The "Health Screening 40+" program: about the price of lies, "silent" disorders, and the "golden rule" for adults

After the age of 40, many of us simply get used to fatigue, stress, and living "on autopilot." Symptoms become background noise, and the phrase "it's nothing serious" becomes a universal answer to everything. It is at this moment that health begins to change quietly and imperceptibly. To help detect these changes in time, the national program "Health Screening 40+" has been launched in Ukraine.Together with Larysa Demchenko, medical director of the "Likuyu" clinic network, and family doctor Diana Ledney-Opalenyk LIGA.net It breaks down what the "patient's journey" looks like, why screening is not an exam, and what to do if the results show abnormalities."Patient's Journey" in the "Health Screening 40+" ProgramAfter reaching the age of 40 (30 days after the birthday), an invitation to undergo the national "Health Screening 40+" program appears in the "Diia" app.The patient confirms their participation, opens or uses an existing Diia.Card, and receives UAH 2,000 in this account within seven days.– Next, a person chooses any medical facility from the official list of program participants, regardless of their place of residence, the presence or absence of a declaration, or the form of ownership of the medical facility.This means a patient can have a signed declaration with a doctor in a state hospital in the Sumy region, but still undergo screening in Kyiv at a private medical center. Or vice versa. In any case, the service will be free of charge for the patient, as everything is covered by the state.For those who do not use the Diia app, it is possible to apply for a bank card and submit an application through a local administrative service center. This can also be done 30 days after your birthday.Specifically, we schedule screenings through the contact center or the medical center's administrator: the patient is immediately informed about the date, time, location, and even the doctor who will conduct the screening," explains Larysa Demchenko.How does the "Health Screening 40+" differ from preventive check-ups referred by a family doctor?The key difference is in the format and focus.Formally, preventive examinations can also be done through a family doctor, but in practice, people aged 40+ often postpone prevention if there are no systemic complaints and "it doesn't go away on its own," says the medical director:– In addition, the option to see a doctor only in the morning clashes with work schedules. That's why we came up with a separate program that removes all these barriers, as screening can be done throughout the day, not just in the morning.Why 40+?Larysa Demchenko explained that the "40+" age category was not chosen by chance, as, according to the Ministry of Health statistics, it is after the age of 40 that the risks of developing arterial hypertension, heart attacks and strokes, type 2 diabetes, and anxiety and depressive disorders (especially in conditions of war and chronic stress) significantly increase.In numbers, this statistic looks like this:Every day in Ukraine, more than 1,000 people die from cardiovascular diseases, which cause about 60% of all premature deaths.More than 1.2 million people live with diabetes, and about half of them are not even aware of their condition, because in the initial stages, diabetes often has no obvious symptoms.Up to 10 million people are facing psychological or mental health problems, largely due to the war and chronic stress.Family doctor Diana Ledney-Opalenyk explains what changes occur in health after 40 years of age.Changes in metabolismMetabolism slows down, so the risk of weight gain, insulin resistance, and type 2 diabetes increases.There is a growing tendency for cholesterol levels to rise, which creates the preconditions for atherosclerosis.Therefore, the following become important: glucose analysis, lipid profile, calculation of body mass index, and waist circumference.Cardiovascular systemBlood vessels lose their elasticity, blood pressure rises, and atherosclerotic plaques form. This is the first "warning sign" for hypertension, stroke, and heart attack.Therefore, the following are recommended: regular blood pressure measurement, ECG, and determination of cholesterol and triglyceride levels.Mental healthIt is after this age that the number of "silent" disorders increases: masked depression, anxiety, burnout, and cognitive decline. They often manifest not through emotions, but through the body – fatigue, pain, insomnia, and pressure.A direct link between the psyche and the somatic system has been proven:Depression increases the risk of cardiovascular disease.Chronic stress – type 2 diabetes;Anxiety affects the heart, gastrointestinal tract, and immune system.In parallel, in people over 40, hormonal and neurotransmitter changes occur, sleep is disturbed, the burden of roles increases – work, children, parents, and there is less resource for recovery.Therefore, without an assessment of the mental state, health screening is incomplete.The "Health Screening 40+" program includes the following questionnaires:PHQ-9 is a patient health questionnaire for depression screening.GAD-7 is a test for assessing anxiety levels.FINDRISC (Finnish Diabetes Risk Score) is a Finnish scale for assessing the 10-year risk of developing type 2 diabetes. It is used as a simple screening tool for prediabetes and type 2 diabetes.CHADS₂ is a scale for assessing the risk of thromboembolic complications in patients with atrial fibrillation.AUDIT is a test for detecting alcohol use disorders.Stratification of overall cardiovascular risk – SCORE2 and SCORE2-OP scales.Tobacco Use Assessment Form.If you are not open and willing to cooperate with your doctor, the benefits of screening will be minimal, says Diana Ledney-Opalenyk."Screening is appropriate even for patients who have already been diagnosed with diabetes or cardiovascular disease; in this case, it will help monitor their health and check for other risks," adds Larysa Demchenko.If the patient wants an extended package, can they use the 2000 UAH as a partial payment?