A Newcastle University study has shown that people over the age of 85 are more likely to consult their GP for their medical needs. By the age of 90, most primary care consultations are with a GP.

The findings, published in BMJ Open, indicate that it is essential current and future GPs are appropriately skilled, and supported by specialist geriatric colleagues, to improve patient outcomes and help primary care services cope with this workload.

Growing concern

Experts say these findings add weight to growing concerns that the NHS primary care system will struggle to meet the medical needs of a rapidly ageing population, particularly as the number of family doctors fall. 

Louise Robinson, Director of Newcastle University’s Institute for Ageing, and Regius Professor of Ageing, led the Newcastle 85+ study into this research area.

She said: “Our society is rapidly ageing. The fastest growing sector of our population is the very old and there is increasing concern about the impact this will have on the NHS.

“Our study has looked specifically at healthcare by the very old, those aged over 85. It showed that the majority of their care falls on GP not hospital services.

“This is particularly worrying as this group requires a complexity of care which GPs may not be trained in at a time when the NHS is under increasing strain.  

“It is essential that current and future GPs are appropriately skilled, and adequately supported by specialist colleagues, as the main healthcare provider for a rapidly ageing society with complex and challenging needs.”

Newcastle 85+ study

The Newcastle 85+ study  is the first of its kind to successfully recruit and retain a large cohort of people aged 85 years and over. Participants were sourced from GP registers in Newcastle and North Tyneside.

The study was set up by Newcastle University in 2006 and has opened up a wealth of knowledge about the complex factors contributing to health in old age. A number of research projects have used the study for their findings.

Between 2015 and 2035, the older population of England and Wales – people aged 65 years and over – is expected to increase by 48%, whereas numbers aged 85 years and older will rise by 113%.

Findings of the study show that multimorbility (two or more chronic medical conditions) is the norm, yet the majority remain able to live independently although with family support.

Between the ages of 85 and 90 years, the mean number of all consultations increased significantly by 2.9 extra consultations per patient and the mean number of GP consultations went up by 1.6.

There was an increase in primary care consultations of 0.8 between ages 85 and 88, of which the majority were with the GP.  

In contrast, no significant changes were found for those aged 85+ in the use of secondary care services, including A&E and outpatient clinics.

The study also suggests the provision of teaching geriatric care in the medical undergraduate curricula should be urgently reviewed to ensure the NHS is adequately prepared to deal with demands of an ageing population.        

Professor Robinson said: “The resulting larger proportion experiencing multimorbidity, cognitive decline and frailty will place considerable pressures on health and social care provision.

“Better access to geriatric expertise, through community-based multidisciplinary assessment teams, may in future be beneficial to both patients and our primary gatekeeper healthcare services by providing easier availability to specialist knowledge and support.”

Increased workload

Recent research, looking at more than 100 million primary care consultations for all age groups between 2007 and 2014, found GP workload rose by more than 16% compared with over 1% for practice nurses. Consultation rates were among the highest for the very old.

In England, an average GP consultation is 10 minutes, but for people aged 85 and over, where there are high rates of sensory impairment and multimorbility is the norm, such consultations may be longer and more complex.

Further research is required to explore how best to configure services to address the healthcare needs of older people while maintaining quality of care.

This research was carried out with support from the NIHR School for Primary Care Research, as well as the NIHR Newcastle Biomedical Research Centre, awarded to the Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University.

Reference

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

Mohammad Esmaeil Yadegarfar, Carol Jagger, Rachel Duncan, Tony Fouweather, Barbara Hanratty, Stuart Parker, Louise Robinson

BMJ Open. DOI: 10.1136/bmjopen-2017-019218