Making Brain Health Actionable for Older Persons in Primary Care: The Proposed SHAPES Framework

Brain health is increasingly recognised as a life-course priority, but its translation into routine primary care for older persons remains uncertain. Vascular risk, sensory function, mobility, nutrition, sleep, mood, environmental exposure, and social participation are often addressed separately, leaving people with multiple recommendations but no coherent plan. We propose SHAPES-Sensory access; Heart, vessels, and movement; Appetite, food, and nutrition; Pollution, tobacco, and alcohol; Emotional health and sleep; and Social connection, purpose, and learning-as a conceptual implementation framework for co-design and feasibility testing. The workflow begins with a brief scan of all six domains. Findings are classified as Protect, Notice, or Investigate using explicit safety criteria. Notice is reserved for a mild, uncertain, non-progressive concern; any persistent, recurrent, progressive, function-limiting, or red-flag change requires clinical assessment. Safety signals take priority; otherwise, one person-valued priority is selected according to importance, likely benefit, modifiability, feasibility, and structural context. The next step may be behavioural, clinical, social/supportive, or service/system. Behavioural actions may be converted into small cue-linked actions, and meaningful success is agreed before follow-up. SHAPES is not a diagnostic test, decision rule, or validated risk score. SHAPES has not yet demonstrated content or face validity, feasibility in routine consultations, or acceptability to older persons or clinicians; its safety, equity and effectiveness also require prospective evaluation.