Information
Editors
Health Check for the Elderly
Basic rules
- The most convincing evidence concerns preventive home-visits including health checks, when they are carried out for physically still relatively fit aged persons (72-78 years of age), are done multidimensionally with geriatric expertise, and include several (> 4) follow-up visits.
- There is also proof of the efficacy of preventive measures in the elderly for the following interventions: breast cancer screening, smoking cessation, treatment of hypertension, increasing the amount of exercise, vaccinations and preventig falls.
- Screening performed by health care providers (community nurse, personal physician) during the patient's visits to the health centre might also be beneficial with certain reservations. It is well suited for population-based primary care. Screening can be performed by any health care professional, with a more thorough health check performed by a physician when necessary. Evidence on the benefits of non-targeted screening in the elderly population is contradictory, despite the fact that various undiagnosed diseases may often be found.
- Only those diseases or disabilities for which an effective treatment exists and which could be considered for the elderly should be sought for.
Screening of own patients
Content of screening in primary care
- No consensus exists on the content of a feasible screening programme, but scientific proof of the efficacy of the following screening measures is available:
- The following measures have also been suggested:
- physical exercise and its changes
- nutritional state examined with the MNA questionnaire (Mini Nutritional Assessment), possible changes registered
- managing daily activities; ADL (Activities of Daily Living) Assessment of Functional Capacity in the Elderly and IADL (Instrumental Activities of Daily Living; shopping, finance, preparing food, using the telephone)
- hearing: history or whispering 20 cm from the ear
- mood (examined e.g. with a depression test: Zung, GDS, DEPS) and loneliness
- screening test for cognitive function (MMSE and drawing of a clock face, for example; see Clinical Assessment of Memory Impairment)
- visual acuity, intraocular pressure
- laboratory tests: blood glucose, cholesterol, thyroid function
- ECG
- bone density measured with densitometry http://www.dynamed.com/prevention/geriatric-health-maintenance#OSTEOPOROSIS
- ability of getting into and out of a chair and speed of walking (patients at increased risk of falling or with a history of previous falls) http://www.dynamed.com/prevention/geriatric-health-maintenance#FALLS_AND_GAIT_INSTABILITY.
- However, it has been found that
- screening the visual acuity of asymptomatic elderly persons does not improve vision Community Screening for Visual Impairment in the Elderly.
- screening performed by health care professionals seldom leads to the detection of new problems and does not improve the general health status of the elderly; it is essential that the person performing the screening has geriatric expertise and an ability to identify the essential issues among the risk factors of the elderly.
- routine use of questionnaires for detecting psychiatric disorders (depression, anxiety) does not increase the detection rate or improve the prognosis of emotional disturbances
- interventions aimed at reducing the risk of falling should be targeted at patients most likely to benefit from them
- various services and activities aiming at reducing loneliness may be beneficial. Find out about local availability.
- There is no settled view on the significance of prostate palpation and/or PSA in the screening of prostate cancer.
Whom to screen and how often?
- The above-listed screening measures or some of them can be recommended to be carried out at 1 to 5 year intervals if the test results influence the actions taken by the physician. When the findings of a screening lead to treatment measures, these should be evidence-based and their success must be followed up. There is evidence of effectiveness from studies that have included several preventive home visits.
- Setting an upper age limit to screening is difficult; however, the meaningfulness of screening asymptomatic over 85-year-old persons for diseases has been questioned. Health checks are most useful when performed on elderly aged about (65-)72 to 78 years who may have single risk factors that can be intervened with treatment. Based on follow-up studies, it is probably also beneficial to recognize incipient frailty and sarcopenia (nutrition and physical activity as interventions).
- In institutionalized elderly, focus should be on preventing pressure sores, urinary incontinence and falls and in maintaining the ability to move. Regular review of patient's medication list is also important. Yearly laboratory investigations are not considered justified in these patients.
- Evaluating the potential benefits is particularly problematic when
- there is no cure for the disease
- earlier examinations have been negative
- the person in question has a severely limited functional ability or is demented
- the expected quality or duration of life is limited because of some other cause.
- Although the age of 85 years is considered the upper limit of screening, the individual differences in personality and need for care must be taken into account.
References