Screening for Disease in Elderly Persons

  • John R. Feussner
  • Eugene Z. Oddone


Early detection of disease, or screening, is an attractive diagnostic strategy for physicians. Screening for disease facilitates detection of disease early in its clinical course, before many pathologic changes have occurred and while the disease may be more amenable to treatment. As attractive as early detection may seem, however, certain principles should be considered to assure the appropriateness of any decision to seek early diagnoses (Table 8.1).1 Such considerations include the importance or seriousness of the target disease; the presence of an early presymptomatic period; the accuracy and acceptability of available diagnostic tests; the risk associated with invasive diagnostic testing; the efficacy, cost, and availability of treatment; and the risk of treatment, such as adverse drug effects or adverse outcomes of surgery. The absence of clear information about any one of these considerations may diminish the potential value of any screening strategy no matter how attractive it may seem.


Cervical Cancer Elderly Person Fecal Occult Blood Test Nursing Home Resident Cervical Cancer Screening 
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  1. 1.
    Wilson JMG, Jungner G. Principles of Early Disease Detection. Geneva, Switzerland: World Health Organization; 1968;34:27–39. Public Health Papers.Google Scholar
  2. 2.
    Sackett DL, Haynes RB, Tugwell PX. Clinical Epidemiology: A Basic Science for Clinical Medicine. Boston, Mass: Little Brown & Co Inc; 1985: 139–155.Google Scholar
  3. 3.
    Eddy DM. The economics of cancer prevention and detection: getting more for less. Cancer 1981; 47: 1200 1209.Google Scholar
  4. 4.
    Working Group on Hypertension in the Elderly. Statement on hypertension in the elderly. JAMA 1986; 256: 70–74.CrossRefGoogle Scholar
  5. 5.
    Siegel D, Kuller L, Lazarus NB, et al. Predictors of cardiovascular events and mortality in the Systolic Hypertension in the Elderly Program pilot project. Am J Epidemiol 1987; 126: 385–399.PubMedGoogle Scholar
  6. 6.
    Curb JD, Burhni NO, Entwiske G, et al. Isolated systolic hypertension in 14 communities. Am J Epidemiol 1985; 121: 362–370.PubMedCrossRefGoogle Scholar
  7. 7.
    Hypertension Detection and Follow-up Cooperative Group. Five-year findings of the Hypertension Detection and Follow-up Program. JAMA 1979; 242: 2572–2577.CrossRefGoogle Scholar
  8. 8.
    The Australian Therapeutic Trial in Mild Hypertension, the Management Committee. Treatment of mild hypertension in the elderly. Med J Aust 1981; 2: 398–402.Google Scholar
  9. 9.
    Amery A, Birkenhager W, Brixbe P, et al. Morbidity and mortality results from the European Working Party on Hypertension in the Elderly trial. Lancet 1985; 293: 1146 1151.Google Scholar
  10. 10.
    National Heart, Lung, and Blood Institute Lipid Research Clinics Coronary Primary Prevention Trial results, I. reduction in incidence of coronary heart disease. JAMA 1984; 251: 351–364.CrossRefGoogle Scholar
  11. 11.
    Frick MH, Elo Q, Haapa K, et al. Helsinki Heart Study: primary prevention with gemfibrozil in middle age men with dyslipidemia. N Engl J Med 1987; 317: 1237–1245.PubMedCrossRefGoogle Scholar
  12. 12.
    Anderson KM, Castelli WP, Levy D. Cholesterol and mortality. 30 years of follow-up from the Framingham study. JAMA 1987; 257: 2176–2180.PubMedCrossRefGoogle Scholar
  13. 13.
    National Heart, Lung, and Blood Institute. Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Arch Intern Med 1988; 148: 36–69.CrossRefGoogle Scholar
  14. 14.
    Jajich CL, Ostfeld AM, Freeman DH. Smoking and coronary heart disease in the elderly. JAMA 1984; 252: 2831–2834.PubMedCrossRefGoogle Scholar
  15. 15.
    Hermanson B, Omenn GS, Kronmal RA, et al. Beneficial six-year outcome of smoking cessation in older men and women with coronary artery disease: results from the CASS Registry. N Engl J Med 1988; 319: 1365–1369.PubMedCrossRefGoogle Scholar
