title: Health risk appraisal for older people 4: case finding for hypertension, hyperlipidaemia and diabetes mellitus in older people in English general practice before the introduction of the Quality and Outcomes Framework.
abstract: BACKGROUND
  Early intervention can help to reduce the burden of disability in the older population, but many do not access preventive care. There is uncertainty over what factors influence case finding in older patients in general practice.
  
  
  OBJECTIVE
  To explore factors associated with case finding for hypertension, hyperlipidaemia and diabetes mellitus in older patients.
  
  
  METHODS
  Two thousand four hundred and ninety-one patients aged 65 years and above were recruited from three large practices in suburban London before the introduction of the Quality and Outcomes Framework (QOF) completed a questionnaire on health, functional status, health behaviours and preventive care.
  
  
  RESULTS
  Those not reporting heart disease, diabetes or hypertension were included in a secondary data analysis to explore factors influencing uptake of preventive care measures. Approximately one-third denied having had a blood pressure check in the previous year. They were more likely to have had little contact with doctors and to have an unhealthy lifestyle (smoking and a high-fat diet). One-third reported a cholesterol test in the previous five years. Cholesterol measurement was reported more often by men and those with a high body mass index. Those with unhealthy lifestyles (smoking and high-fat diet), those who had only received the state pension and those who limited their activities because of a fear of falling were less likely to report cholesterol measurement. About 10% reported a fasting blood glucose measurement and were more likely to consult more often and have more medications, but they were less likely to have a high-fat diet. Preventive care uptake was associated with frequent contacts with doctors, but overall the uptake of preventive care was low. Older people with healthier lifestyles were more likely to have primary preventative care interventions. These findings provide a baseline against which the effect of the QOF on the care of older people can be measured in future studies.
authors.affiliation: Department of Primary Care and Population Health, University College London, London, UK.
authors.forename: Mareeni
authors.initials: M
authors.lastname: Raymond
authors.forename: Steve
authors.initials: S
authors.lastname: Iliffe
authors.forename: Kalpa
authors.initials: K
authors.lastname: Kharicha
authors.forename: Danielle
authors.initials: D
authors.lastname: Harari
authors.forename: Cameron
authors.initials: C
authors.lastname: Swift
authors.forename: Gerhard
authors.initials: G
authors.lastname: Gillmann
authors.forename: Andreas E
authors.initials: AE
authors.lastname: Stuck
mesh_terms: D000368:Aged; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D058006:General Practice / Q000379:methods* / Q000592:standards; D015438:Health Behavior; D006801:Humans; D006949:Hyperlipidemias / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D006973:Hypertension / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D008131:London; D008297:Male; D015337:Multicenter Studies as Topic; D011314:Preventive Health Services / Q000379:methods / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment / Q000379:methods; D011795:Surveys and Questionnaires