Abstract
A random 10% sample of patients aged 65 years and over in a large rural practice were screened by a member of the primary health care team. Five 'at risk' categories were chosen: lives alone, unable to prepare own food, no telephone, death of partner in last two years and discharged from hospital in last two months. The aim was to identify those at risk and those who had unmet needs for services and to see if the at risk criteria were valid indicators of unmet need. The cost of the screening itself and the cost of the services and aids were calculated. Thirty nine per cent of those aged 65 years old and over had one or more of the risk factors. The cost of screening all people in our practice aged 65 years and over who were living independently was estimated at 16,600 pounds and this screening revealed the estimated cost of additional needs to be 45,151 pounds per annum. The cost of screening the elderly could be reduced by first restricting it to those aged 75 years and over, the group with greatest need, and secondly by using opportunistic screening, since 87% of all those aged 85 years and over and 71% of the 75-84 year olds are seen annually by the primary health care team for other reasons. This could reduce the cost of screening all those aged 75 years and over in our practice from 7560 pounds to 1925 pounds. Contact is not synonymous with screening and a conscious effort to ask the salient questions is required in order to discover the unmet needs.
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