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Frequent attendance in primary care in the oldest old: evidence from the AgeCoDe-AgeQualiDe study

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Abstract

Background

There are very few studies examining the determinants of frequent attendance in primary care among the oldest old.

Aims

The purpose of this study was to determine the characteristics of frequent attendance among individuals aged 85 years or older.

Methods

Cross-sectional data stem from the multicenter prospective cohort “Study on needs, health service use, costs and health-related quality of life in a large sample of oldest old primary care patients (85 +)” (AgeQualiDe). This study covers very old primary care patients (n = 861, mean age of 89.0 years ± 2.9; 85–100 years). The number of self-reported GP visits in the preceding 3 months was used to quantify frequent attenders. We defined patients in the top decile as frequent attenders.

Results

Multiple logistic regressions showed that frequent attendance was associated with more chronic diseases (adjusted OR 1.12, 95% CI 1.01–1.23), worse functioning (OR 0.97, 95% CI 0.95–0.99), worries about one’s financial situation (OR 2.20, 95% CI 1.07–4.53) and it was inversely associated with depression (OR 0.26, 95% CI 0.08–0.80).

Discussion

In contrast to studies based on younger samples, different factors were associated with frequent users in our study, showing that it is important to study the determinants of frequent attendance among the oldest old.

Conclusion

In Germany, among the group of the oldest old, frequent attendance was positively associated with worse physical health status (e.g., number of chronic diseases), but negatively with depression. This might indicate that the German health care system is responsive to the physical, but not psychological needs of the oldest old.

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Acknowledgements

We want to thank both all participating patients and their general practitioners for their good collaboration. Members of the AgeCoDe & AgeQualiDe Study Group: Wolfgang Maier (Principal Investigator), Martin Scherer (Principal Investigator), Steffi G. Riedel-Heller (Principal Investigator), Heinz-Harald Abholz, Christian Brettschneider, Cadja Bachmann, Horst Bickel, Wolfgang Blank, Sandra Eifflaender-Gorfer, Marion Eisele, Annette Ernst, Angela Fuchs, André Hajek, Kathrin Heser, Frank Jessen, Hanna Kaduszkiewicz, Teresa Kaufeler, Mirjam Köhler, Hans-Helmut König, Alexander Koppara, Diana Lubisch, Tobias Luck, Dagmar Lühmann, Melanie Luppa, Tina Mallon, Manfred Mayer, Edelgard Mösch, Michael Pentzek, Jana Prokein, Alfredo Ramirez, Susanne Roehr, Anna Schumacher, Janine Stein, Susanne Steinmann, Franziska Tebarth, Hendrik van den Bussche (Principal Investigator 2002–2011), Carolin van der Leeden, Michael Wagner, Klaus Weckbecker, Dagmar Weeg, Jochen Werle, Siegfried Weyerer, Birgitt Wiese, Steffen Wolfsgruber, Thomas Zimmermann.

Funding

This publication is part of the German Research Network on Dementia (KND), the German Research Network on Degenerative Dementia (KNDD; German Study on Ageing, Cognition and Dementia in Primary Care Patients; AgeCoDe), and the Health Service Research Initiative (Study on Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85 + ; AgeQualiDe)) and was funded by the German Federal Ministry of Education and Research (Grants KND: 01GI0102, 01GI0420, 01GI0422, 01GI0423, 01GI0429, 01GI0431, 01GI0433, 01GI0434; Grants KNDD: 01GI0710, 01GI0711, 01GI0712, 01GI0713, 01GI0714, 01GI0715, 01GI0716; Grants Health Service Research Initiative: 01GY1322A, 01GY1322B, 01GY1322C, 01GY1322D, 01GY1322E, 01GY1322F, 01GY1322G). The publication was also supported by the study “Healthy Aging: Gender specific trajectories into latest life” (AgeDifferent.De) that was funded by the German Federal Ministry of Education and Research (Grants 01GL1714A; 01GL1714B; 01GL1714C; 01GL1714D).

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Author notes

  1. Elżbieta Buczak-Stec and André Hajek contributed equally.

  2. Martin Scherer and Hans-Helmut König contributed equally.

Authors and Affiliations

  1. Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    Elżbieta Buczak-Stec, André Hajek & Hans-Helmut König

  2. Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany

    Hendrik van den Bussche, Marion Eisele & Martin Scherer

  3. Institute of General Practice, Hannover Medical School, Hannover, Germany

    Birgitt Wiese & Silke Mamone

  4. Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany

    Siegfried Weyerer & Jochen Werle

  5. Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany

    Angela Fuchs & Michael Pentzek

  6. Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany

    Susanne Röhr, Franziska Welzel & Steffi G. Riedel-Heller

  7. Department of Psychiatry, Technical University of Munich, Munich, Germany

    Dagmar Weeg & Edelgard Mösch

  8. Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany

    Kathrin Heser, Michael Wagner & Wolfgang Maier

  9. German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany

    Michael Wagner & Wolfgang Maier

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  1. Elżbieta Buczak-Stec
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Corresponding author

Correspondence to Elżbieta Buczak-Stec.

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Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of all research centers involved (approval numbers: Hamburg: OB/08/02, 2817/2007, MC-390/13; Bonn: 050/02; 174/02, 258/07, 369/13;Mannheim: 0226.4/2002, 2007-253E-MA, 2013-662 N-MA; Leipzig: 143/2002, 309/2007, 333-1318112013; Düsseldorf: 2079/2002,2999/2008, 2999; München: 713/02, 713/02 E) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Ethical approval

The ethics committees of all six study centers have approved the study. The study was conducted according to the principles expressed in the Declaration of Helsinki.

Informed consent

Informed consent was obtained from all individual participants included in the study. The procedures followed were in accordance with the ethical standards of the responsible committees.

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Buczak-Stec, E., Hajek, A., van den Bussche, H. et al. Frequent attendance in primary care in the oldest old: evidence from the AgeCoDe-AgeQualiDe study. Aging Clin Exp Res 32, 2629–2638 (2020). https://doi.org/10.1007/s40520-020-01495-2

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