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Age and Ageing Advance Access published online on March 11, 2005
Age and Ageing, doi:10.1093/ageing/afi055
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Age and Ageing © British Geriatrics Society 2005; all rights reserved
Received September 8, 2004
Revised December 21, 2004

Article

Effectiveness of screening for risk of medical emergencies in the elderly

Lesley Walker 1 and Konrad Jamrozik 2*

1 Department of Primary Care and Social Medicine, Imperial College, London, UK
2 School of Population Health, University of Queensland, Herston Road, Herston, Queensland 4006, Australia; Evidence-Based Health Care and Public Health, University of Western Australia

* To whom correspondence should be addressed.
Konrad Jamrozik, E-mail: k.jamrozik{at}sph.uq.edu.au


  Abstract

Study objective: UK government policy mandates the introduction of ‘intermediate care services’ to reduce emergency admissions to hospital from the population aged 75 years or more. We evaluated one of these initiatives--the Keep Well At Home (KWAH) Project--in a West London Primary Care Trust.

Design: KWAH involves a two-phase screening process, including a home visit by a community nurse. We employed cohort methods to determine whether KWAH resulted in fewer emergency attendances and admissions to hospital in the target population, from October 1999 to December 2002.

Results: estimated levels of coverage in the two phases of screening were 61 and 32%, respectively. The project had not maintained records of which additional health and social care services had been delivered following screening. The rates of emergency admissions to hospital in the 9 months before screening were similar in practices that did and did not join the project (rate ratio (RR) = 1.05; 95% CI 0.95-1.17), suggesting absence of volunteer bias. Over the first 37 months of the project, there was no significant impact on either attendances at Accident & Emergency departments (RR = 1.02; 95% CI 0.97-1.06) or emergency admissions of elderly patients (RR = 0.98; 95% CI 0.93-1.05).

Conclusion: the KWAH Project has been ineffective in reducing emergency admissions among the elderly. Significant questions arise in relation to selection of the screening instruments, practicality of achieving higher coverage of the eligible population, and creation of a new postcode lottery.

Keywords: screening, elderly, emergency, National Service Framework, EASY-Care Questionnaire.
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Intermediate care: policy before evidence
BMJ, August 6, 2005; 331(7512): 320 - 320.
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