Scripties UMCG - Rijksuniversiteit Groningen
English | Nederlands

Het effect van de toename van kwetsbaarheid bij ouderen op het zorggebruik in de huisartsgeneeskunde

(2010) Elshof, M.H.A.

Introduction: In the Netherlands, aging and longer life expectancy lead to an increase in the number of elderly (persons aged 65 and older) with co-morbidity, cognitive and psychosocial problems and disabilities. Elderly persons afflicted with these multiple problems are defined as frail. Because of the increasing number of frail elderly, the demand for general medical care is on the rise. This will in turn put pressure on GP healthcare, possibly leading to higher costs, an increased workload for general practitioners and capacity problems in general practices. An unfortunate consequence of all this may be a decrease in the quality of care available for frail elderly. Therefore it is important to examine the effects of an increase in frailty among elderly people, on GP health care utilization.
Material and method: We used three stratified samples (N=180) to select patients from general practices in the north of the Netherlands. Frailty was measured by the general practitioner, using the Clinical Frailty Scale (CFS), a validated instrument consisting of 7 items. Patients who met the inclusion criteria received an invitation to participate in the study. The frailty of the positive responders (N=86) was measured again, with the Groningen Frailty Indicator (GFI) during an interview at the patient’s home. The care utilization of the enrolled patients in 2009 was measured by using a General Practitioner Information System. A (multivariate) Generalized Linear Model is used to analyze the relations between frequencies of the care consumption and the rate of frailty, and is expressed in Rate Ratio’s (RR’s).
Results: Out of 180 selected patients, 28 patients (15.6%) were excluded and 66 patients (43,4%) declined participation. Of the 86 participating patients (56,6%), 34,9 % were frail according to the GFI (GFI score ≥4). Nearly three-quarters of these frail patients, scored relatively high on the psychosocial domain. Both the GFI score and the CFS score were significantly higher in patients aged 80 years and older (p<0,05). An increase of the GFI score, leads to an increase in health care utilization among the elderly. In this relation, age, is a confounding factor. An increased CFS score, does not lead to an increase in GP health care utilization by the elderly.
Conclusion: The study shows that an increase of frailty, measured by the GFI, leads to an increase in GP health care utilization by the elderly. With the growing number of frail elderly in the Netherlands, pressure on primary health care will also intensify. Therefore we need to start with consistent care to prevent the quality of care for frail elderly from suffering under this growing pressure. Hence, general practitioners should use the GFI, despite the fact that measurements by this test are time consuming. With the degree of frailty as a starting-point, appropriate care for the elderly can be delivered in time and the unnecessary burden of disease can be prevented. Future studies, with larger study populations, should be conducted in order to investigate whether frail elderly are receiving the care they really need.

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