Background. In the UK, the GP contract requires annual consultations a
nd offers of home visits to the elderly. However, as many as 50% of el
derly people refuse the offer of a health screen. Objective. To descri
be the characteristics of elderly people who declined the offer of an
annual home visit. Method. All elderly people aged 75 years and over,
registered with a general practice of 13 full time and 3 part time doc
tors with a list size of 33,000 people, were offered a home visit. Dat
a from this prospective cohort were linked with data from a community
survey two years previously, which had achieved a 95% response rate. T
he main outcome measures were perceived health status, perceived lonel
iness, morale score, physical and mental disability, use of primary ca
re and social services. Results. Thirty-six percent of all elderly peo
ple registered with the practice declined to take up the offer of a ho
me visit. Those refusing a visit had not recently joined the practice
and had very similar distributions of all demographic and most health
and wellbeing characteristics to those who took up the offer. However,
those declining appeared to have higher levels of morale (P = 0.010)
and less contact with the general practitioner (P 0.021) including an
average of three weeks longer since last consultation with their gener
al practitioner than those accepting the visit. Conclusions. There app
ears little evidence in this population that elderly people who declin
e a home visit are necessarily part of an 'iceberg' of unmet need.