Slicing the health service cake: the Islington study.
BACKGROUND
Little is known about the factors that are associated with receipt of care in older people. This study aims to describe the pattern and predictors of service usage, by a representative sample of people aged 65 and over.


METHODS
We assessed psychiatric and physical morbidity, formal and informal care and prescribed medication by standardized questionnaires.


RESULTS
1085 people were interviewed at home. Having dementia was a negative predictor of GP and hospital consultation (both P<0.001). Depressed participants were most likely to consult with GPs (P<0.05); 13.1% were on antidepressants. People with dementia use health services less than their counterparts. The presence of co-resident informal caregivers predicts less use of social services but no increase in health consultations.


CONCLUSIONS
Carers give compensatory care rather than act as bridges to link people with dementia with the health care system. People with dementia need advocates. Older people with depression are high users of all services. They remain under-treated pharmacologically.
Nelson
Tanya
T
Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, Archway campus, Holborn Union Building, Highgate Hill, London N19 5NF, UK. tnelson_uk@yahoo.com
Livingston
Gill
G
Knapp
Martin
M
Manela
Monica
M
Kitchen
Ginnette
G
Katona
Cornelius
C
D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D003153:Community Health Services / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003704:Dementia / Q000523:psychology; D003866:Depressive Disorder / Q000523:psychology; D005260:Female; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008131:London; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010344:Patient Advocacy / Q000523:psychology*; D011203:Poverty; D014505:Urban Population