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 outc omes of studies on these types of screening differ considerably regarding t heir 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 possibilit ies for treatment: hearing and visual disorders, urinary incontinence and m obility disorders. Methods. In an intervention study in 12 general practices, 1121 subjects ag ed 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 th e 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 n ot screened in the first year. In the second year, all patients in both gro ups were screened for the four disorders. Results. For none of the four disorders was a measurable effect of the scre ening at the population level found. In the first year, 1013 new disorders were found involving 479 of 576 people. The GPs considered information to b e new in 293 cases. In 245 cases tout of 293), the GP discussed the new inf ormation with the patient. Of the 89 cases in which the patient ag reed wit h an intervention, improvement was reported in 17 cases. Conclusions. Implementing a standardized screening programme for four highl y prevalent disorders for elderly people is not recommended. Preventive ass essment of the elderly should be applied in ways other than by screening. P reventive 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 fl exible way.