Beyond multimorbidity: primary care and the older person with complex needs
Jennifer Mann A B E , Fintan Thompson B , Rachel Quigley
A C , Robyn McDermott D , Susan Devine B and Edward Strivens A C
+ Author Affiliations
- Author Affiliations
A Cairns and Hinterland Hospital and Health Service, PO Box 906, Cairns, Qld 4870, Australia.
B College of Public Health, Medicine and Veterinary Sciences, James Cook University, Townsville, Qld 4811, Australia.
C College of Medicine and Dentistry, James Cook University, Townsville, Qld 4811, Australia.
D Division of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
E Corresponding author. Email: jennifer.mann@my.jcu.edu.au
Australian Journal of Primary Health 27(3) 194-201 https://doi.org/10.1071/PY20125
Submitted: 25 May 2020 Accepted: 26 October 2020 Published: 4 February 2021
Abstract
The aim of this study was to present the health and social characteristics of community-dwelling older people within the Cairns region who were identified by their GP as having complex care needs. This paper reports the subanalysis of baseline data from the Older Persons Enablement and Rehabilitation (OPEN ARCH) stepped wedge randomised controlled trial of an integrated model of care for community-dwelling older people. Data were analysed at the level of the participant and the level of the participant cluster (group of participants from the one GP). Median quality of life, as assessed by the EQ-5D, was higher for females than males (80 vs 70 respectively; P = 0.05) and for people living alone than living with family (80 vs 60 respectively; P = 0.0940). There was greater functional independence among non-Indigenous than Indigenous participants (median Functional Independence Measure scores of 122 vs 115 respectively; P = 0.0937) and the incidence rate (95% confidence intervals) of presentation to the emergency department was sevenfold higher for Indigenous than non-Indigenous participants (11.47 (5.93–20.03) vs 1.65 (0.79–3.04) per 1000 person days respectively). Finally, 61.3% of participants required support to remain living in the community and 44% accessed allied health, with podiatry the most common intervention. The findings indicate that previous hospital utilisation is not a consistent indicator of complexity. Multimorbidity, cultural context and the living and caring situation are considered as matters of complexity, yet variation exists at the participant level.
Keywords: complex, context, GP, multimorbidity, older person.
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