Identifying unmet needs in older patients--nurse-GP collaboration in general practice.
BACKGROUND
Australia's rapidly aging population has a high prevalence of chronic disease and disability, leading to an increased social and economic burden. The Enhanced Primary Care program seeks to reduce this burden by promoting preventive and coordinated care. This study aimed to identify unmet needs in community dwelling general practice patients aged 75 years and over through annual health assessments performed by a general practitioner-nurse team.


METHODS
Community dwelling patients of a large suburban general practice aged 75 years and over were invited to participate. Five hundred and forty-six consecutive, eligible patients were recruited. Data were collected by GP-nurse teams on physical and psychosocial variables using a combination of physical examination, self reporting, and rating scales.


RESULTS
Fifty percent of the women and 25% of the men lived alone. Over 90% of participants reported one or more health problems, with musculoskeletal issues being most common. Men rated their health more poorly than women. Incontinence affected one-third of patients, mainly women. Women reported more psychological distress. There were age and gender differences in activities of daily living (ADL). Mobility, ADL, visual impairment, bowel problems, use of sleep medications and psychological wellbeing were strongly associated to self reported health.


CONCLUSIONS
Health assessments were effective in identifying significant physical and psychosocial problems in older adults. The importance of such assessments is underscored by strong associations between various domains and perceived general health. Collaboration between a GP and a practice based community nurse represents a potential solution to identifying (and responding to) unmet physical and psychosocial needs to improve quality of life in community dwelling older adults.
Williams
Ian D
ID
MBBS, FRACGP, is Senior Lecturer, Discipline of General Practice, University of Queensland.
O'Doherty
Lorna J
LJ
Mitchell
Geoffrey K
GK
Williams
Karen E
KE
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D002908:Chronic Disease; D003299:Cooperative Behavior; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D015577:Geriatric Assessment; D005851:Geriatric Nursing / Q000458:organization & administration*; D006304:Health Status; D006801:Humans; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration*; D019555:Physician-Nurse Relations; D010865:Pilot Projects; D011320:Primary Health Care / Q000458:organization & administration*