TY - JOUR T1 - Identifying unmet health needs in older people: comprehensive screening is not the answer JF - British Journal of General Practice JO - Br J Gen Pract SP - 404 LP - 406 VL - 56 IS - 527 AU - Steve Iliffe AU - Martin Orrell Y1 - 2006/06/01 UR - http://bjgp.org/content/56/527/404.abstract N2 - The case for routine comprehensive screening for unmet health needs in the older population has collapsed. A very large randomised controlled trial in the UK has demonstrated that there are little or no benefits to quality of life or health outcomes from population screening,1 endorsing the deletion of the obligation to offer annual screening from the contract for general practice in Britain. The evidence of benefit from such whole population screening had always been thin, and the UK's ‘75 and over checks’ had stalled long before they disappeared quietly from the new GP contract, suggesting that a mechanistic approach to needs assessment without a robust evidence base makes both bad science and bad policy.2In contrast, the editorial3 accompanying the paper by Fletcher et al1 concluded that people over 75 should be offered ‘preventative home visits’ and argued that ‘the common core is the multidimensional geriatric assessment, which helps to identify and manage the multiple problems and risks of older people’. The belief that screening could prevent functional impairment in older people has had an enduring appeal to researchers, clinicians, and older people, since the original study by Williamson.4 The accumulating evidence against the value of whole population screening is not going to extinguish this enthusiasm for intervention, and nor should it, since there is some evidence that needs assessment of older people followed by active management may improve survival and function.3 Efforts to improve the health of an ageing population should logically focus on a two-stage process, with case finding leading to highly selective comprehensive geriatric assessment, as advocated by GPs over a decade … ER -