Cardiovascular health check in the elderly in one general practice: does it offer new information and lead to interventions?

BACKGROUND: Prevention of cardiovascular disease in the elderly is becoming increasingly important. GPs are in a unique position to initiate preventive interventions in this age group. However, it is not clear which strategy a GP should follow to identify patients at increased cardiovascular risk-case finding or screening. OBJECTIVE: We aimed to assess the value of a single cardiovascular health check compared with a normal care case finding and to investigate the diagnostic or therapeutic consequences of detecting new cardiovascular risk indicators. METHODS: In 1991, 1002 persons aged 60 years and over, enlisted in one general practice, were invited. Of the 805 subjects who responded (80%), the cardiovascular risk profile was determined by a research physician. The proportion of newly detected cardiovascular risk indicators was the main outcome measure. A risk indicator was considered newly detected when it was not mentioned in the GP's summary of the patient record, which had been checked by the patient for its completeness. The patient records of participants with newly detected hypertension, diabetes or hypercholesterolaemia were systematically reviewed to detect diagnostic and therapeutic interventions by the GP. RESULTS: In 25.1% of the participants, one or more cardiovascular risk indicators were found which were previously unknown to the GP, including 38 (4.7%) cases of hypertension, 82 (10%) cases of isolated systolic hypertension, 14 (1.7%) cases of diabetes mellitus and 63 (7.8%) cases of hypercholesterolaemia. On the basis of these findings, the GP initiated therapeutic interventions in almost all subjects with newly detected diabetes. However, reports of newly detected hypertension or high cholesterol levels were usually not followed by an intervention. CONCLUSION: A single cardiovascular health check in the elderly can detect a considerable number of risk indicators that are unknown to a patient's GP. In most cases, however, the detection of hypertension or cholesterol > or = 6.5 mmol/l did not lead to interventions by the GP. More efforts are needed to ensure that the beneficial effects of these interventions are not limited to participants in clinical trials but can be extended to patients in general practice.

Prevalence of hearing impairment and hearing complaints in older adults: a study in general practice.

In one general practice, 660 people aged 60 years or over were screened by means of pure tone audiometry and a specific questionnaire to assess the prevalence of hearing impairment and hearing complaints. Hearing impairment was defined as an average loss of 35 dB or more in the 1, 2 and 4 kHz frequencies in one or both ears. In total, 37.4% (95% CI, 33.3-41.1%) of the participants was hearing impaired. The prevalence was higher in men (55.1%) than in women (44.9%) and clearly increased with age in both sexes. The prevalence of hearing complaints in terms of hearing difficulties and/or tinnitus, was 37.3% (95% CI, 33.6-41.0%), and increased with age, especially in women. Of the subjects with hearing impairment, 64.4% reported hearing complaints. Of the subjects without hearing impairment, 21.1% experienced hearing complaints. This study suggests that screening older adults with relatively simple methods, may identify a large proportion of men and women in general practice with hearing problems. Providing information to both patients and general practitioners about the possibilities of hearing improvement is a crucial step in making people become more aware of hearing problems. This could ultimately lead to improvement of the quality of life of older men and women with hearing problems.