title: Assessment of appropriateness of screening community-dwelling older people to prevent functional decline.
abstract: OBJECTIVE
  To identify appropriate screening conditions, stratified according to age and vulnerability, to prevent functional decline in older people.
  
  
  METHODS
  A RAND/University of California at Los Angeles appropriateness method.
  
  
  METHODS
  The Netherlands.
  
  
  METHODS
  A multidisciplinary panel of 11 experts.
  
  
  METHODS
  The panelists assessed the appropriateness of screening for 29 conditions mentioned in guidelines from four countries, stratified according to age (60-74, 75-84, ≥85) and health status (general, vital, and vulnerable) and received a literature overview for each condition, including the guidelines and up-to-date literature. After an individual rating round, panelists discussed disagreements and performed a second individual rating. The median of the second ratings defined the appropriateness of screening.
  
  
  RESULTS
  The panel rated screening to be appropriate in three of the 29 conditions, indicating that screening was expected to prevent functional decline. Screening for insufficient physical activity was considered appropriate for all three age and health groups. Screening for cardiovascular risk factors and smoking was considered appropriate for the general and vital population aged 60 to 74. Of the 261 ratings, 63 (24%) were classified as uncertain, of which 42 (67%) concerned the vulnerable population. The panelists considered conditions inappropriate mainly because of lack of an adequate screening tool or lack of evidence of effective interventions for positive screened persons.
  
  
  CONCLUSIONS
  The expert panel considered screening older people to prevent functional decline appropriate for insufficient physical activity and smoking and cardiovascular risk in specific groups. For other conditions, sufficient evidence does not support screening. Based on their experience, panelists expected benefit from developing tests and interventions, especially for vulnerable older people.
authors.affiliation: Department of Public Health and Primary Care (Postzone V0-P), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands. y.m.drewes@lumc.nl
authors.forename: Yvonne M
authors.initials: YM
authors.lastname: Drewes
authors.forename: Jacobijn
authors.initials: J
authors.lastname: Gussekloo
authors.forename: Victor
authors.initials: V
authors.lastname: van der Meer
authors.forename: Henk
authors.initials: H
authors.lastname: Rigter
authors.forename: Janny H
authors.initials: JH
authors.lastname: Dekker
authors.forename: Marleen J B M
authors.initials: MJ
authors.lastname: Goumans
authors.forename: Job F M
authors.initials: JF
authors.lastname: Metsemakers
authors.forename: Riki
authors.initials: R
authors.lastname: van Overbeek
authors.forename: Sophia E
authors.initials: SE
authors.lastname: de Rooij
authors.forename: Henk J
authors.initials: HJ
authors.lastname: Schers
authors.forename: Marieke J
authors.initials: MJ
authors.lastname: Schuurmans
authors.forename: Ferd
authors.initials: F
authors.lastname: Sturmans
authors.forename: Kerst
authors.initials: K
authors.lastname: de Vries
authors.forename: Rudi G J
authors.initials: RG
authors.lastname: Westendorp
authors.forename: Annet W
authors.initials: AW
authors.lastname: Wind
authors.forename: Willem J J
authors.initials: WJ
authors.lastname: Assendelft
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D019983:Guideline Adherence; D006304:Health Status; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D015397:Program Evaluation / Q000379:methods*; D011596:Psychomotor Disorders / Q000453:epidemiology / Q000517:prevention & control*