Effects of screening for disorders among the elderly: an intervention study in general practice

Background. Preventive assessment of prevalent disorders may be considered as an instrument to maintain independence in the elderly. However, the outcomes of studies on these types of screening differ considerably regarding their effects. Objectives. The aim of the present study was to assess the effects of GPs' screening of the elderly on four highly prevalent disorders with possibilities for treatment: hearing and visual disorders, urinary incontinence and mobility disorders. Methods. In an intervention study in 12 general practices, 1121 subjects aged 75 years and over were screened. Randomization was done by practice into an intervention group (576) and a control group (545). In the intervention group, all elderly patients were screened for the four disorders during the first year of the study. When the GP and patient agreed on intervention, usual care was provided by the GP. The patients in the control group were not screened in the first year. In the second year, all patients in both groups were screened for the four disorders. Results. For none of the four disorders was a measurable effect of the screening at the population level found. In the first year, 1013 new disorders were found involving 479 of 576 people. The GPs considered information to be new in 293 cases. In 245 cases tout of 293), the GP discussed the new information with the patient. Of the 89 cases in which the patient ag reed with an intervention, improvement was reported in 17 cases. Conclusions. Implementing a standardized screening programme for four highly prevalent disorders for elderly people is not recommended. Preventive assessment of the elderly should be applied in ways other than by screening. Preventive care should pay attention to the individual needs of the elderly, should be started before the age of 75 years and should be offered in a flexible way.