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Geriatric assessment is a means to collect health and functional data of an individual older person in a standard way. It has been developed on the secondary care level in the specialties of geriatric and rehabilitative medicine. Transferring geriatric assessment into primary care may improve health outcomes of older people, especially as it facilitates preventive diagnostic and therapeutic intervention. Yet, it is not possible to use geriatric assessment, as it is carried out in secondary care, under primary care conditions. Several adaptations will be necessary. An assessment instrument will have to be developed which takes epidemiological features of the older population into account. It will have to be tailored to the specific conditions of health delivery in primary care. Moreover, to achieve effectiveness and acceptance by health care providers and users, we see the necessity of creating an algorithmic assessment instrument which allows the use in different health situations with different levels of diagnostic detail. A primary care assessment for older people then would need to be evaluated according to its effectiveness of improving health outcomes. Potential negative effects on health beliefs may be worth considering. The final task lies in the implementation of a primary care assessment instrument into our existing health delivery format.

Background: British trials from the 60's reveal that older patients tend to underreport their health problems. They misjudge them as non specific or being caused by old age. In this study we investigate whether standard preventive assessment facilitates the detection and early intervention of ophthalmological problems in old age., Methodology: For the first time a representative screening trial for older patients visiting their general practitioner was carried out in Germany, 1994. The surgeries as well as the 466 participating patients over 69 years were randomly selected. GPs were asked to examine the visual problems of the participants per standardized questionnaire and visual accuracy test. GPs had to report uncovered problems and planned interventions., Results: Altogether, 75% of the participating patients had some need for a further ophthalmological diagnostic or therapeutic intervention. Every fourth patient had not seen an ophthalmologist within the last two years. 40% of the participants complained of eye problems. 22% had symptoms of a glaucoma. Visual accuracy was low in 17% of the older patients. General practitioners had only been aware of 50% of all visual problems requiring further intervention. About half of the patients with a low visual accuracy and 70% with an indication of glaucoma had been unknown before. For about half of the patients requiring ophthalmological investigation (excluding problems with glasses) an intervention was planned. For every fifth, the general practitioners initiated referrals., Conclusion: The standard preventive facilitated to detect a high rate of visual problems in old age. Close cooperation with ophthalmologists is necessary for patients who do not take up the specialists' eye check ups (especially those at risk). Patients with severe eye problems in some cases in spite of specialists' care also require interdisciplinary treatment.

Ambulatory Geriatric Screening (AGES) is a standardized interview and examination instrument, the purpose of which is to detect major health or psychosocial problems in the elderly ambulatory patient, and thus prevent secondary illnesses. It comprises a patient and doctor's assistant questionnaire and a doctor's examination sheet with brief instructions for use. In a study conducted between 1992 and 1995, AGES was employed in 67 randomly selected general practitioners' offices in the area around Leipzig and Hannover. An important result was that in an average of 10.2 health-related problems per patient, 4.8, that is almost a half, had been unknown to the care-providing physician. In the case of very old patients, however, the family doctor was usually better informed. The application of the AGES in the office is less time-consuming than might be feared. For the evaluation of the patient questionnaire and the scheduled small examinations, the doctor's assistant needs only 10 to 15 minutes. Thereafter, the family doctor can check the results at a glance and use them as a basis for further talks with the patient and his therapeutic approach.

Scientific literature reveals different levels of efficiency in geriatric screening in the primary care setting. Part I of our review deals with the development of geriatric screening up to the implementation of regular health checks in Great Britain. Studies in primary care show that through screening 1-2 previously unknown conditions per patient can be detected, with a particularly high prevalence of unknown problems in the following areas: vision and hearing, continence, mobility, cognitive function, mood, isolation, and lack of help. Further research is still required to transfer the results of screening studies into primary care, particularly in validating instruments of geriatric assessments and selecting risk groups.

Geriatric screening detects many problems previously unknown to the primary health care physician. In spite of this, a valid judgement can only be made if the effectiveness of the induced intervention is proven. Prospective studies evaluating these screening-induced interventions show diverse results. Nevertheless, international task forces conclude from the evidence of existing studies that there are areas which are effective, efficacious, and enhance the quality of life. It remains a continuing task for research to develop geriatric assessment instruments as well as to set up objective guidelines of intervention in these areas.