title: Slicing the health service cake: the Islington study.
abstract: 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.
authors.affiliation: 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
authors.forename: Tanya
authors.initials: T
authors.lastname: Nelson
authors.forename: Gill
authors.initials: G
authors.lastname: Livingston
authors.forename: Martin
authors.initials: M
authors.lastname: Knapp
authors.forename: Monica
authors.initials: M
authors.lastname: Manela
authors.forename: Ginnette
authors.initials: G
authors.lastname: Kitchen
authors.forename: Cornelius
authors.initials: C
authors.lastname: Katona
mesh_terms: 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