Characterising complex health needs and the use of preventative therapies in the older population: a population-based cohort analysis of UK primary care and hospital linked data

BackgroundSeveral definitions exist for multimorbidity, frailty or polypharmacy, but no formal definition exists for "complex health needs". We aimed to identify and characterise older people with complex health needs based on healthcare resource use (unplanned hospitalisations or polypharmacy) or frailty. MethodsIn this cohort study, data was extracted from UK primary care records (CPRD GOLD), with linked Hospital Episode Statistics inpatient data. People aged >65 on 1st January 2010, registered in CPRD for [≥]1 year were included. We identified complex health needs as the top quintile of unplanned hospitalisations, number of prescribed medicines, and electronic frailty index. We characterised all three cohorts, and quantified point-prevalence and incidence rates of preventative medicines use. ResultsOverall, 90597, 110225 and 116076 individuals were included in the hospitalisation, frailty, and polypharmacy cohorts respectively. Frailty and polypharmacy cohorts had the highest bi- directional overlap. Most comorbidities such as diabetes and chronic kidney disease were more common in the frailty and polypharmacy cohorts compared to the hospitalisation cohort. Generally, prevalence of preventative medicines use was highest in the polypharmacy cohort compared to the other two cohorts: For instance, one-year point-prevalence of statins was 64.2% in the polypharmacy cohort vs. 60.5% in the frailty cohort. ConclusionsThree distinct groups of older people with complex health needs were identified. Compared to the hospitalisation cohort, frailty and polypharmacy cohorts had more comorbidities and higher preventative therapies use. Research is needed into the benefit-risk of different definitions of complex health needs and use of preventative therapies in the older population.