Screening in the elderly

It has been known for some years that elderly people have unreported health problems and screening as a means of earlier detection and treatment has been advocated in the past. More recently there has been a renewed interest in this type of preventive health care for elderly people. Conventional screening for early asymptomatic disease is often termed secondary prevention, but in the case of elderly people, screening more closely resembles tertiary prevention. Regular call and recall or consultation-based opportunistic screening are alternative ways of organising screening of elderly people in primary care. Each approach has particular problems but the increased workload for staff resulting from screening is common to both. Selective screening has been tried to resolve this issue. It has taken two forms; the ‘at-risk’ group approach and the use of postal questionnaires. Neither of these approaches is entirely satisfactory. The published randomised controlled screening trials are too small to show any significant effect on measures of disability levels, social functioning or psychological well-being in old people, although one study demonstrated decreased mortality in the intervention group. Larger evaluative studies are needed before any form of screening for elderly people can be recommended.