Abstract
A survey of patients aged 75 years and over registered with general practitioners in north and north west London was carried out by trained interviewers to investigate cognitive impairment. A random sample of 239 patients was selected for the more detailed home assessment. General practitioners had seen nearly two thirds (65.3%) of their patients aged 75 years and over in the three months prior to the study, the majority of these consultations (82.1%) being initiated by the patient and occurring at the surgery. Half of the patients lived alone (50.2%), nearly one in three had no living siblings (31.9%), a similar proportion had no living children (29.5%), and contact with neighbours and relatives was relatively infrequent. One in five elderly patients had evidence of depression (22.0%) although this appeared to be severe in only two cases, and 36 participants (15.1%) had scores on the mini-mental state examination suggesting cognitive impairment. General practitioners underdiagnosed both dementia and depression. The population contained a small group of people who consumed alcohol on a daily basis (10.5%). This study showed that an annual assessment of elderly people as required by the new general practitioners' contract would yield much new evidence of depression and dementia and assist in the identification of heavy drinkers. Up to 30% of patients aged 75 years and over are likely to require further assessment on the basis of screening tests for depression and cognitive impairment, although it remains unclear to what extent identification of these patients will lead to improvements in outcome for them or their carers.
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- Baldwin R. C., Jolley D. J. The prognosis of depression in old age. Br J Psychiatry. 1986 Nov;149:574–583. doi: 10.1192/bjp.149.5.574. [DOI] [PubMed] [Google Scholar]
- Dunne F. J., Schipperheijn J. A. Alcohol and the elderly. BMJ. 1989 Jun 24;298(6689):1660–1661. doi: 10.1136/bmj.298.6689.1660. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Folstein M. F., Folstein S. E., McHugh P. R. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189–198. doi: 10.1016/0022-3956(75)90026-6. [DOI] [PubMed] [Google Scholar]
- Grundy E. Community care for the elderly 1976-84. Br Med J (Clin Res Ed) 1987 Mar 7;294(6572):626–629. doi: 10.1136/bmj.294.6572.626. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gurland B., Kuriansky J., Sharpe L., Simon R., Stiller P., Birkett P. The Comprehensive assessment and Referral Evaluation (CARE)--rationale, development and reliability. Int J Aging Hum Dev. 1977;8(1):9–42. doi: 10.2190/cl3j-0e20-97xx-mv5l. [DOI] [PubMed] [Google Scholar]
- Iliffe S., Booroff A., Gallivan S., Goldenberg E., Morgan P., Haines A. Screening for cognitive impairment in the elderly using the mini-mental state examination. Br J Gen Pract. 1990 Jul;40(336):277–279. [PMC free article] [PubMed] [Google Scholar]
- Jones D. A., Vetter N. J. Formal and informal support received by carers of elderly dependents. Br Med J (Clin Res Ed) 1985 Sep 7;291(6496):643–645. doi: 10.1136/bmj.291.6496.643. [DOI] [PMC free article] [PubMed] [Google Scholar]
- KATZ S., FORD A. B., MOSKOWITZ R. W., JACKSON B. A., JAFFE M. W. STUDIES OF ILLNESS IN THE AGED. THE INDEX OF ADL: A STANDARDIZED MEASURE OF BIOLOGICAL AND PSYCHOSOCIAL FUNCTION. JAMA. 1963 Sep 21;185:914–919. doi: 10.1001/jama.1963.03060120024016. [DOI] [PubMed] [Google Scholar]
- MacDonald A. J. Do general practitioners "miss" depression in elderly patients? Br Med J (Clin Res Ed) 1986 May 24;292(6532):1365–1367. doi: 10.1136/bmj.292.6532.1365. [DOI] [PMC free article] [PubMed] [Google Scholar]
- O'Connor D. W., Pollitt P. A., Hyde J. B., Brook C. P., Reiss B. B., Roth M. Do general practitioners miss dementia in elderly patients? BMJ. 1988 Oct 29;297(6656):1107–1110. doi: 10.1136/bmj.297.6656.1107. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wattis J. P. Alcohol problems in the elderly. J Am Geriatr Soc. 1981 Mar;29(3):131–134. doi: 10.1111/j.1532-5415.1981.tb01976.x. [DOI] [PubMed] [Google Scholar]