title: Much more medicine for the oldest old: trends in UK electronic clinical records.
abstract: BACKGROUND
  the oldest old (85+) pose complex medical challenges. Both underdiagnosis and overdiagnosis are claimed in this group.
  
  
  OBJECTIVE
  to estimate diagnosis, prescribing and hospital admission prevalence from 2003/4 to 2011/12, to monitor trends in medicalisation.
  
  
  METHODS
  observational study of Clinical Practice Research Datalink (CPRD) electronic medical records from general practice populations (eligible; n = 27,109) with oversampling of the oldest old.
  
  
  METHODS
  we identified 18 common diseases and five geriatric syndromes (dizziness, incontinence, skin ulcers, falls and fractures) from Read codes. We counted medications prescribed ≥1 time in all quarters of studied years.
  
  
  RESULTS
  there were major increases in recorded prevalence of most conditions in the 85+ group, especially chronic kidney disease (stages 3-5: prevalence <1% rising to 36.4%). The proportions of the 85+ group with ≥3 conditions rose from 32.2 to 55.1% (27.1 to 35.1% in the 65-84 year group). Geriatric syndrome trends were less marked. In the 85+ age group the proportion receiving no chronically prescribed medications fell from 29.6 to 13.6%, while the proportion on ≥3 rose from 44.6 to 66.2%. The proportion of 85+ year olds with ≥1 hospital admissions per year rose from 27.6 to 35.4%.
  
  
  CONCLUSIONS
  there has been a dramatic increase in the medicalisation of the oldest old, evident in increased diagnosis (likely partly due to better record keeping) but also increased prescribing and hospitalisation. Diagnostic trends especially for chronic kidney disease may raise concerns about overdiagnosis. These findings provide new urgency to questions about the appropriateness of multiple diagnostic labelling.
authors.affiliation: Epidemiology and Public Health, University of Exeter Medical School, Barrack Road, Exeter EX2 5DW, UK.
authors.forename: David
authors.initials: D
authors.lastname: Melzer
authors.affiliation: Epidemiology and Public Health, University of Exeter Medical School, Barrack Road, Exeter EX2 5DW, UK.
authors.forename: Behrooz
authors.initials: B
authors.lastname: Tavakoly
authors.affiliation: Epidemiology and Public Health, University of Exeter Medical School, Smeall Building, St Luke's Campus, Exeter EX1 2LU, UK.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Winder
authors.affiliation: Epidemiology and Public Health, University of Exeter Medical School, Barrack Road, Exeter EX2 5DW, UK.
authors.forename: Jane A H
authors.initials: JA
authors.lastname: Masoli
authors.affiliation: Health Statistics Group, University of Exeter Medical School, St Luke's Campus, Exeter EX1 2LU, UK.
authors.forename: William E
authors.initials: WE
authors.lastname: Henley
authors.affiliation: Epidemiology and Public Health, University of Exeter Medical School, Barrack Road, Exeter EX2 5DW, UK.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ble
authors.affiliation: Primary Care Research Group, University of Exeter Medical School, Smeall Building, St Luke's Campus, Exeter EX1 2LU, UK.
authors.forename: Suzanne H
authors.initials: SH
authors.lastname: Richards
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D003955:Diagnostic Tests, Routine / Q000639:trends; D011307:Drug Prescriptions; D057286:Electronic Health Records / Q000639:trends*; D005260:Female; D005853:Geriatrics / Q000639:trends*; D006295:Health Resources / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D008297:Male; D010343:Patient Admission / Q000639:trends; D019338:Polypharmacy; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011237:Predictive Value of Tests; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D013997:Time Factors; D006113:United Kingdom
keywords: admission; kidney; older people; oldest; prescribing; prevalence
references.citation: BMJ. 2013 Oct 25;347:f6361
references.pmid: 24162944
references.citation: J Am Geriatr Soc. 2008 Dec;56(12):2340-8
references.pmid: 19093934
references.citation: Diabet Med. 2011 May;28(5):575-82
references.pmid: 21480968
references.citation: Br J Gen Pract. 2010 Mar;60(572):e128-36
references.pmid: 20202356
references.citation: Lancet. 2013 Oct 26;382(9902):1405-12
references.pmid: 23871492
references.citation: Eur J Heart Fail. 2013 Dec;15(12):1335-42
references.pmid: 23845798
references.citation: Eur J Ageing. 2013 Mar 26;10(3):237-245
references.pmid: 28804299
references.citation: BMJ Qual Saf. 2013 Jan;22(1):53-64
references.pmid: 22918988
references.citation: BMJ. 2013 Jul 29;347:f4298
references.pmid: 23900313
references.citation: Annu Rev Public Health. 2007;28:321-44
references.pmid: 17222077
references.citation: BMJ. 2009 Dec 22;339:b4904
references.pmid: 20028777
references.citation: Lancet. 2012 Jul 7;380(9836):37-43
references.pmid: 22579043
references.citation: Br J Gen Pract. 2011 Jan;61(582):e12-21
references.pmid: 21401985
references.citation: J Gerontol A Biol Sci Med Sci. 2012 Dec;67(12):1379-86
references.pmid: 22960475
references.citation: N Engl J Med. 2004 Sep 30;351(14):1448-54
references.pmid: 15459308
references.citation: Age Ageing. 2012 Jul;41(4):529-33
references.pmid: 22431153
references.citation: J Gerontol B Psychol Sci Soc Sci. 2011 Jan;66(1):75-86
references.pmid: 21135070
references.citation: Aging Ment Health. 2011 Nov;15(8):978-84
references.pmid: 21777080
references.citation: BMJ. 2013 Sep 09;347:f5125
references.pmid: 24018000
references.citation: BMJ. 2012 Jul 12;345:e4535
references.pmid: 22791787
references.citation: JAMA. 2005 Aug 10;294(6):716-24
references.pmid: 16091574
references.citation: BMJ Open. 2013 Jan 07;3(1):
references.pmid: 23299113
references.citation: Am J Hypertens. 2012 Jan;25(1):97-102
references.pmid: 22031453
references.citation: J Natl Cancer Inst. 2009 Mar 18;101(6):374-83
references.pmid: 19276453
references.citation: Eur Respir J. 2008 Oct;32(4):945-52
references.pmid: 18550607
references.citation: BMJ. 2012 May 28;344:e3502
references.pmid: 22645185