Family Practice Advance Access originally published online on November 6, 2007
Family Practice 2007 24(6):604-609; doi:10.1093/fampra/cmm063
Preventive health risk appraisal for older people and impact on GPs' patient management: a prospective study
a Horten Centre, University Hospital of Zurich, CH-8091 Zurich, Switzerland
b Association for Preventive and Social Medicine (AKS), Province of Vorarlberg, A-6900 Bregenz
c Practice for Family Medicine, Habsburgerstrasse 1, A-6830 Rankweil, Austria. Correspondence to Johann Steurer, Horten Centre, Zurich University, Postfach Nord, CH-8091 Zurich, Switzerland; Email: johann.steurer{at}usz.ch
Received 15 January 2007; Revised 20 August 2007; Accepted 21 September 2007.
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Abstract |
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Background. Health risk appraisals (HRAs) are recommended for detection of potentially modifiable risk factors for health status decline of older people. Little is known how family physicians manage detected risk factors.
Objective. We evaluated (i) if risk factors in one or more of five predefined domains were detected in a primary care-based HRA and (ii) how often these findings had an impact on the further management of patients.
Methods. We performed a prospective observational study in a rural community in Austria and included persons (age 
70 years) living at home. We applied the standardized assessment for elderly people in primary care (STEP) instrument and evaluated risk factors for status decline assessing five domains (cognitive function, depression, urinary incontinence, hearing impairment and mobility/falls).
Results. Two hundred and sixty-four persons participated and the HRA revealed a wide range of risk factors for health status decline [from 4.5% (12/264) in the depression domain up to 31% (81/264) for mobility/falls and 41% (107/264) in the cognitive domain]. The findings had an impact on the further management in four domains: hearing impairment (100% of findings with impact), mobility/falls (93%), depression (83%) and urinary incontinence (65%). In contrast, abnormal cognitive findings lead to action only in every fifth participant (18%; 19/107).
Conclusion. In contrast to other domains, family physicians are hesitant to act upon abnormal findings of cognitive testing. Additional knowledge is needed to clarify the value of abnormal cognitive findings for management of patients and support of their carers.
Keywords. Aged, dementia, health risk appraisal, preventive health services, primary health care.
Eichler K, Scrabal C, Steurer J and Mann E. Preventive health risk appraisal for older people and impact on GPs' patient management: a prospective study. Family Practice 2007; 24: 604–609.