Studies in Scotland in the 1960s demonstrated that much disease and disability among older people was unknown to their GPs. General practice was then response based; if patients did not complain they were assumed to be well. In addition, older people did not appreciate that some afflictions of later life were not simply due to ageing but were the consequence of potentially remediable disease. Often, some older people dreaded the undignified and unpleasant processes of medical investigation and treatment more than the illness and the prospect of premature death. One response to this problem was to institute various kinds of surveillance.
The issue of surveillance may arise in occupational medicine, with the increase in numbers of older workers, many of whom will not wish to seek medical attention if they thereby risk both investigation and possible loss of employment. While it might seem logical to consider special surveillance for older workers, both to safeguard their health and also to prevent accidents or loss of production due to unrecognized impairments, there are ethical questions, and a blanket policy which is not risk-based and easily defensible cannot be endorsed. It is prudent to be vigilant for problems that an older worker is more likely than a younger colleague to encounter, but if certain groups of workers are subject to regular review, to ensure that they meet minimum physical and health standards for their particular assigned tasks and are not adversely affected by their work, then review procedures should cover members of that group equally and not discriminate by age.