Factors Contributing to Persistent Frequent Attendance in Primary Care Among the Oldest Old: Longitudinal Evidence From the AgeCoDe-AgeQualiDe Study

Elżbieta W Buczak-Stec; André Hajek; Hendrik van den Bussche; Marion Eisele; Anke Oey; Birgitt Wiese; Siegfried Weyerer; Jochen Werle; Angela Fuchs; Michael Pentzek; Melanie Luppa; Margit Löbner; Dagmar Weeg; Edelgard Mösch; Kathrin Heser; Michael Wagner; Steffi G Riedel-Heller; Wolfgang Maier; Martin Scherer; Hans-Helmut König

doi:10.3389/fmed.2022.815419

Factors Contributing to Persistent Frequent Attendance in Primary Care Among the Oldest Old: Longitudinal Evidence From the AgeCoDe-AgeQualiDe Study

Front Med (Lausanne). 2022 Mar 21:9:815419. doi: 10.3389/fmed.2022.815419. eCollection 2022.

Authors

Elżbieta W Buczak-Stec¹, André Hajek¹, Hendrik van den Bussche², Marion Eisele², Anke Oey³, Birgitt Wiese³, Siegfried Weyerer⁴, Jochen Werle⁴, Angela Fuchs⁵, Michael Pentzek⁵, Melanie Luppa⁶, Margit Löbner⁶, Dagmar Weeg⁷, Edelgard Mösch⁷, Kathrin Heser⁸, Michael Wagner^{8

9}, Steffi G Riedel-Heller⁶, Wolfgang Maier^{8

9}, Martin Scherer², Hans-Helmut König¹

Affiliations

¹ Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
² Department of General Practice and Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
³ Hannover Medical School, Institute of General Practice, Hanover, Germany.
⁴ Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
⁵ Medical Faculty, Institute of General Practice, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
⁶ Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany.
⁷ Department of Psychiatry, Technical University of Munich, Munich, Germany.
⁸ Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany.
⁹ German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.

Abstract

Objective: Since there is a lack of longitudinal studies in this area, our aim was to identify the determinants of persistent frequent attendance in primary care among the oldest old in Germany.

Methods: Longitudinal data (follow-up wave 7-9) were taken from the multicenter prospective cohort "Study on needs, health service use, costs, and health-related quality of life in a large sample of oldest-old primary care patients (85+)" (AgeQualiDe), covering primary care patients ≥ 85 years (FU7 n = 741, mean age 88.9 years (SD 2.9; 85-100)). Persistent frequent attenders of general practitioner (GP) services (the patients in the top decile of the number of GP consultations in two or more consecutive waves) were our main outcome of interest. Logistic random-effects models were used.

Results: Our analysis included 1,891 observations (766 individuals). Across three waves, we identified 56 persistent frequent attenders. Results of random-effects logistic regressions showed that the odds of being persistent frequent attender were higher for widowed individuals (OR = 4.57; 95% CI [1.07-19.45]). Moreover, a one-point increase in the frailty score and having one more chronic condition increased the odds of being a persistent frequent attender by 68% (OR =1.68; 95% CI [1.05-2.69]) and 23% (OR=1.23, 95% CI [1.05-1.44]), respectively.

Conclusion: Our study stressed the longitudinal association between frailty and widowhood as well as chronic diseases and persistent frequent attendance among the oldest old in Germany.

Keywords: 80 and over; aged; frequent attender; general practitioners (GP); health care utilization; health services needs and demand; persistent frequent attendance; primary health care.