Problems found in the over-75s by the annual health check

Research into the health of elderly people has found problems unknown to their general practitioners. It was anticipated that annual checks, as required by the 1990 general practitioner contract, would help to detect these problems, yet the value of these checks has been questioned.

To investigate the problems found by general practice contractual annual checks of the over-75s and the consequent actions taken; to identify patient, demographic or practice characteristics associated with the discovery of problems.

In 40 practices, information was collected on patients over 75 years of age receiving a health check during a 3-month period. Practices used their normal methods of recruitment and assessment. Practice staff were interviewed to find how assessments were organized.

Practices saw a mean of 12% of their over-75s during the study; 44% were found to have at least one problem. Action was taken to help resolve problems in 82% of patients with a problem. The most prevalent problems related to physical condition, and fewer functional problems than expected were found. There were large differences between practices in the proportions of elderly patients seen for a check and the proportion found to have problems; these were not attributable to practice size or demography. Multivariate analysis showed that practice or patient characteristics were poor predictors of finding problems.

The argument in favour of conducting annual checks is supported by the finding that nearly half the patients assessed were found to have problems for which some action was taken. Some practices could increase their rate of uptake by modifying the organization of invitations for checks. More problems may be found by adopting a more functionally based assessment.