63 * OVERDIAGNOSING AND MISSING THE POINT?

Abstract

Introduction:In UK primary care there is a drive towards diagnostic labelling, supported by the Quality of Outcomes Framework. There are concerns that this may expose older people with multiple comorbidities to increased medicalization and polypharmacy. We aimed to estimate diagnosis, prescribing and hospital admission trends in adults over 85 (the oldest old).Methods:Observational study of 27, 109 anonymised records of adults over 64 from the Clinical Practice Research Datalink(CPRD). We estimated prevalence of 18 common clinical diagnoses and 5 additional diagnoses commonly associated with ageing.The main outcome measures were percentage change in prevalence of common morbidities, medical count and hospital admissions from 2003 to 2011 in adults aged 64-84 and 85+.Results:Prevalence of diagnostic labels increased 2003-2011 in adults 85 + , particularly in chronic kidney disease (36.4% increase in stage 3-5, CI 34.8-38.0), diabetes (8.3% increase, CI 7.1–9.5) and dementia (4.7% increase, CI 3.1-6.3%). The proportion of adults with more than 3 medical diagnoses increased in 65-84 year olds from 27.1% to 35.1% (absolute increase 8.0%, 95% CI 5.5–10.6%) and in 85+ from 32.2% to 55.1% (absolute increase 22.9%, CI 20.4–25.3%). Adults 85+ had marked increases in emergency admissions and the numbers of medications on repeat prescriptions. Documentation of functional status and severity scores for cognition was very limited.Conclusions:There has been a diagnostic explosion in the oldest old over the last decade, accompanied by increased trends in prescribing and emergency admissions to hospital. However, despite increased diagnostic labelling and prescribing, we found limited documentation of the person-related aspects of care, such as functional status and cognitive grading. It is unclear whether this increased medicalization is of benefit to the oldest old, or whether a change is required to avoid missing the point in people with potentially complex medical and social needs.