Screening & diagnostics

1.4.4 Screening for old age disorders

For screening for disorders associated with aging, recommendations are highly individualized and often tied to functional status rather than a specific age. Unlike more common health screenings (like those for cancer or heart disease), these checks are often integrated into a broader geriatric assessment.

Frailty Screening

Frailty is a state of increased vulnerability and reduced physiological reserve that can lead to a greater risk of adverse health outcomes, like falls, hospitalization, and disability. It is not a disease but a clinical syndrome.

The NHS in England is a global leader in systematically identifying frailty using the electronic Frailty Index (eFI) (Clegg et al., 2016). This tool uses data from a patient’s electronic health record to identify individuals aged 65 and older who may be living with mild, moderate, or severe frailty. Clinicians then use this information to create personalized care plans.

The US recommends a comprehensive geriatric assessment for patients at risk including evaluating physical function, gait speed, grip strength, and a person’s ability to perform daily activities.

Screening Tools:

• Gait Speed: A test to measure how quickly a person can walk a short distance (e.g., 4 meters).
• Timed Up and Go (TUG) Test: Measures the time it takes for a person to stand from a chair, walk 3 meters, turn, and sit back down.
• PRISMA-7 Questionnaire: A 7-item questionnaire designed for self-completion to identify disability and frailty.
• SARC-F Questionnaire: A five-item questionnaire used to screen for sarcopenia (the loss of muscle mass).

Hearing and Vision Screening

Vision and hearing loss are strongly linked to an increased risk of falls, social isolation, and cognitive decline.

Recommendations:

• UK recommend an eye test every two years for all people, with more frequent checks if a person is at higher risk for conditions like glaucoma or diabetes. The NHS Health Check for those 40-74 includes a discussion about sensory issues, and people can be referred for an eye test (free for those aged 60 and over) or audiology services.
• US: guidelines stress the importance of regular checks.

Cognitive Health and Dementia

While early detection could theoretically offer benefits, the current consensus from major public health bodies like the USPSTF and UK NSC is that the harms and uncertainties of population-wide screening outweigh the proven benefits due to the lack of a proven treatment, lack of accuracy of screening tests and psychological distress that could be caused.

Recommendations:

• UK: Diagnosis is clinical and is based on a combination of a person’s history, symptom presentation, and a cognitive assessment if there are concerns (like the GPCOG (Brodaty et al., 2002).
• US: Recommendations are for assessment of memory and cognitive function if a patient or a family member raises concerns.

Sarcopenia

Sarcopenia is the progressive and generalized loss of skeletal muscle mass and strength with age and is a major component of frailty. There is no national screening program for sarcopenia. However, it is an important condition to screen for in high-risk individuals.

Similar to frailty, sarcopenia is often screened for using simple tools such as:

• Grip Strength (measured with a hand dynamometer)
• Gait Speed
• SARC-F Questionnaire: A five-item questionnaire that asks about strength, walking, rising from a chair, climbing stairs, and falls.