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Abstract Background Exercise reduced tolerance and breathlessness are common in the elderly and can result in substantial loss in functionality and health related quality of life. Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are common underlying causes, but can be difficult to disentangle due to overlap in symptomatology. In addition, other potential causes such as obesity, anaemia, renal dysfunction and thyroid disorders may be involved. We aim to assess whether screening of frail elderly with reduced exercise tolerance leads to high detection rates of HF, COPD, or alternative diagnoses, and whether detection of these diseases would result in changes in patient management and increase in both functionality and quality of life. Methods/Design A cluster randomized diagnostic trial. Primary care practices are randomized to the diagnostic-treatment strategy (screening) or care as usual. Patient population: Frail (defined as having three or more chronic or vitality threatening diseases and/or receiving five or more drugs chronically during the last year) community-dwelling persons aged 65 years and older selected from the electronic medical files of the participating general practitioners. Those with reduced exercise tolerance or moderate to severe dyspnoea (≥2 score on the Medical Research Counsel dyspnoea scale) are included in the study. The diagnostic screening in the intervention group includes history taking, physical examination, electrocardiography, spirometry, blood tests, and echocardiography. Subsequently, participants with new diagnoses will be managed according to clinical guidelines. Participants in the control arm receive care as usual. All participants fill out health status and other relevant questionnaires at baseline and after 6 months of follow-up. Discussion This study will generate information on the yield of screening for previously unrecognized HF, COPD and other chronic diseases in frail elderly with reduced exercise tolerance and/or exercise induced dyspnoea. The cluster randomized comparison will reveal whether this yield will result in subsequent improvements in functional health and/or health related quality of life. Trial registration ClinicalTrials.gov NCT01148719

Background: chronic dyspnoea is common in older people and is often of cardiac or pulmonary aetiology. Information on the exact prevalence and distribution of underlying causes is scarce. Our aim was to review the literature on prevalence and underlying causes of dyspnoea in the older population.Methods: two MEDLINE searches were conducted: the first on studies on the prevalence of dyspnoea in older persons aged ≥65 years using the Medical Research Council (MRC) dyspnoea scale and the second on the underlying causes of dyspnoea in this population. Quality assessment was performed for all included studies. Random effects models based on the logit transformed prevalences were used to calculate pooled prevalence with 95% confidence intervals (95% CI).Results: a total of 21 articles from 20 different populations reported the prevalence in the general older population with a median sample size of 600 (Interquartile range 262–1289). The pooled prevalence was 36% (95% CI: 27–47%) for an MRC of ≥2, 16% (95% CI: 12–21%) for an MRC of ≥3 and 4% (95% CI: 2–9%) for an MRC of ≥4. Prevalence rates were higher in women than in men.Only one article investigated the underlying causes of dyspnoea in older persons; in 70% of these patients, the dyspnoea was considered to be of cardiac or pulmonary origin.Conclusion: dyspnoea is very common in older people, but estimates vary considerably between studies. Only one study describes the underlying causes. [ABSTRACT FROM AUTHOR]