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Effortsforearlydetec/onofgeriatricproblemsintheelderly

attheprimarycareclinicby10-mincomprehensivescreeningDaisukeSon,TakamasaWatanabe,YasukiFujinuma

CentreforFamilyMedicineDevelopment(CFMD),HeWCo-opJapan

Objec/ve

Elderlypa=entsarefacingmul=pleandcomplexhealthproblems,andmakingdiagnosisofthemwithinalimited=meisoendifficultinclinicalprac=ce.

Becausemanyoftheproblemsarechronic,itisimportanttodiagnoseandtreat

themearlier.Thescreeningprojectofgeriatricgiants"(cogni/veimpairment,

urinaryincon/nence,depression,instability)wasconductedover5monthsto

alltheregularlyvisi=ngoutpa=entsovertheageof70atthelocalprimarycare

clinicinTokyo,Japan.

Methods

Targetedpeoplewereallthepa=entswithchronicdiseasesovertheageof70whovisitedourclinicregularly(about150pa=ents),andthescreening

wasdoneduring5monthsfromAugusttoDecember2010.

Doctorsaskedpa=entsconsentforscreeningtestattheendoftheconsulta=on,andtowhomtheconsentwasobtained,oneofthestaff

(doctor,nurseorclinicalclerk)conductedthe10-minutecomprehensive

screeningusingaques=onnaire.Theques=onnairewascitedfromAge-

FriendlyPrimaryHealthCareCentresToolkit"developedbyWHO.

Results

Thescreeningques=onnaireswereconductedwith136elderlypa=entsinfivemonths.Themeanagewas77.1yearsold(SD6.0).

Bythecogni/veimpairmentscreeningconductedbyathree-wordrecallmethod,20%(27/136)recalledonlyonewordorlessinthreewords,andamongthem6%(8/136)werenewlydetectedand

cared.Forurinaryincon/nence,13%(18/136)reportedurineleakagewithinthelastweek,and

amongthem2%(3/136)werenewlydetectedandcared.Depressivemoodwasobservedin22%(30/136),and6%(8/136)werenewlyrecognizedandcared.Gaitinstabilityorhistoryoffallwas

observedin24%(33/136),and2%(3/136)werenewlyrecognizedandcared.

Disucussion

Amongelderlypa=entsovertheageof70inouroutpa=entclinic,geriatricproblemswerefoundatleastin

13%to24%bythescreeningques=onnaire,andsome

pa=entswerenewlydiagnosedandfollowedupforcare.

Thisscreeningmethodusingasimplestructuredques=onnairehasanadvantagethatcanbecarriedout

simplyandshortlyintheclinicalprac=ce,whichleadsto

effec=veearlydetec=onofgeriatricproblemsinthe

elderlypa=ents.

10-mincomprehensivescreeningques=onnaire(fromWHOsAge-FriendlyPHCToolkit)

80%

14%6%

87%

11%2%

prevalenceofeachgeriatricproblems

detectedby10-mincomprehensivescreening

78%

16%6%

76%

22%2%

cogni/veimpairment urinaryincon/nence

depressivemood gaitinstability

newlydetected

exis=ngsymptom

nosymptom