  16. 16.
    Rogers RL, Myer JS, Judd BW, et al. Abstention from cigarette smoking improves cerebral perfusion among elderly chronic smokers. JAMA 1985; 253: 2970–2974.PubMedCrossRefGoogle Scholar
  17. 17.
    O’Malley MS, Fletcher SW. Screening for breast cancer with breast self-examination: a critical review. JAMA 1987; 257: 2196–2203.PubMedCrossRefGoogle Scholar
  18. 18.
    American Cancer Society. Guidelines for the cancer-related checkup. CA 1980; 30: 194–240.Google Scholar
  19. 19.
    Baker LH. Breast Cancer Detection Demonstration Project: five year summary report. CA 1982; 32: 194–225.PubMedGoogle Scholar
  20. 20.
    Shapiro S, Venet W, Strax P, et al. Ten-to-14-year effect of screening on breast cancer mortality. JNCI 1982; 69: 349–355.PubMedGoogle Scholar
  21. 21.
    Tabar L, Gad A, Holmberg LH, et al. Reduction in mortality from breast cancer after mass screening with mammography: randomized trial from the Breast Cancer Screening Working Group of the Swedish National Board of Health and Welfare. Lancet 1985; 1: 829832.Google Scholar
  22. 22.
    Mandelblatt J, Gobal I, Wisterick M. Gynecological care of elderly women. JAMA 1986; 256: 367–371.PubMedCrossRefGoogle Scholar
  23. 23.
    Richart RM, Barron BA. Screening strategies for cervical cancer and cervical intraepithelial neoplasia. CA 1981; 47: 1176–1181.Google Scholar
  24. 24.
    National Institute of Health Consensus Statement: cervical cancer screening. Br Med J 1980;281:1264–1266.Google Scholar
  25. 25.
    Walton RJ, Blauchet M, Boyes DA. Cervical cancer screening programs. Can Med Assoc J 1976; 114: 1003 1033.Google Scholar
  26. 26.
    Celentano DD, Klassen AC, Weisman CS, et al. Cervical cancer screening practices among older women: results from the Maryland cervical cancer case-control study. J Clin Epidemiol 1988; 41: 531–541.PubMedCrossRefGoogle Scholar
  27. 27.
    Pollack SV. Skin cancer in the elderly. Clin Geriatr Med 1987; 3: 715–729.PubMedGoogle Scholar
  28. 28.
    Canadian Task Force on the Periodic Health Examination. The periodic health examination, II. 1984 update. Can Med Assoc J 1984; 130: 1278–1285.Google Scholar
  29. 29.
    Winawer SJ, Millard D. Screening for colorectal cancer. Bull WHO 1987; 65: 105–111.PubMedGoogle Scholar
  30. 30.
    Hardcastle JD, Armitage NC, Chamberlain J, et al. Fecal occult blood screening for colorectal cancer in the general population. Cancer 1986; 58: 397–403.PubMedCrossRefGoogle Scholar
  31. 31.
    Simon JB. Occult blood screening for colorectal cancer: a critical review. Gastroenterology 1985; 88: 820–837.PubMedGoogle Scholar
  32. 32.
    Gilbertsen VA, McHugh RB, Schuman L, et al. The earlier detection of colon cancers: a preliminary report of the results of the occult blood study. Cancer 1980; 45: 2899–2901.PubMedCrossRefGoogle Scholar
  33. 33.
    Guinan P, Bush I, Ray V, et al. The accuracy of the rectal examination in the diagnosis of prostate carcinoma. N Engl J Med 1980; 303: 499–503.PubMedCrossRefGoogle Scholar
  34. 34.
    Transrectal ultrasonography in prostate cancer: Diagnostic and Therapeutic Technology Assessment (DATTA). JAMA 1988; 259: 2757–2760.CrossRefGoogle Scholar
  35. 35.
    Berlin NI, Buncher RC, Fontana RS, et al. The National Cancer Institute Cooperative Early Lung Cancer Detection Program: results of the initial screen (prevalence)-early lung cancer detection: introduction. Am Rev Respir Dis 1984; 130: 545–549.PubMedGoogle Scholar
  36. 36.
    Baranovsky A, Myers MH. Cancer incidence and survival in patients 65 years of age and older. CA 1986; 36: 27–41.Google Scholar
  37. 37.
    Goodwin JS, Samet JM, Key CR, et al. Stage at diagnosis of cancer varies with age of the patient. J Am Geriatr Soc 1986; 34: 20–26.PubMedGoogle Scholar
  38. 38.
