs.

Among older individuals, the wide variation in health and functional levels creates a greater need for individualized advice and interventions. Holistic interventions targeting frail older individuals are well-studied, and there is some evidence of positive effects, although results are also conflicting. International recommendations point to a multifactorial causal relationship behind frailty/functional decline, and there is consensus that increased physical activity and reduced malnutrition can counteract these issues, and that an active lifestyle is associated with a reduced risk of frailty.

A current question is which health outcomes are most important for the older population. Studies show that many older individuals value good quality of life and high independence more than maximum lifespan. As a complement to traditional measurements of health-related quality of life using EQ-5D, which focuses on symptoms and function, it is proposed to measure "Capability": the ability to perform activities that are meaningful and important to the individual . ICECAP-O is a quality-of-life instrument that has also been used for health economic evaluations [9].

AIM: