I was talking with a colleague this week about blood pressure monitoring by optometrists. The topic is raised in one of this week’s CET articles (see page 28) which includes the line, ‘Measure your older patients’ blood pressure at each visit.’
A decade or so ago, GPs were wary of allied health professionals undertaking BP measurements, especially if using electronic testing kit rather than the old ‘lub-dub’ sphygmo and stethoscope. The recent statistics of undiagnosed hypertension along with an acceptance of the accuracy of simple electronic testing kit (most GPs now use them) has turned this attitude on its head. Indeed, my GP told me: ‘The more testing the better.’ And we see the over-forties every couple of years, even the men. Something blood pressure screeners would envy.
My colleague, however, got me thinking. Her thought was that while systemic health screening attracted media attention, mental health does not. When Cardiff University published their DEPVIT study some years back establishing a clear link between sight loss (as we see every day in the elderly rather than dramatic hospital cases) and clinical depression, I was not alone in suggesting ECPs undertake training to be able to identify early signs of depression and use simple screening questions to ensure people received the help that is available but all too often is not accessed.
Many disagreed – I remember ‘opening up a can of worms’ being said by one academic. A meta-analysis in this week’s British Journal of Ophthalmology clearly shows a strong link between AMD and dementia states. It concludes: ‘A significant association between dementia and AMD calls for greater clinical awareness. The cost-effectiveness of routine screening for the other condition in patients with primary diagnosis of dementia/AD or AMD requires further study.’ Surely the time has come for ECPs to play a role in mental welfare screening.