Annual visits to patients over the age of 75--who is missed?
BACKGROUND
In the UK, the GP contract requires annual consultations and offers of home visits to the elderly. However, as many as 50% of elderly people refuse the offer of a health screen.


OBJECTIVE
To describe the characteristics of elderly people who declined the offer of an annual home visit.


METHODS
All elderly people aged 75 years and over, registered with a general practice of 13 full time and 3 part time doctors with a list size of 33,000 people, were offered a home visit. Data from this prospective cohort were linked with data from a community survey two years previously, which had achieved a 95% response rate. The main outcome measures were perceived health status, perceived loneliness, morale score, physical and mental disability, use of primary care and social services.


RESULTS
Thirty-six percent of all elderly people registered with the practice declined to take up the offer of a home visit. Those refusing a visit had not recently joined the practice and had very similar distributions of all demographic and most health and wellbeing characteristics to those who took up the offer. However, those declining appeared to have higher levels of morale (P = 0.010) and less contact with the general practitioner (P = 0.021) including an average of three weeks longer since last consultation with their general practitioner than those accepting the visit.


CONCLUSIONS
There appears little evidence in this population that elderly people who decline a home visit are necessarily part of an 'iceberg' of unmet need.
Jagger
C
C
Department of Epidemiology and Public Health, University of Leicester, UK.
Clarke
M
M
O'Shea
C
C
Gannon
M
M
D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000706:statistics & numerical data; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006792:House Calls / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008403:Mass Screening / Q000706:statistics & numerical data; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology