How effective are ‘age’ tools at changing patient behaviour? A rapid review

Abstract

BackgroundA common form of risk communication is to relay the relative risk (%) of an adverse outcome based on surrogate markers associated with the outcome. A novel way of communicating risk is through ‘effective age’ of a person or specific organ. These tools can be used to change patient behaviour.ObjectiveTo determine the effect of ‘effective age’ tools on patient behaviour as compared with more traditional methods of risk communication.Study selectionWe performed a search of the PubMed database up to February 2019 for systematic reviews and randomised controlled trials (RCT) that answered our question. Interventions were ‘effective age’ tools, comparators were usual care or alternative risk communication tools. Primary outcomes were behavioural change measures.FindingsWe included 1 overview of systematic reviews (level 1 evidence), 2 systematic reviews (level 1 evidence) and 13 RCTs (level 2 evidence). Both systematic reviews concluded the evidence base was not conclusive enough to make specific recommendations.Age tools assessed in the 13 RCTs were: ‘lung age’ (n=5), ‘heart age’ (n=3), ‘health age’ (n=2), ‘cardiovascular age’ (n=1), ‘body age’ (n=1) and ‘net present value’ (n=1). 7/13 (54%) RCTs demonstrated a clinical effect on behaviour change favouring the ‘age’ tool; 2/13 (15%) demonstrated a null effect; 4/13 (31%) favoured control.ConclusionsOur findings indicate that systematic review evidence needs updating. The evidence from RCTs on the effect of using age metrics on patient behaviour is poor. There is a need for high-quality trials to decrease uncertainty in the available evidence.

Current Best Practice for Presenting Probabilities in Patient Decision Aids: Fundamental Principles

“…''Biological age'' is an increasingly popular risk format that converts an absolute risk to a younger or older age by comparing risk factors to ideal or average levels, resulting in various labels such as real age, fitness age, heart age, lung age, kidney age, and bone age. 82,83 Age is a time-based concept, but biological age could also be conceptualized as an evaluative label or a relative risk, as it involves comparing a person's risk to ideal or average values. There is of particular interest in heart age, which is increasingly used around the world, 84 but the methods used to calculate these risk formats are highly variable: the same person may get a younger or older heart age depending on the model used and whether they are compared with ideal or average risk factors.…”

Experiences of a National Web-Based Heart Age Calculator for Cardiovascular Disease Prevention: User Characteristics, Heart Age Results, and Behavior Change Survey

“…Existing research on the effect of heart age calculators is divided into small experimental samples that were randomized (which show mixed results overall) [ 13 ] and large population samples where users have been simply described. This study aimed to draw these 2 areas together by reporting on the users of a new Australian heart age calculator, followed by lifestyle change outcomes in a smaller sample of users who signed up to receive a report and further support by email.…”

Future directions in cardiovascular disease risk prediction

“…31 While there are claims that giving patients an 'older' heart age can motivate them to change their lifestyles, a review of biological age formats found no evidence that this is more effective than absolute risk formats. 32 Anecdotally, New Zealand GPs find this to be a useful communication tool to get people interested in their CVD risk and lifestyle change, but absolute risk must be used when considering medication. 33 This is important not only to determine who is at high risk and likely to benefit from medication, but also to enable a shared, informed decision with the patient.…”