Assessment of Older People's Health and Social Care Needs and ...

.~A..aStandardised Proactive Assessment InstrumentA two-part standardised proactive assessment instrument has been designed by the STEP group and thishas been taken to each of the European member countries for evaluation. Part I of the assessmentinvolves a thirty-point questionnaire which may be self-administered by the patient, though if an assessoris present with the patient, he/she can gain great insight into the patient. If there are certain areas ofpositive response in Part 1, a trained assessor then conducts a follow-up, thirty-point assessment with thepatient. In Part 2 of the assessment, the emphasis is on administration by a trained assessor, since itincludes clinical questions which would have medico-Iegal consequences if not followed up properly,Screening Older People: CaveatsThere are two caveats to be aware of in promoting the screening of older people, The STEP group isanxious that older people should not go into a screening programme unless follow-up procedures andservices are in place and likely to be available to them in a timely way. Otherwise expectations areraised that cannot be met and this is ethically questionable. It is also extremely frustrating forworkers in services to identify conditions and find that they cannot do anything about them'.__1---------There are important overview issues and questions to be considered as we become involved in aprocess which may lead to a national assessment framework for older people in the community. Weneed to adhere to WHO/Wilson's 1968 principles and practices for screening disease which state that:• screening must deal with common and important health problems• it must deal with significant unreported illness• intervention must be of benefit• suitable tests must be available, with high degrees of sensitivity and specificity so that testsyielding high numbers of false positives or false negatives are disregarded• side-effects must be low and procedures should not distress patients more than they benefit them• treatment/therapy must be available• the procedure must be acceptable to patients and not be carried out if it is not• it must be cost effective and co5ts in this exercise must be looked at broadly so that the costimplications of primary prevention, of reducing the possibilities of patients arriving in hospitals,for example, are fully considered.3. Dr Prosser's own research background has been with the National Care of the Elderly Study, implemented by the IrishCollege of General Practitioners, following the 1991 Year of the Elderly. This research was conducted across 26 counties,involved 350 GPs and 2,617 patients and studied the prevalence of mobility, hearing, vision and incontinence problems ir,older people in the community. The results of the four studies were presented in her paper, as were the referral patternsto hospitals and community services. The detailed research findings have been published,in the British Journal of GeneralPractice, the European Journal of General Practice and the Irish Medical Journal. See Natin D. Prosser, S. Maguire N.Boland K. 'Screening for visual probiems in eiderly patients in general practice'. Eur J Gen Pract 2000; 6:10-14; MaguireN, Prosser S, Boland R, McDonnel1 A, Screening for hearing loss in general practice using a questionnaire and the WhisperTest, Eur, J. Gen Pract 1998; 4 : 18-21; Dobbs, F, Prosser, S, Maguire, N.. 'Mobility Screening in the elderiy and resultingreferral'. Irish Med Journal 1999 vol 92: 1; and Prosser, S. Dobbs, F. 'Case-finding Incontinence in the over 755' BJGP1997,47,498-500.Assessment of Older People's Health and Social Care Needs and Preferences