– No. The funds allocated under the program have a specific purpose and can only be used for services included in the national health screening for people aged 40+.However, if a patient, either at their own request or on the recommendation of a doctor, wishes to undergo additional examinations not included in the screening, they can do so at their own expense.The program is positioned as a quick check-up lasting 60–90 minutes. Is there a separate office or a "green corridor" for such patients?– Our network of clinics provides separate time slots for patients specifically for screening. This means that appointments are organized so that people don't have to stand in a general queue and can undergo the examination without rushing.Screening is performed by specially designated doctors on specific days, who work specifically with this program. This approach allows us to maintain the stated duration of the examination and make the process as comfortable as possible."The first visit is the most comprehensive and lasts approximately 60–90 minutes. During this time, the patient fills out standardized risk assessment questionnaires, undergoes a physical examination, and provides mandatory laboratory tests," explains the medical director.What patients most often "embellish" or keep silent about during a surveySleep: I sleep fine.Reality: 5–6 hours, late bedtimes, waking up in the middle of the night, phone in bed.Stress "Nothing special."Although in the background, there is a constant tension that is noticeable even in behavior.Alcohol: For the holidays / a glass of wineAnd the doctor hears: regularity, a way to relieve tension, increased tolerance.Meals: They're more or less fine.In reality: skipping meals, snacking on the go, coffee instead of breakfast.Physical activity: I am an active person.Although all the traffic is a road from the car to work.Well-being: "Just fatigue"In reality: exhaustion, apathy, irritability, a feeling that "nothing brings joy."Medicines and dietary supplements: "I don't use anything."...besides magnesium, sedatives, and painkillers "from time to time," and sometimes something for blood pressure or joints.What does the doctor actually pay attention to?1. Contradictions. When words don't match the body:"I sleep well" and at the same time, I have dark circles under my eyes."I'm not nervous," but the tense speech, clenched jaw, clenched fists, and stiff posture say otherwise.2. Regularity, not isolated episodes. It's not important that it "happened once," but how often symptoms appear: waking up at night, headaches, heart palpitations, irritability.3. Compensatory mechanisms. Coffee, sweets, alcohol, and working without breaks are not "habits," but attempts to hold on and survive, rather than to live a full life.4. Body language. Shoulders, breathing, speech tempo, gaze. The body almost never lies.5. Marker phrases. The doctor is alarmed by phrases like: "That's just my personality," "Everyone is like that now," "I'll rest later."What "all indicators are normal" really meansThis means only one thing: no abnormalities were detected at the time of the examination.Most chronic conditions develop over years without symptoms. Lifestyle, stress, sleep, and hormonal changes can alter the picture faster than you might think.What are the patient's next steps if the screening reveals an abnormality?Laboratory results are entered into the system within 72 hours, after which the doctor explains them in a "traffic light" format:Green – normal;yellow – limit values;Red – violations detected.Depending on the situation, several scenarios are possible, explains Larysa Demchenko:– The specialist can provide recommendations and refer the patient to their family doctor for further observation.Based on the indications, an electronic referral is issued to a specialist – a cardiologist, endocrinologist, psychiatrist, or psychotherapist.Within their competence, a doctor can immediately prescribe treatment and issue an electronic prescription for medications available under the "Affordable Medicines" program.How often should I repeat check-ups?Diana Ledney-Opalenyk explains:Basic preventive examination: Once a year is the golden rule for most adults, even if "nothing hurts."An important point that is rarely mentioned. People don't go to the doctor because they "don't take care of themselves," but because they've endured everything for too long.Prevention is not about finding diseases. This is about:timely minor adjustments;preserved resource;Life without "waiting until symptoms appear."So, good test results are not the end. They are a permit to live on, but with regular check-ups (after all, we regularly send our car to the service station, and don't operate it without doing so)."Screening is not an exam. And it's not a place where you have to look 'good.' Honest answers are not a weakness, but a way to ensure help is timely, not just 'when it's already broken.' Because in medicine, as in life, the problem is not that a person is struggling, but that they pretend to cope for too long," Diana Ledney-Opalenyk summarizes.Read alsoCheck-up after 40: how to avoid unnecessary expenses and stay healthy

The "Health Screening 40+" program: about the price of lies, "silent" disorders, and the "golden rule" for adults

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