    O’Rourke MA, Feussner JR, Feigel P, et al. Age trends of lung cancer stage at diagnosis: implications for lung cancer screening in the elderly. JAMA 1987; 258: 921–926.PubMedCrossRefGoogle Scholar
  39. 39.
    Yatsu FM, Grotta JC, Pettigrew LC. Asymptomatic carotid bruit and stenosis. Semin Neurol 1986; 6: 262–266.PubMedCrossRefGoogle Scholar
  40. 40.
    Chambers BR, Norris JW. Outcome in patients with asymptomatic neck bruits. N Engl J Med 1986; 315: 860–865.PubMedCrossRefGoogle Scholar
  41. 94.
    John R. Feussner and Eugene Z. OddoneGoogle Scholar
  42. 41.
    Feussner JR, Matchar DB. When and how to study the carotid arteries. Ann Intern Med 1988; 109: 805–818.PubMedGoogle Scholar
  43. 42.
    Winslow CM, Solomon DH, Chassin MR, et al. The appropriateness of carotid endarterectomy. N Engl J Med 1988; 318: 721–727.PubMedCrossRefGoogle Scholar
  44. 43.
    Powell KE, Farer LS. The rising age of the tuberculosis patient: a sign of success and failure. J Infect Dis 1980; 142: 946–948.PubMedCrossRefGoogle Scholar
  45. 44.
    Stead WW, Lofgren JP. Does the risk of tuberculosis increase with old age? J Infect Dis 1983; 147: 951–55.PubMedCrossRefGoogle Scholar
  46. 45.
    Stead WW, To T. The significance of the tuberculin test in elderly person. Ann Intern Med 1987; 107: 837–842.PubMedGoogle Scholar
  47. 46.
    Stead WW, To T, Harrison RW, et al. Benefit-risk reduction in preventive treatment for tuberculosis in elderly persons. Ann Intern Med 1987; 107: 843–845.PubMedGoogle Scholar
  48. 47.
    Kopanoff DE, Snider DE, Caros GJ. Isonazide related hepatitis: a U.S. Public Health Service Cooperative Surveillance Study. Am Rev Respir Dis 1978; 117: 991 1001.Google Scholar
  49. 48.
    Mulrow CD, Agular C, Hill J, et al. Functional handicaps in elderly individuals with hearing impairment. Clin Res 1988; 36: 91A.Google Scholar
  50. 49.
    Lichtenstein MJ, Bess FH, Logan SA. Validation of screening tools for identifying hearing-impaired elderly in primary care. JAMA 1988; 259: 2875–2878.PubMedCrossRefGoogle Scholar
  51. 50.
    Kahn HA, Lieboritz HM, Ganley JP, et al. The Framingham Eye Study: outline and major prevalence findings. Am J Epidemiol 1977; 106: 17–32.PubMedGoogle Scholar
  52. 51.
    Straatsma BR, Meyer KJ, Bastek JV, et al. Posterior chamber intraocular lens implantation by ophthalmology residents. Ophthalmology 1983; 90: 327–335.PubMedGoogle Scholar
  53. 52.
    Applegate WB, Miller ST, Elam JT, et al. Impact of cataract surgery with lens implantation on vision and physical function in the elderly. JAMA 1987; 257: 1064 1066.Google Scholar
  54. 53.
    Hollows FL, Graham PA. Intraocular pressure, glaucoma, and glaucoma suspects in a defined population. Br J Ophthalmol 1966; 50: 570–586.PubMedCrossRefGoogle Scholar
  55. 54.
    Stromberg V. Ocular hypertension: frequency, course, and relation to other disorders occurring in glaucoma. Acta Ophthalmol 1969; 69 (suppl): 1962.Google Scholar
  56. 55.
    Power EJ, Wagner JL, Duffy BM, eds. Screening for Open-Angle Glaucoma in the Elderly. Office of Technology Assessment; 1988.Google Scholar
  57. 56.
    Ford VJ, Zimmerman TJ, Kooner K. A comparison of screening methods for the detection of glaucoma. Invest Ophthalmol Vis Sci 1982; 22 (suppl); 257.Google Scholar
  58. 57.
    Eddy DM, Sanders LE, Eddy JF. The value of screening for glaucoma with tonometry. Sury Ophthalmol 1983; 28: 194–205.CrossRefGoogle Scholar
  59. 58.
    Graham PA. The definition of preglaucoma: a prospective study. Trans Ophthalmol Soc UK 1968; 88: 153–165.Google Scholar
  60. 59.
    Grant WM, Burke JF. Why do some people go blind from glaucoma? Ophthalmology 1982; 89: 991–998.PubMedGoogle Scholar
  61. 60.
    Blazer D, Williams CD. Epidemiology of dysphoria and depression in an elderly population. Am J Psychiatry 1980; 137: 439–444.PubMedGoogle Scholar
  62. 61.
