Beyond multimorbidity: primary care and the older person with complex needs

Area of Science:

• Gerontology
• Public Health
• Health Services Research

Background:

• Community-dwelling older adults with complex care needs present unique health and social challenges.
• General practitioners (GPs) identify older adults with complex care needs, necessitating tailored support models.
• The Older Persons Enablement and Rehabilitation (OPEN ARCH) trial investigates an integrated care model for this population.

Purpose of the Study:

• To characterize the health and social profiles of community-dwelling older adults with complex care needs in the Cairns region.
• To analyze baseline data from the OPEN ARCH trial to understand participant characteristics.
• To identify factors contributing to complexity in older adults' care needs.

Main Methods:

• Subanalysis of baseline data from the OPEN ARCH stepped wedge randomized controlled trial.
• Data analyzed at both individual participant and GP cluster levels.
• Quality of life (EQ-5D) and functional independence (Functional Independence Measure) were assessed.

Main Results:

• Females and those living alone reported higher quality of life.
• Non-Indigenous participants demonstrated greater functional independence than Indigenous participants.
• Indigenous participants had a sevenfold higher emergency department presentation rate compared to non-Indigenous participants.
• 61.3% required support for community living, and 44% accessed allied health, primarily podiatry.

Conclusions:

• Previous hospital use is not a reliable predictor of care complexity.
• Multimorbidity, cultural factors, and living/caring situations are key aspects of complexity.
• Significant individual-level variation exists in the manifestation of complex care needs among older adults.