Health promotion for community-dwelling elderly: pros and cons of a preventive health centre for the elderly
12 / 2006 - 12 / 2012
The objective of this study is to develop and test strategies for a preventive health centre for older people. Development of the strategies will be done by using a systematic approach based on theory, the needs and demands of elderly at risk (like elderly migrants, elderly with low socioeconomic status and the eldest elderly) and experiences with preventive health centres which already exist in the Netherlands. The increasing number of elderly has important consequences for our society, not only for economic outcomes, but also for medical outcomes. The particular increase of the number of older people from the ethnic minorities, elderly with a low socioeconomic position, and the eldest elderly amplify this problem, since these groups have higher risks on chronic diseases, disability and diminished quality of life. Various answers have been proposed to this coming problem. National as well as local stakeholders in the Netherlands have pleaded preventive health centres for the elderly. At some places these centres have been established, often as a result of political decisions. However, until now there is no evidence that these initiatives are an appropriate solution to the described problem, in terms of costs, effects, acceptance and feasibility.The present study will answer the following questions: What are the health needs and demands of elderly that we have to meet (including somatic, psychological and social issues)? Which of these can be met with some kind of preventive care? What type of preventive care is most appropriate for the elderly, especially for people with a low socioeconomic status, older migrants and elderly with a chronic disease? What are the pros and cons of a preventive health centre?The first stage of the study consists of a needs assessment, using the technique of Intervention Mapping. Main instruments will be literature review, questionnaires, focus group interviews and in-depth interviews. This stage will also give insight into the question which preventive strategy or strategies is/are most likely to be successful. In the second stage a pilot study will be performed in order to evaluate the various ways in which preventive strategies aimed at the elderly can effectively be offered. The variety of strategies will take into account which (subgroups of) the elderly are best reached with specific preventive interventions. In addition, barriers to implementation on personal, financial and organisational level will be studied. Each phase of the study will result in products like manuals for conducting the Intervention Mapping study, knowledge of factors to be addressed to reach specific target groups (especially useful for public health colleagues in the Netherlands), up-to-date and state-of-the-art reviews on effectiveness of preventive interventions on selected topics in elderly, an evidence-based balance of pros and cons of the most often applied intervention strategies based on a pilot study comparing three strategies. Implementation will be supported by a large variety of multi-target strategies, including workshops, a website, publications, presentations and participation in guideline committees. The final result of this study will be a summary of models for evidence-based strategies for preventive healthcare services for older people, which can be used by other Municipal Health Services in the Netherlands to develop or stimulate preventive care for the elderly.