Medical characteristics of the oldest old: retrospective chart review of patients aged 85+ in an academic primary care centre

Abstract

BackgroundThe population aged 85 + − the “oldest old” – is now the fastest growing age segment in Canada. Although existing research demonstrates high health services utilization and medication burden in this population, little clinically derived evidence is available to guide care. This is a descriptive study in a primary care context seeking to describe the most common health conditions and medications used in the “oldest old”.MethodsWe conducted a retrospective chart review of all family practice patients aged 85+ (N = 564; 209 males, 355 females) at Sunnybrook Health Sciences Centre in Toronto, Canada. Electronic medical records were reviewed for all current chronic conditions and medication prescriptions, and then stratified by sex and age subgroup (85–89, 90–94, 95+) for descriptive analysis.ResultsOn average, patients experienced 6.4 concurrent chronic conditions and took 6.8 medications. Most conditions were related to cardiovascular (79%) and bone health (65%). Hypertension (65%) was the most common condition. Bone-related conditions (e.g. osteoarthritis, osteoporosis) and hypothyroidism predominantly affected women, while coronary artery disease and type 2 diabetes were more prevalent in men. The top two prescribed medications were atorvastatin (33%) and aspirin 81 mg (33%). Males were more likely to be prescribed lipid-lowering medications, while females were more likely to receive osteoporosis therapy. Patients received less lipid-lowering therapy with increasing age.ConclusionsMultimorbidity and polypharmacy are highly prevalent in patients in the 85+ age group. The most common clinical conditions are related to cardiovascular and bone health, and the most commonly prescribed medications are directed towards risk factors for these illnesses. In the absence of data to guide clinical decision-making, this study provides a first look at the common health concerns and medication profiles in this population and reveals trends that give rise to reflections on how clinical care for these patients can be improved.

Prescribing in the oldest old inpatients: a retrospective analysis of patients referred for specialist geriatric consultation

“…The median number of co‐morbidities was 7–8 in this cohort of inpatients, which is comparable to a Canadian study of 564 primary care patients among whom those in the 85+ age group experienced, on average, 6.4 concurrent chronic conditions . The patients in this study were also frail, with an FI between 0.45 and 0.47.…”

“…19 The median number of co-morbidities was 7-8 in this cohort of inpatients, which is comparable to a Canadian study of 564 primary care patients among whom those in the 85+ age group experienced, on average, 6.4 concurrent chronic conditions. 20 The patients in this study were also frail, with an FI between 0.45 and 0.47. When the FI is contextualised against clinical descriptors, the Clinical Frailty Scale, this value denotes a group of frail patients who are completely dependent on others for ADL, or are terminally ill. 21 Also, though the majority were admitted from the community, the median length of stay of nearly a month and almost a third requiring discharge for the first time to an RACF reflect the inherent frailty of this population, which did not vary in its magnitude across the age groups.…”

“…In this cohort, as age increased, the rate of prescribing of insulin, oral hypoglycaemics, propulsives, statins and warfarin decreased. Other studies have noted less frequent prescribing of lipid lowering therapy and hypoglycaemic agents and of warfarin with increasing age. One explanation is prescriber recognition of the increased risk of harm, such as hypoglycaemia or bleeding related to traumatic falls, and little evidence of benefit, resulting from the use of these medications in the oldest old patients.…”

Polypharmacy as a risk factor for hospital admission among ambulance‐transported old‐old patients

“…reported the clinical characteristics of old‐old patients in Canada and showed that these patients received a mean number of 6.8 medications per day. They suggested that multimorbidity and polypharmacy were highly prevalent in old‐old adults . Hohl et al .…”

Hipertensão arterial e osteoporose no processo do envelhecimento: uma revisão de literatura

“…A hipertensão arterial é uma doença multifatorial que pode acarretar graves consequências para o indivíduo, sendo considerada como a causa mais frequente de morbimortalidade nos idosos (OLIVEIRA; MOREIRA, 2010). Tsoi et al (2014) observou, em uma revisão de prontuários médicos realizada no Canadá com pacientes com 85 anos de idade ou mais, que a hipertensão (65%) foi a segunda DCNT mais prevalente na população em estudo, atrás apenas das doenças cardiovasculares (79%).…”