Major Survey Shows Deficiency In Geriatric Care

In England, a large portion of the population is not receiving adequate
basic care from the National Health Service and private healthcare
systems, especially older and weaker people, according to a study
released on August 15, 2008 in BMJ. 



As the populations in developed countries such as England become
collectively older, health coverage issues for seniors and older adults
are becoming increasingly important. Geriatric conditions may be higher
in this population, which include falls, osteoarthritis, urinary
incontinence, vision problems (cataract), hearing problems, and
osteoporosis.



To understand the overall care of this older population, a research
team from the University of East Anglia examined the quality of care
given to 8,688 patients aged 50 or over with serious health conditions,
to investigate whether effective healthcare interventions were
received. Examination was conducted using a combination of
questionnaires,
interviews, and a set of quality of care indicators, used for both
public and private care as part of the English Longitudinal Study of
Aging (ELSA). This included specific examination of 13 different health
conditions including heart disease, diabetes, stroke,
depression and osteoarthritis.



Upon analysis, the authors concluded that only 62% of the recommended
care for older adults is actually received. That is, of 19,082
potential opportunities for care delivery, only 11,911 actually were
received by the patients. This varied drastically depending on health
conditions. for instance, 83% of patients with ischaemic heart disease
received the recommended care, a relatively high rating in contrast
with the 29% of osteoarthritis patients who received appropriate
treatment.



This attention rate was higher for screening and preventative care, at
80%, than for treatment and follow-up, with 64%, both of which were
higher than diagnostic care at 60%. Notably, some medical conditions
merit additional awards when addressed by general practitioners under
the current Quality and Outcomes Framework: these were generally better
attended. In 75% of applicable cases, correct treatment was
administered, but this was true for only 58% of conditions not covered
in this contract.



Disability and frailty related conditions were the least attended to in
this context. General medical conditions received substantially more
consistent
care, at 74%, while geriatric conditions only achieved 57% of the
recommended care. This is notable in the context that there are no
geriatric conditions included in the aforementioned framework contract.
According to the researchers, improvement will best be achieved through
initiatives to improve quality for chronic conditions that affect older
people. They suggest that restructured payment schemes for general
practitioners might be one effective approach to achieve this.



Professor Bruce Guthrie from the University of Dundee contributed an
accompanying editorial that focuses on the local interventions needed
for improvement of care.



Self reported receipt of care consistent with 32 quality
indicators: national population survey of adults aged 50 or more in
England

Nicholas Steel, Max Bachmann, Susan Maisey, Paul Shekelle, 
Elizabeth Breeze, Michael Marmot, David Melzer

BMJ 2008;337:a957

doi:10.1136/bmj.a957

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Written by Anna Sophia McKenney