Primary Care Variation in Rates of Unplanned Hospitalizations, Functional Ability, and Quality of Life of Older People

Predictors of independence in older people: A longitudinal, population-based study using the CARE75 + cohort

BACKGROUND

The ability to predict older people's functional independence has implications for the development and provision of services to improve individual sense of self and wellbeing.

METHODS

Using linear regression analyses we identified predictors of independence, measured using the Nottingham Extended Activities of Daily Living (NEADL) scale, at 12 and 24-months from baseline. Data were obtained from 1277 community-dwelling people aged ≥ 75. Multivariable models included predictors that were selected through review of existing literature, perspectives of older people, and univariable analyses. Multiple imputation was used to account for missing data.

RESULTS

Participants' mean age was 84.61 years (SD 4.95) and just over half were female (n = 655, 51.29%). At baseline, participants had a mean NEADL score of 53.82 (SD 13.19). Younger age, fewer hours of informal help received, no registered visual impairment, lower frailty, living alone, higher cognitive function, greater physical function, absence of depression, and higher baseline NEADL were significant predictors of greater independence at 12-months. Younger age, higher baseline NEADL score, living alone, less frailty, higher cognitive function, alcohol consumption, greater physical function, and absence of depression predicted greater independence at 24-months.

CONCLUSION

Depression and frailty are important predictors of an older person's independence with other variables such as activities of daily living, age, cognitive function, alcohol consumption, and living status also having an impact over a prolonged period. Refining understanding of the mechanisms within frailty and depression is likely to improve targeting of support and interventions, which will have a lasting impact on older people's independence.

Associations of primary care workforce composition with population, professional and system outcomes: retrospective cross-sectional analysis

Background: Diversification of types of staff delivering primary care may affect professional, population and system outcomes. Aim: To estimate associations between workforce composition and outcomes. Design and Setting: Cross-sectional analysis of 6210 GP practices in England in 2019. Method: Multivariable regression analysis relating numbers of staff in four groups (GPs; Nurses; Health Professionals; and Health Associate Professionals) to patient access and satisfaction, quality of clinical care and prescribing, use of hospital services, GP working conditions, and costs to National Health Service. Results: More GPs were associated with higher satisfaction for patients and GPs, More workers of other types had opposite associations with these outcomes. More Nurses and Health Associate Professionals were associated with lower cost per prescription but more prescribing activity. More GPs were associated with higher costs per prescription and lower use of narrow-spectrum antibiotics. Except for Health Associate Professionals, more staff were associated with more hospital activity. Higher NHS costs were associated most with more Nurses and least with more Health Professionals. The effects of different staff types on outcomes were largely independent. Conclusion: Professional, population and system outcomes show a variety of associations with primary care workforce composition. More Nurses are associated with lower quality in some aspects and higher costs and activity. More Health Professionals and Health Associate Professionals associates less than additional GPs with higher costs, but is associated with lower patient and GP satisfaction.