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Aim: To explore the perspectives of both professionals and older people on modifiable health behaviours and risks in later life. Background: Promotion of health and prevention of disability in later life are major health policy priorities across Europe. A system for health risk appraisal in later life, health risk appraisal in older people (HRA-O) permits a population-wide assessment to be carried out. The HRA-O technology is a single assessment process-based questionnaire, which generates a computer decision support system, to offer tailored advice about modifying health risks and behaviours. Method: Qualitative study using nominal groups and interviews. Setting: General practices, National Health Service and local government social services, and voluntary organisations in two London boroughs. Recruitment: Nominal groups were recruited from general practice, older people's forums, voluntary organisations and social services departments, and individual interviews were carried out with health and social care commissioners, clinicians, professionals and public health practitioners, which discussed the HRA-O questionnaire. Results: Public and professional evaluation identified necessary refinements of the HRA-O technology, the need for greater insight into the social psychology of ageing on the part of those engaged in health promotion, and the necessary and appropriate involvement of professionals in reinforcing health promotion advice. Discussion: This study discusses the findings from the nominal groups and interviews in the light of the technology's failure to change self-reported behaviour and places them in the context of current approaches to health promotion for older populations. [ABSTRACT FROM AUTHOR]

Background: This paper describes the study protocol, the recruitment, and base-line data for evaluating the success of randomisation of the PRO-AGE (PRevention in Older people-Assessment in GEneralists' practices) project., Methods/design: A group of general practitioners (GPs) in London (U.K.), Hamburg (Germany) and Solothurn (Switzerland) were trained in risk identification, health promotion, and prevention in older people. Their non-disabled older patients were invited to participate in a randomised controlled study. Participants allocated to the intervention group were offered the Health Risk Appraisal for Older Persons (HRA-O) instrument with a site-specific method for reinforcement (London: physician reminders in electronic medical record; Hamburg: one group session or two preventive home visits; Solothurn: six-monthly preventive home visits over a two-year period). Participants allocated to the control group received usual care. At each site, an additional group of GPs did not receive the training, and their eligible patients were invited to participate in a concurrent comparison group. Primary outcomes are self-reported health behaviour and preventative care use at one-year follow-up. In Solothurn, an additional follow-up was conducted at two years. The number of older persons agreeing to participate (% of eligible persons) in the randomised controlled study was 2503 (66.0%) in London, 2580 (53.6%) in Hamburg, and 2284 (67.5%) in Solothurn. Base-line findings confirm that randomisation of participants was successful, with comparable characteristics between intervention and control groups. The number of persons (% of eligible) enrolled in the concurrent comparison group was 636 (48.8%) in London, 746 (35.7%) in Hamburg, and 1171 (63.0%) in Solothurn., Discussion: PRO-AGE is the first large-scale randomised controlled trial of health risk appraisal for older people in Europe. Its results will inform about the effects of implementing HRA-O with different methods of reinforcement.