Open Access Open Badges Research article

Development, feasibility and performance of a health risk appraisal questionnaire for older persons

Andreas E Stuck12*, Kalpa Kharicha3, Ulrike Dapp4, Jennifer Anders4, Wolfgang von Renteln-Kruse4, Hans Peter Meier-Baumgartner4, Danielle Harari5, Cameron G Swift6, Katja Ivanova1, Matthias Egger7, Gerhard Gillmann7, Jerilyn Higa8, John C Beck9 and Steve Iliffe3

Author Affiliations

1 Department of Geriatrics, University of Bern, Spital Bern-Ziegler, Morillonstrasse 75-91, CH-3001 Bern, Switzerland

2 Division of Geriatrics, Department of General Internal Medicine, Insel University of Bern Hospital, CH-3010 Bern, Switzerland

3 Department of Primary Care and Population Sciences, University College London, Hampstead Campus, Rowland Hill Street, London NW3 2PF, UK

4 Albertinen-Haus Geriatrics Centre, University of Hamburg, Sellhopsweg 18-22, D-22459 Hamburg, Germany

5 Department of Ageing and Health, Guys and St Thomas' NHS Foundation Trust, 9th Floor North Wing, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK

6 Department of Health Care of the Elderly, Kings College London, Clinical Age Research Unit, King's College Hospital, Bessemer Road, London SE5 9PJ, UK

7 Department of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, CH-3012 Bern, Switzerland

8 Department of Emergency Medicine, University of California, Los Angeles, California, USA

9 School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave. 32-144, Los Angeles CA-90024-1687, USA

For all author emails, please log on.

BMC Medical Research Methodology 2007, 7:1  doi:10.1186/1471-2288-7-1

Published: 11 January 2007



Health risk appraisal is a promising method for health promotion and prevention in older persons. The Health Risk Appraisal for the Elderly (HRA-E) developed in the U.S. has unique features but has not been tested outside the United States.


Based on the original HRA-E, we developed a scientifically updated and regionally adapted multilingual Health Risk Appraisal for Older Persons (HRA-O) instrument consisting of a self-administered questionnaire and software-generated feed-back reports. We evaluated the practicability and performance of the questionnaire in non-disabled community-dwelling older persons in London (U.K.) (N = 1090), Hamburg (Germany) (N = 804), and Solothurn (Switzerland) (N = 748) in a sub-sample of an international randomised controlled study.


Over eighty percent of invited older persons returned the self-administered HRA-O questionnaire. Fair or poor self-perceived health status and older age were correlated with higher rates of non-return of the questionnaire. Older participants and those with lower educational levels reported more difficulty in completing the HRA-O questionnaire as compared to younger and higher educated persons. However, even among older participants and those with low educational level, more than 80% rated the questionnaire as easy to complete. Prevalence rates of risks for functional decline or problems were between 2% and 91% for the 19 HRA-O domains. Participants' intention to change health behaviour suggested that for some risk factors participants were in a pre-contemplation phase, having no short- or medium-term plans for change. Many participants perceived their health behaviour or preventative care uptake as optimal, despite indications of deficits according to the HRA-O based evaluation.


The HRA-O questionnaire was highly accepted by a broad range of community-dwelling non-disabled persons. It identified a high number of risks and problems, and provided information on participants' intention to change health behaviour.