Risk factors for ill-health in old age.
Year: 2007
Type: article
Abstract: The two papers in this issue of the journal by Kharicha,1 Iliffe2 and colleagues display the best intentions of primary care researchers: to increase understanding through rigorous study, and to make evidence-based recommendations for treatment allocation that will raise health and quality of life. The authors' premises are explicit: ‘population screening for unmet need in later life has failed to improve the health of older people’, and those ‘living alone are thought to be an “at-risk” group worthy of further investigation’. The goal is effective targeting, and the theory is that by concentrating scarce treatment resources on those at ‘high risk’, more health benefits will accrue, partly through early diagnosis and treatment, and partly through the triage principle of it maximising treatment effectiveness. The principles are noble but challenging. Even in the abstract, the goals of targeting to minimise mortality, morbidity, pain and disability as well as treatment hours or costs (consultations or hospital bed days) are not fully commensurable. Finding the optimal solution stretches the most astute linear programmer.
The premises require qualification. While it is a matter of history that the incorporation of the 75+ years annual check into GPs' contracts ‘did not work’, that was because it was resisted and never fully implemented. The authors cite a large MRC trial of two forms of assessment and management of older patients to support their conclusion that population screening is ineffectual, but the summary description of its findings is too categorical a view. The trial …
Source: Europe PMC (PubMed Central)
Author: Anthony M Warnes
Institution: University of Sheffield
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1893799342