Use of primary care and other healthcare services between age 85 and 90 years: longitudinal analysis of a single-year birth cohort, the Newcastle 85+ study (original) (raw)
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The journal of nutrition, health & aging, 2018
Objectives: The aim of this study was to identify determinants of outpatient health care utilization among the oldest old in Germany longitudinally. Design: Multicenter prospective cohort "Study on Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)" (AgeQualiDe). Setting: Individuals in very old age were recruited via GP offices at six study centers in Germany. The course of outpatient health care was observed over 10 months (two waves). Participants: Primary care patients aged 85 years and over (at baseline: n=861, with mean age of 89.0 years±2.9 years; 85-100 years). Measurements: Self-reported numbers of outpatient visits to general practitioners (GP) and specialists in the past three months were used as dependent variables. Widely used scales were used to quantify explanatory variables (e.g., Geriatric Depression Scale, Instrumental Activities of Daily Living Scale, or Global Deterioration Scale). Results: Fixed effects regressions showed that increases in GP visits were associated with increases in cognitive impairment, whereas they were not associated with changes in marital status, functional decline, increasing number of chronic conditions, increasing age, and changes in social network. Increases in specialist visits were not associated with changes in the explanatory variables. Conclusion: Our findings underline the importance of cognitive impairment for GP visits. Creating strategies to postpone cognitive decline might be beneficial for the health care system.
Health and disease in 85 year olds: baseline findings from the Newcastle 85+ cohort study
BMJ, 2010
Objectives The Newcastle 85+ Study aims to systematically study the clinical, biological, and psychosocial attributes of an unselected cohort of 85 year olds and to examine subsequent health trajectories as the cohort ages; health at baseline is reported. Design Cross sectional analysis of baseline data from a cohort study. Setting Newcastle upon Tyne and North Tyneside primary care trusts, United Kingdom. Participants 1042 people born in 1921 and registered with the participating general practices. Main outcome measures Detailed health assessment and review of general practice records (disease, medication, and use of general practice services); participants could decline elements of the protocol. Results Of the 1453 eligible people, 851 (58.6%) were recruited to health assessment plus record review, 188 (12.9%) to record review only, and 3 (0.2%) to health assessment only. Data from record review are reported on a maximum of 1030 and from health assessment on a maximum of 853; individual denominators differ owing to withdrawal and missing values. Of the health assessment sample (n=853), 62.1% (n=530) were women and 10.4% (n=89) were in institutional care. The most prevalent diseases were hypertension (57.5%, 592/1030) and osteoarthritis (51.8%, 534/1030). Moderate or severe cognitive impairment was present in 11.7% (96/824) of participants, severe or profound urinary incontinence in 21.3% (173/813), hearing impairment in 59.6% (505/ 848), and visual impairment in 37.2% (309/831). Health assessment identified participants with possible disease but without a previous diagnosis in their medical record for hypertension (25.1%, 206/821), ischaemic heart disease (12.6%, 99/788), depression (6.9%, 53/772), dementia (6.7%, 56/840), and atrial fibrillation (3.8%, 30/788). Undiagnosed diabetes mellitus and thyroid disease were rare (1%, 7/717 and 6/762, respectively). A median of 3 (interquartile range 1-8) activities of daily living were undertaken with difficulty. Overall, 77.6% (646/832) of participants rated their health compared with others of the same age as good, very good, or excellent. High contact rates in the previous year with general practitioners (93.8%, 960/1024) were recorded. Women had significantly higher disease counts (medians: women 5, men 4; P=0.033) and disability scores (medians: women 4, men 2; P=0.0006) than men, but were less likely to have attended outpatient clinics in the previous three months (women 29% (150/524), men 37% (118/320), odds ratio 0.7, 95% confidence interval 0.5 to 0.9). Conclusions This large cohort of 85 year olds showed good levels of both self rated health and functional ability despite significant levels of disease and impairment. Hypertension, ischaemic heart disease, atrial fibrillation, depression, and dementia may be underdiagnosed. Notable differences were found between the sexes: women outnumbered men and had more disease and disability.
Factors associated with the frequency of medical consultations by older adults: a national study
Revista da Escola de Enfermagem da USP, 2020
Objective: To analyze factors associated with the high frequency of medical consultations (five or more consultations) among older adult participants of the National Health Survey - 2013. Method: A quantitative cross-sectional study conducted with data from individuals aged 60 years and over (n = 19,503). The outcome variable came from the question: ‘How many times have you consulted the doctor in the last 12 months? Fifty-seven (57) independent variables were listed. The Waikato Environment for Knowledge Analysis software program was used in the analysis. The data set was balanced and the dimensionality reduction test was performed. The variables which were strongly related to the dependent variable were analyzed using logistic regression. Results: The independent variables listed were strongly related to the outcome variables: female gender, negative self-perception of health condition, inability to perform usual activities for health reasons, diagnosis of chronic disease, seeking...
Annual visits to patients over the age of 75— who is missed?
Family Practice, 1996
Annual visits to patients over the age of 75-who is missed? Family Practice 1996; 13: 22-27. Background. In the UK, the GP contract requires annual consultations and offers of home visits to the elderly. However, as many as 50% of elderly people refuse the offer of a health screen. Objective. To describe the characteristics of elderly people who declined the offer of an annual home visit. Method. All elderly people aged 75 years and over, registered with a general practice of 13 full time and 3 part time doctors with a list size of 33,000 people, were offered a home visit. Data from this prospective cohort were linked with data from a community survey two years previously, which had achieved a 95% response rate. The main outcome measures were perceived health status, perceived loneliness, morale score, physical and mental disability, use of primary care and social services. Results. Thirty-six percent of all elderly people registered with the practice declined to take up the offer of a home visit. Those refusing a visit had not recently joined the practice and had very similar distributions of all demographic and most health and wellbeing characteristics to those who took up the offer. However, those declining appeared to have higher levels of morale {P = 0.010) and less contact with the general practitioner (P = 0.021) including an average of three weeks longer since last consultation with their general practitioner than those accepting the visit.
