1.  AGEING POPULATION - Burden or Benefit? Demographic Stream 11:30-12:30 Tuesday 22 January 2002 Balmoral Hotel, Edinburgh

2.  Keeping track of elderly patients in general practice - impact on morbidity data Sue Davies Office for National Statistics What impact will implementation of ICD-10 have on mortality statistics by cause in the elderly? Clare Griffiths Office for National Statistics

3.  Keeping track of elderly patients in general practice - impact on morbidity data Sue Davies Head of Morbidity & Health Care Team Office for National Statistics

4. Contents nBackground to issue nData sources used nIllustrative analyses nDiscussion nYour ideas nFurther work

5. Background nTrends in population aged 85+

6. England & Wales population aged 85+ (thousands) in 1971, 2000, 2025

7. Background nTrends in population aged 85+ nMorbidity at older ages nIncreasing importance of analyses at oldest ages nStandard age-group analyses nSome age-specific morbidity rates don’t exhibit expected patterns

8. Data sources (1) General Practice Research Database (GPRD) nSeveral million patients nUp to 12 years of longitudinal data nAgreed guidelines for recording of clinical data - all significant morbidity events - every prescription issued - all consultant outpatient referrals nAnonymised, patient-based clinical records submitted on a regular basis

9. Data sources (2) “Key Health Statistics from General Practice 1998” nA publication of data from GPRD by ONS n211 practices in E&W, total population 1.4 million patients, 2.6% of the population of E&W nSimilar age/sex-distribution to E&W population nMorbidity prevalence; prescription rates; referral rates; disease management

10. Data sources (3) Hospital Episode Statistics (HES) nIn-patient care provided by NHS hospitals in England nConsultant episodes nFinished consultant episodes are indirect measure of hospital admissions

11. Age-specific prevalence of treated disease, women, 1998

12. Age-specific prevalence of treated disease, men, 1998

13. Age-specific prescription rates by BNF chapter, women, 1998

14. Age-specific prescription rates by BNF chapter, men, 1998

15. Age-specific outpatient referral rates by specialty, women, 1998

16. Age-specific outpatient referral rates by specialty, men, 1998

17. HES admission rates, England, 1996-97 Men Persons Women

18. Discussion - possible explanations nDoctors lack of inclination to refer the oldest patients to surgery nActual lower treatment rates nLeast healthy patients admitted to hospital nSome diagnoses/treatments arising from home visits not entered on practice computer nTime lag between patients dying and being removed from practice list

19. Discussion - your ideas/possible solutions n?n? nContinuous improvement in (completeness of) data recording nCareful interpretation of data analyses nMore use of other data sources, e.g. HES, disease registers

20. Planned further work nCompare GPRD data on hospitalisations with HES data, by specialty nAnalyse data from disease registers nCombine a few years’ data together to make analyses more robust

21.  Keeping track of elderly patients in general practice - impact on morbidity data Sue Davies Head of Morbidity & Health Care Team Office for National Statistics