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Shift towards ‘intensive medicalisation’ of the elderly, shows study

Patients aged 85 and over are given a vastly increasing number of diagnoses and drug prescriptions, experts have shown.

In the first study of its kind, researchers pointed to a major shift towards ‘intensive medicalisation’ of the most elderly patients in the UK over the past decade, with over half now diagnosed with at least three different medical conditions and taking at least three long-term medications.

The researchers from the University of Exeter Medical School’s department of Epidemiology and Public Health said they could not prove whether this increase had caused net harm or benefit but said the findings provided ‘new urgency’ to question whether it is appropriate.

Drawing on data covering 27,109 patients in the Clinical Practice Research Datalink over the past 10 years, the researchers found 55% of over-85s now have three diagnoses compared to just 32% in 2003/04 – a rise of 72%. Meanwhile 66% were now taking at least three long-term medications, up from 45% 10 years prior.

Chronic kidney disease saw the largest jump in prevalence over the study period, likely triggered by the introduction of the QOF CKD register in 2006 and changes to NHS diagnostic guidelines in 2008, the researchers said. At the same time, prevalence of stages 3-5 CKD rose from less than 1% in 2003/04 to 36.4% in 2011/12, the study found.’

However diagnoses of diabetes, osteoporosis, osteoarthritis and hypertension have also surged, suggesting QOF is not the only factor, researchers said. The study, published earlier this month (7 August) in the journal Age and Ageing, also found that 35% of over-85s are now hospitalised at least once a year, up from 28% in 2003/04.

The researchers warned that these trends have emerged despite a lack of clinical trials in the age group and amid an array of ‘contradictory and unworkable guidelines’ and said that especially the CKD findings ‘raised concerns about overdiagnosis’.

Their report said: ‘Evidence-based guidelines frequently prove contradictory and unworkable in the oldest old. Perhaps because of these complexities, there have been claims of both underdiagnosis and overdiagnosis in this group… Trends especially in recorded CKD may raise concerns about overdiagnosis.’

The study concluded: ‘These findings provide new urgency to question the appropriateness of multiple diagnostic labelling and the limited evidence of risks and benefits of multiple disease-specific interventions, especially for those of advanced age and with complex needs.’

It comes as the RCGP this month launched an enquiry into harms of overdiagnosis and overtreatment in a bid to bring about more useful guidelines for GPs in the management of patients with multiple conditions. GP leaders debating at the Pulse Live conference earlier this year said that the GP contract, and especially the new ‘named clinician’ directive and unplanned admissions DES, lead to both overdiagnosing and overtreatment of elderly patients.