Join us in trialling the Ageing Well Tool
A screening and early intervention tool designed to identify and reduce risks for dementia and enhance overall wellbeing in primary care patients aged 60-70, to set them up for ageing well.
The Ageing Well Tool measures risk factors for dementia and poor wellbeing in older adults in primary care. These risk factors and common mental disorders include depression, anxiety, alcohol overconsumption and cardiovascular risk. The tool has been developed to measure these factors through screening, treatment, monitoring and evaluation.
Following screening, GPs/practice nurses may plan some evidence-based risk reduction strategies with patients as needed. The Ageing Well Tool measures modifiable risk factors including:
- alcohol consumption
- anxiety
- blood pressure and cardiovascular risk
- cholesterol
- cognitive engagement (mental stimulation)
- cognitive functioning
- depression
- diabetes
- diet (fish consumption)
- falls and head injury risk (frailty)
- hearing loss
- insomnia
- loneliness
- physical activity
- smoking
- social activities
- social isolation
- weight and height.
Purpose of this research
Routine screening in primary care can reduce the under-detection and under-treatment of older adult mental disorders, as well as identify early risk factors for poor mental health and dementia. The Ageing Well Tool has been developed in consultation with older patients, clinicians, and researchers to ensure its acceptability and feasibility for wider, sustained use.
We will evaluate the clinical and cost-effectiveness of this screening tool in a multisite, cluster randomised trial during 2024–2025.
There are three phases:
Co-design with consumers, clinicians and PHN staff – includes focus groups and surveys.
Pilot study of feasibility, acceptability and efficacy – MQ Health General Practice Unit.
Cluster Randomised Trial – all Sydney North Health Network and other primary health networks.
Screening guidelines
Patients must be:
- 60-70 years of age
- able to read and write in English at a sufficient level such as being able to read the newspaper
- a patient of a General Practitioner or Practice Nurse in a General Practice in Sydney North Health Network (or another primary health network we partner with)
- have normal cognition (no dementia)
- community dwelling (not in residential aged care).
What's involved
Patients will complete a survey on a tablet at their GP clinic three times in 12 months. Once at the start of the study, and six and 12 months later.
The survey will:
- ask patients to rate their current level of symptoms on a range of psychological and wellbeing variables such as feelings of depression, anxiety, social isolation, and lifestyle habits such as their usual diet, alcohol use, and exercise routine
- take approximately 30 minutes. It will be completed in the waiting room before the consultation with their GP/practice nurse or online before their appointment if preferred.
The GP/practice nurse consultation follows. In the consultation:
- medical data that reports the patient’s cardiovascular risk, body mass index, diabetes, cholesterol and smoking will be added to the survey
- patients may be sent for additional tests to ensure their health data is up to date.
Reports
Patients will receive personalised reports on their risk factors immediately following each screening or after all three screenings have occurred at the 12-month follow-up (based on random assignment). GPs/practice nurses will offer resources, recommendations and information on how to reduce any identified risk factors as provided by the study.
Each patient will still be under the care of their treating GP/practice nurse during this period and will be able to see how their risk has changed, at the 12-month measurement. Patients will receive information on how to reduce risk for developing dementia and maintain wellbeing in later life.
More information below:
Measures and timing | Study procedures |
|---|---|
Practice enrolment |
|
Patient enrolment and screening |
|
Baseline assessment |
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Six-month assessment |
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12-month assessment |
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The cluster randomised clinical trial will involve GPs and practice nurse(s) completing training on the study methods, identifying suitable patients, and facilitating the collection of patient data against a range of risk factors.
- The payment structure for GPs/practice nurses is per patient.
- You will also have the opportunity to earn CPD points through your participation. Learn more about CPD points.
GPs/practice nurses will be provided access to resources and clinical recommendations to use with patients as desired at the appropriate time in the study.
Training
GPs/practice nurses will undergo a 30-minute (unpaid) mandatory training on these procedures (in-person or online via Zoom or Teams).
There is also a step-by-step process on study procedures to refer to if needed (including two videos and a written guide, depending on the condition your practice has been allocated to). Both of these can be accessed with a link provided to you following your enrolment in the study.
- Implementing the Ageing Well Tool with personalised risk reports and treatment recommendations with immediate feedback.
- Self-help patient booklet and tracking health and wellbeing for 12 months with access to full reports and recommendations after the 12-month survey.
Practice staff
To participate, you must be a General Practitioner or Practice Nurse in a participating general practice in Sydney North Health Network or other PHNs we partner with. Information and training related to the study will be provided by researchers, arranged through your practice manager.
Watch a brief video of Professor Simon Willcock discussing his experiences implementing the tool in a pilot study at MQ Health General Practice.
To sign up: Contact your practice manager to enquire about participating in the program. If your practice is not within one of the PHNs we are partnered with, your practice manager can contact ageing.well@mq.edu.au to discuss setting your practice up with the study.
How to get involved
Sydney North Health Network and other PHNs we partner with will inform practices in their PHNs about the study and ask for practices to volunteer to be involved in the trial.
- The researchers will run information evenings at any interested practices to explain the details of the study and answer any questions you have.
- Once a practice has indicated their interest in participating, practitioners within these practices will be individually invited to participate by emails from the practice managers.
- Not all practitioners or practice nurses will need to participate within a practice.
Cognitive measures
To check eligibility for the study and maximise study outcomes, patients will also be scheduled for an appointment at a time convenient to them to complete a short check of cognition and memory.
This cognitive assessment will be conducted via Zoom/Teams or in person at the Macquarie University Lifespan Health and Wellbeing Emotional Health Clinic if desired (audio and video recorded for scoring purposes) by a trained research assistant, at the start of the study and 12 months later.
This is done to examine subtle changes in specific cognitive abilities between groups over time as related to changes in risk factors for dementia.
Voluntary feedback on the acceptability of the screening tool
Patients might be:
- asked to provide information about their experiences with the screening and risk reduction resources via a short online survey
- invited to attend a Zoom focus group for additional feedback. Participation in the focus group will be compensated ($40 for approximately 60 minutes).
How to get involved
You must be a patient of a GP or practice nurse in Sydney North Health Network (or another primary health network we partner with).
To sign up: Contact your practice to enquire about participating in the program. If your practice is not enrolled in the program, email ageing.well@mq.edu.au for information about practices that may be near you where you can complete the study.
Our researchers
Contact: ageing.well@mq.edu.au for information about the study or to sign up for the trial.
Funding sources
- Medical Research Future Fund Emerging Leadership Fellowship
- The Ian Potter Foundation grant
Partners
- Sydney North Health Network
- MQ Health General Practice Unit