Abstract
Introduction:
Older adults accessing hospital care represent a distinct population, in whom patterns of multiple long-term conditions (MLTC) may differ to the wider population, especially given a higher likelihood of complex health and care requirements. A recent scoping review identified variability in the definition and operationalisation of MLTC in older adults accessing hospital care, with minimal description of MLTC in UK hospitals and limited consideration of complexity. To address this research gap, we aimed to describe the epidemiology and complexity of MLTC in older adults accessing emergency hospital care.
Methods:
Adults aged ≥65 years who had at least one emergency admission to Newcastle-upon-Tyne Hospitals Trust (NuTH) between 1/7/21 and 30/6/22 were included in analyses. MLTC was defined based on a list of 60 pre-specified long-term conditions (LTC). A range of approaches were employed to characterise MLTC including counts of conditions (2+, 3+ and 4+) and Harrison’s method (≥3 LTC from ≥3 body systems). Associations between age (in 5-year categories), sex, index of multiple deprivation and different characterisations of MLTC were tested.
Results:
Of 44,233 adults who had at least one emergency admission in the 12-month observation period, 18,618 (42.1%) were ≥65 years (median 77 years, IQR 71-84 years). Prevalence of MLTC increased with age but overall, MLTC was highly prevalent irrespective of approach used to determine presence at all ages. For example, among 65 to 69-year-olds, 82.1% had ≥2 LTC and 52.9% had ≥4 LTC; Harrison’s method identified 57.6% with complex MLTC, comparable prevalence estimates were 96.0%, 78.6% and 80.9% among those ≥90 years.
Conclusion:
MLTC is highly prevalent among older adults accessing emergency hospital care in the North East of England. To capture clinically meaningful variability in the care needs of older adults living with MLTC, novel approaches to the characterisation of complexity of MLTC need to be identified.