The Newcastle 85+ study: health care use by the very old increase as they age - true or false?

Problem

The fastest growing sector of our population is the very old, those aged 85 years and over. This group can show good levels of self-rated health and functional ability, but have considerable disease burden with multi-morbidity the norm. With increasing age comes greater risk of cognitive decline and physical frailty and thus risk of admission to hospital and long term care. One could hypothesise that an ageing population, with increasing multimorbidity, cognitive decline and frailty, will place considerable demands on GP and community services. Using data from the Newcastle 85+ study, we aim to describe how GP services and other health care use by 85 year olds changes as they age further.

Approach

The Newcastle 85+ Study is a prospective observational study of 1921 birth cohort who turned 85 during 2006; recruitment was via GP lists in Newcastle upon Tyne and North Tyneside. Contact was established with 97% (n=1409/1459) of eligible 85 year olds; 74% (n=1042/1409) agreed to take part. Consent was obtained from 851 to undergo detailed multidimensional health assessment (MHA) and a general practice medical records review (MRR); 3 consented to MHA only; 188 consented to MRR only and 358 declined all participation. Health and social care use was recorded for the 12 months prior to their MDHA interview, at baseline, 36 and 60 months. Information gathered included 14 different types of professional seen; due to small numbers some categories were combined. All consultation types were analysed in the overall sample and also participants who took part at all 3 time points. To compare health care use (consultations) over time we used negative binomial regression to account for overdispersion with models fitted for consultations for each professional (and the broad groups) separately and adjusted for sex. Analyses were undertaken in Stata 12.0.

Findings

A total of 845 participants had complete data at baseline (319 male, 526 female), with 485 (176 male, 309 female) included at 36 months and 344 (118 male, 226 female) at 60 months. There was a significant increase in the mean number of all consultations over the five years regardless of whether all participants of those surviving five years were included (both p<0.001).’ Mean number of consultations with the GP also increased significantly but those with the GP out of hours service, practice nurse and district nurse significantly reduced, particularly between 36 and 60 months. Significant increases were also observed in hospital inpatient and A&E use over time.

Consequences

Although our study confirms increasing GP consultations as the cohort of over 85s age, it also reveals interesting data about their use of other healthcare services. Additional data will be provided and the implications for future primary and community care service provision discussed.