General practice encounters with older Australians
Australasian Journal on Ageing, 2004
To describe the content of general practitioners' (GP) encounters with patients aged 65 years or more, and to determine any differences in the way problems are managed between the 65 -74 and 75 years and over age groups. Method: A secondary analysis of data collected through the Bettering the Evaluation and Care of Health (BEACH) program was carried out. Results: Encounters with older patients accounted for 25.0% of a GP's total workload. Circulatory conditions, in particular hypertension, were the most frequently managed, with cardiovascular medications the most frequently prescribed.
BMJ, 2008
Objective To assess the receipt of effective healthcare interventions in England by adults aged 50 or more with serious health conditions. Design National structured survey questionnaire with face to face interviews covering medical panel endorsed quality of care indicators for both publicly and privately provided care. Setting Private households across England. Participants 8688 participants in the English longitudinal study of ageing, of whom 4417 reported diagnoses of one or more of 13 conditions. Main outcome measures Percentage of indicated interventions received by eligible participants for 32 clinical indicators and seven questions on patient centred care, and aggregate scores. Results Participants were eligible for 19 082 items of indicated care. Receipt of indicated care varied substantially by condition. The percentage of indicated care received by eligible participants was highest for ischaemic heart disease (83%, 95% confidence interval 80% to 86%), followed by hearing problems (79%, 77% to 81%), pain management (78%, 73% to 83%), diabetes (74%, 72% to 76%), smoking cessation (74%, 71% to 76%), hypertension (72%, 69% to 76%), stroke (65%, 54% to 76%), depression (64%, 57% to 70%), patient centred care (58%, 57% to 60%), poor vision (58%, 54% to 63%), osteoporosis (53%, 49% to 57%), urinary incontinence (51%, 47% to 54%), falls management (44%, 37% to 51%), osteoarthritis (29%, 26% to 32%), and overall (62%, 62% to 63%). Substantially more indicated care was received for general medical (74%, 73% to 76%) than for geriatric conditions (57%, 55% to 58%), and for conditions included in the general practice pay for performance contract (75%, 73% to 76%) than excluded from it (58%, 56% to 59%). Conclusions Shortfalls in receipt of basic recommended care by adults aged 50 or more with common health conditions in England were most noticeable in areas associated with disability and frailty, but few areas were exempt. Efforts to improve care have substantial scope to achieve better health outcomes and particularly need to include chronic conditions that affect quality of life of older people.
2019
Context. Various ways to improve the practice and organisation of primary care are being explored in response to ageing populations, but it remains unclear why attempts have been largely unsuccessful in demonstrating benefits to older people's health outcomes. Aim. To investigate the influence of GP and practice characteristics on hospitalisations, functional ability, and quality of life of older people in New Zealand and the Netherlands Methods. This is a secondary analysis of data from two primary care-based cluster randomised controlled trials: n=3,755 participants aged 75+ in 60 practices in New Zealand; n=3,141 participants aged 75+ in 59 practices in the Netherlands. Multilevel models of hospitalisation rates, functional ability, and QOL were separately fitted for each sample, and differences were examined according to GP and practice characteristics with adjustment for participants' characteristics. For the New Zealand sample, 36-month outcomes modelled were unplanned admission rates; Nottingham Extended Activities of Daily Living (NEADL, range 0-22); and QOL domain ratings from the WHOQOL-BREF (range 0-100). For the Dutch sample, 12-month outcomes modelled were unplanned admission rates, Groningen Activity Restriction Scale (GARS, range 18-72), and EQ-5D summary index (Dutch tariff range-0.38-1.00). Results. Significant differences in rates of unplanned admissions were not observed in New Zealand practices, but participants seen by female GPs had lower admission rates when the analysis was restricted to ambulatory sensitive hospitalisations (IRR 0.83, CI 0.71 to 0.98). Differences in function and QOL according to GP and practice characteristics were consistently small (ranging from-0.26 to 0.19 points for NEADL scores and-1.64 to 0.97 points for QOL domain ratings). In the Dutch sample, unplanned admission rates were higher in larger practices (IRR 1.45, CI 1.15-1.81) and those staffed with a practice nurse (IRR 1.74, CI 1.20-2.52), and participants seen by older, more iii experienced Dutch GPs reported slightly poorer QOL on follow-up (0.01 points lower EQ-5D scores). Conclusion. The findings challenge the expectation that primary care interventions focused on professional and organisational factors will reduce rates of unplanned hospitalisations or substantially influence older people's health outcomes in different country contexts. To the participating patients, GPs, and practices, and the original research teams of the BRIGHT trial and ISCOPE study, thank you for making this project possible. vi
Comorbidity and the Use of Primary Care and Specialist Care in the Elderly
The Annals of Family Medicine, 2005
PURPOSE The impact of comorbidity on use of primary care and specialty services is poorly understood. The purpose of this study was to determine the relationship between morbidity burden, comorbid conditions, and use of primary care and specialist services METHODS The study population was a 5% random sample of Medicare beneficiaries, taken from 1999 Medicare fi les. We analyzed the number of ambulatory face-to-face patient visits to primary care physicians and specialists for each diagnosis, with each one fi rst considered as the "main" one and then as a comorbid diagnosis to another. Each patient was categorized by extent of total morbidity burden using the Johns Hopkins Adjusted Clinical Group case-mix system.