Improving the health behaviours of elderly people: randomised controlled trial of a general practice education programme

BMJ 1999;319:683-687 ( 11 September )

General Practice

Improving the health behaviours of elderly people: randomised controlled trial of a general practice education programme

Ngaire M Kerse, research scholar, ^a Leon Flicker, senior lecturer in geriatric medicine, ^b Damien Jolley, senior lecturer in epidemiology and biostatistics, ^a Bruce Arroll, associate professor, ^c Doris Young, professor. ^a

^a Department of General Practice and Public Health, University of Melbourne, Victoria, Australia, ^b National Ageing Research Institute, Parkville, Victoria, Australia, ^c Department of General Practice and Primary Health Care, University of Auckland, New Zealand

Correspondence to: N M Kerse Department of General Practice and Primary Health Care, Faculty of Medicine and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand n.kerse{at}auckland.ac.nz

Objectives: To establish the effect of an educationalintervention for general practitioners on the health behavioursand wellbeing of elderlypatients.
Design: Randomised controlled trial with 1 year followup.
Setting: Metropolitan general practices in Melbourne,Australia.
Subjects: 42 general practitioners and 267 of theirpatients aged over 65years.
Intervention: Educational and clinical practice audit programmefor general practitioners on health promotion for elderlypeople.
Main outcome measures: Patients' physical activity, functional status,self rated health, immunisation status, social contacts, psychologicalwellbeing, drug usage, and rate of influenza vaccination. Primaryefficacy variables were changes in outcome measures over 1 yearperiod.
Results: Patients in the intervention group had increased(a) walking by an average of 88 minutes per fortnight, (b) frequencyof pleasurable activities, and (c) self rated health comparedwith the control group. No change was seen in drug usage, rateof influenza vaccination, functional status, or psychologicalwellbeing as a result of the intervention. Extrapolations of theknown effect of these changes in behaviour suggest mortality couldbe reduced by 22% if activity was sustained for 5years.
Conclusions: Education of the general practitioners hada positive effect on health outcomes of their elderly patients.General practitioners may have considerable public health impactin promotion of health for elderlypatients.

Key messages

Few educational interventions for doctors have shown benefit to the health of patients
Elderly people were identified in the UK health initiatives as in need of additional attention, and levels of health protective behaviours were low in community surveys
A multifaceted educational intervention for general practitioners was effective in improving walking behaviour, self rated health status, and the frequency of social contacts in elderly patients
General practitioners are effective in improving health and health behaviours in their elderly patients

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