http://repub.eur.nl/res/aut/11053/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/32414/ 2008-04-01T00:00:00Z http://repub.eur.nl/res/pub/20000/ 1999-09-01T00:00:00Z One of the major achievements of medicine in this century is its contribution to the increase in life expectancy at birth. Nowadays. this is reflected in the growing Humber of older adults. Unfortunately, part of this group will spend old age in poor health. The consequences for older individuals, their care givers and the society at large. raises the question whether the occurrence of disease in later life can be postponed or even prevented. Prevention of disease can have different aims. Firstly. it call be directed at preventing premature death. Secondly. prevention can aim at reducing morbidity. If our preventive programmes are successful, morbidity may be compressed to a short period at the end of life. However, if preventive programmes also increase life expectancy, expansion of morbidity may occur. Thirdly, preventive efforts can try to improve functional status and maintain independence of older adults. http://repub.eur.nl/res/pub/9171/ 1999-01-01T00:00:00Z BACKGROUND: Prevention of cardiovascular disease in the elderly is becoming increasingly important. GPs are in a unique position to initiate preventive interventions in this age group. However, it is not clear which strategy a GP should follow to identify patients at increased cardiovascular risk-case finding or screening. OBJECTIVE: We aimed to assess the value of a single cardiovascular health check compared with a normal care case finding and to investigate the diagnostic or therapeutic consequences of detecting new cardiovascular risk indicators. METHODS: In 1991, 1002 persons aged 60 years and over, enlisted in one general practice, were invited. Of the 805 subjects who responded (80%), the cardiovascular risk profile was determined by a research physician. The proportion of newly detected cardiovascular risk indicators was the main outcome measure. A risk indicator was considered newly detected when it was not mentioned in the GP's summary of the patient record, which had been checked by the patient for its completeness. The patient records of participants with newly detected hypertension, diabetes or hypercholesterolaemia were systematically reviewed to detect diagnostic and therapeutic interventions by the GP. RESULTS: In 25.1% of the participants, one or more cardiovascular risk indicators were found which were previously unknown to the GP, including 38 (4.7%) cases of hypertension, 82 (10%) cases of isolated systolic hypertension, 14 (1.7%) cases of diabetes mellitus and 63 (7.8%) cases of hypercholesterolaemia. On the basis of these findings, the GP initiated therapeutic interventions in almost all subjects with newly detected diabetes. However, reports of newly detected hypertension or high cholesterol levels were usually not followed by an intervention. CONCLUSION: A single cardiovascular health check in the elderly can detect a considerable number of risk indicators that are unknown to a patient's GP. In most cases, however, the detection of hypertension or cholesterol > or = 6.5 mmol/l did not lead to interventions by the GP. More efforts are needed to ensure that the beneficial effects of these interventions are not limited to participants in clinical trials but can be extended to patients in general practice.