Older persons are more frail after an emergency care visit to the out-of-hours General Practitioner Cooperative in the Netherlands: a cross sectional descriptive TOPICS-MDS study

Abstract

Background In the Netherlands community dwelling older people with primary care emergency problems contact the General Practitioner Cooperative (GPC) after hours. However, frailty remains often unobserved with the hazard of adverse health outcomes. The aim of this study was to provide insight in differences between older persons with or without GPC emergency care visits (reference group) regarding frailty and healthcare use.Methods A cross-sectional descriptive study design was based on data from the public data repository: The Older Persons and Informal Caregivers Survey Minimum Dataset (TOPICS-MDS). Frailty in older persons (65+ years, n=32,149) was measured by co-morbidity, functional and psychosocial aspects, quality of life and a frailty index. Furthermore, home care use and hospital admissions of older persons were identified. We performed multilevel logistic and linear regression analysis. A random intercept model was utilized to test differences between groups, and adjustment factors (confounders) were used in the multilevel analysis. Results Older persons with GPC contact were, compared to the reference group, more frail on the domain of co-morbidity (mean difference 0.52 ; 95% CI 0.47-0.57, p <0.0001), functional limitations (mean difference 0.53 ; 95% CI 0.46-0.60, p <0.0001), reported less emotional wellbeing (mean difference -4.10 ; 95% CI -4.59- -3.60, p <0.0001) and experienced less quality of life (mean difference -0.057 ; 95% CI -0.064- -0.050, p <0.0001). Moreover, older persons reported more often limited social function (OR 1.50, 95%CI 1.39-1.62, p <0.0001) and limited perceived health (OR 1.50, 95%CI 1.39-1.62, p <0.0001). Finally, older persons with GPC contact more often used home care (OR 1.37, 95%CI 1.28-1.47, p <0.0001) or were more often admitted to the hospital (OR 2.88, 95%CI 2.71-3.06, p <0.0001). Conclusions Older persons with out-of-hours GPC contact for an emergency care visit were significantly more frail on all domains, more likely to use home care or to be admitted to the hospital, compared to the reference group. Potentially frail older persons seem to require adequate identification of frailty, and support (e.g. advance care planning) before and after a contact with the out-of-hours GPC.