    Koenig HG, Meador KJ, Cohen HJ, et al. Self-rated depression scales and screening for major depression in the older hospitalized patient with medical illness. J Am Geriatr Soc 1988; 36: 699–706.PubMedGoogle Scholar
  63. 62.
    Norris JT, Gallager D, Wilson A, et al. Assessment of depression in geriatric medical outpatients: the validity of two screening measures. J Am Geriatr Soc 1987; 35: 985–995.Google Scholar
  64. 63.
    Harris RE, Mion LC, Patterson MB, et al. Severe illness in older patients: the association between depressive disorders and functional dependency during the recovery phase. J Am Geriatr Soc 1988; 36: 890–896.PubMedGoogle Scholar
  65. 64.
    Winokur G, Black DW, Nasrallah A. Depression secondary to psychiatric disorders and medical illness. Am J Psychiatry 1988; 145: 233–237.PubMedGoogle Scholar
  66. 65.
    Myers JK, Weissman MM, Tischler GL, et al. Six-month prevalence of psychiatric disorders in three communities. Arch Gen Psychiatry 1984; 41: 959–967.PubMedCrossRefGoogle Scholar
  67. 66.
    Hurt RD, Finlayson RE, Morse RM, et al. Alcoholism in elderly persons: medical aspects and prognosis of 216 inpatients. Mayo Clin Proc 1988; 63: 753–760.PubMedCrossRefGoogle Scholar
  68. 67.
    Mayfield D, McLeod G, Hall P. The CAGE questionnaire: validation of a new alcoholism screening instrument. Am J Psychiatry 1974; 131: 1121–1123.PubMedGoogle Scholar
  69. 68.
    Magruder-Habib K, Harris KE, Fraker GG. Validation of the Veterans Alcoholism Screening Test. J Stud Alcohol 1982; 43: 910–926.PubMedGoogle Scholar
  70. 69.
    Mayfield DG, Johnston RGM. Screening techniques and prevalence estimation in alcoholism. In Fann WE, ed. Phenomenology and Treatment of Alcoholism. New York, NY: Spectrum Press; 1981.Google Scholar
  71. 70.
    Oral Health of United States Adults: The National Survey of Oral Health in U.S. Employed Adults and Seniors: 1985–1986-National Findings. 1987. National Institutes of Health publication 87–2868. US Department of Health and Human Services Public Health Service Washington, D.C.Google Scholar
  72. 71.
    Canadian Task Force on the Periodic Health Examination. Can Med Assoc J 1979; 121: 1–45.Google Scholar
  73. 72.
    Holbrook TL, Grazier K, Kelsey JL, et al. Frequency of Occurrence, Impact and Cost of Selected Musculoskeletal Conditions in the U.S. Chicago, Illinois: American Academy of Orthopedic Surgery; 1984.Google Scholar
  74. 73.
    Rubenstein LZ, Robbins AS, Schulman GNP, Rosado J, Osterweil D, Josephson KR. Falls and instability in the elderly. JAGS 1988; 36: 266–78.Google Scholar
  75. 74.
    Nayak US, Gabell A, Simons MA, et al. Measurement of gait imbalance in the elderly. J Am Geriatr Soc 1982; 30: 516–520.PubMedGoogle Scholar
  76. 75.
    See Chapter 5 in this book.Google Scholar
  77. 76.
    Cummings SR, Kelsey JL, Nevitt MC, et al. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 1985; 7: 178–208.PubMedGoogle Scholar
  78. 77.
    Richelson LS, Wahner HW, Melton LJ, et al. Relative contributions of aging and estrogen deficiency to postmenopausal bone loss. N Engl J Med 1984; 311: 1273 1276.Google Scholar
  79. 78.
    Health and Public Policy Committee, American College of Physicians. Radiologic methods to evaluate bone mineral content. Ann Intern Med 1984; 100: 908–911.Google Scholar
  80. 79.
    NIH Consensus Conference. Osteoporosis. JAMA 1984; 252: 799–802.CrossRefGoogle Scholar
  81. 80.
    Cummings SR, Black D. Should peri-menopausal women be screened for osteoporosis? Ann Intern Med 1986; 104: 817–823.PubMedGoogle Scholar
  82. 81.
    National Safety Council. Accidents Facts. Chicago, ILL. 1983.Google Scholar
  83. 82.
    Riggs BL, Melton U. Involutional osteoporosis. N Engl J Med 1986; 314: 1676–1686.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1990

Authors and Affiliations

  • John R. Feussner
  • Eugene Z. Oddone

There are no affiliations available

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