Health checks that protect independence

The annual GP review (and why to book a long appointment)

A standard 15-minute GP appointment is for a single problem. Annual reviews for older patients should be longer — book a 30-minute "comprehensive review" when needed. Some practices have specific clinics for this; ask.

What a good annual review covers:

• Medication review — every medication still needed? Doses still right? Interactions? Anything causing falls or cognitive fog?
• Falls risk — including a "Timed Up and Go" test if needed
• Cognitive screening — particularly if family has noticed memory changes
• Blood pressure, BMI, weight changes
• Blood tests — HbA1c, kidney, thyroid, vitamin D, vitamin B12, iron
• Mood — depression and anxiety screening
• Continence — almost never raised by patients; routinely improvable
• Hearing and vision — referral if not done in the last year (see hearing and vision)
• Vaccinations — flu, shingles, pneumococcal, COVID, RSV
• Advance Care Plan check — see end of life planning

Vaccines for older adults

Funded eligibility changes — confirm with the GP or pharmacist. Most pharmacies now administer flu, shingles, and COVID vaccines without a GP visit.

Continence — the hidden problem

Up to a third of older people experience some urinary incontinence. Almost none ask for help — embarrassment plus a belief it's "just part of getting old." It isn't. Most cases are improvable, and untreated continence problems are a major reason people end up in residential care prematurely.

• Free Continence Service through Te Whatu Ora — assessment, pelvic floor physio, equipment supply. Referral via GP.
• Continence NZ — continence.org.nz, free helpline 0800 650 659
• Funded products — pads and catheters are free for eligible patients via Health NZ. Don't pay supermarket prices if you don't have to.
• Pelvic floor physiotherapy — works for many forms of incontinence; underused in older patients
• Medication review — diuretics, antidepressants, and others contribute. Often adjustable.

Bone health and osteoporosis

Half of women over 60 and a quarter of men will have an osteoporotic fracture. A fragility fracture (wrist, hip, spine from a low-energy fall) should always be followed by a bone density (DEXA) scan and treatment review.

• DEXA scans — partly publicly funded (regional thresholds) or private (~$150–$200)
• Treatment — bisphosphonates, calcium, vitamin D, exercise. Highly effective at reducing fractures.
• Vitamin D — deficiency is common in NZ winters and a contributor to falls. GP can prescribe supplementation.
• Combine with falls prevention — bone strength + fall prevention = independence

Cardiovascular checks

• Blood pressure — measured at every GP visit; home monitor useful for some patients
• Cholesterol and CV risk assessment — periodic, GP-led
• Atrial fibrillation — irregular pulse can cause strokes; many smartwatches now detect it. Mention any palpitations or pulse irregularity to the GP.

Dental

Adult dental is largely not publicly funded in NZ — the most common reason older people stop eating well or socialising. Worth knowing:

• WINZ Special Needs Grant — covers urgent / emergency dental for low-income people (limit, but useful)
• Community dental services — some Health NZ regions offer subsidised adult dental for high-needs patients
• Dental schools (Otago, AUT) — heavily reduced rates with student dentists supervised by qualified staff
• Marae and community-led services in some regions