1. Newcastle 85+ study Dr Rachel Duncan Clinical Senior Lecturer
& Honorary Consultant Rheumatologist

2. Population projections
65+ increase of 52% 65 – 74 increase of 37% 75 – 84 increase of 52% 85+ increase of 113%

3. AIM To study the complex clinical, biological and psychological factors affecting the very old.

4. Study design Community based
Recruited people from Newcastle and North Tyneside Primary Care Trusts
Single year birth cohort (all people born in 1921 who turned 85 years in 2006
Own home or institution, irrespective of health
Baseline assessment in 2006 (phase 1)
Followed up at 18 months (phase 2)
3 years (phase 3)
5 years (phase 4)
10 year (phase 5)
Collerton et al. BMC Geriatrics 2007

5. Data collection Health assessment - 3 modes of data collection:
Interviews with validated questionnaires
Functional assessments
Bloods
Review of general practice records (GPRR) participants

6. Cohort recruitment Newcastle and North Tyneside PCT General practices
(53/64 participated)
GPs declining similar to those agreeing on general practice outcomes
Invited to participate (n=1459)
Contact made (n=1409)
Declined (n=358)
Recruited (n=1042)
Withdrew all data
(n=2)
HA assessment only (n=3)
HA+GPRR (n=849)
GPRR only (n=188)
Collerton et al. BMJ 2009; Davies et al BMC Geriatrics 2010

7. Newcastle & North Tyneside (%)
Baseline sociodemographic data of population aged 85 years compared to 2001 census
Census 2001
Variables
All %(n) ^
Women %(n)
Men %(n)
Newcastle & North Tyneside (%)
England and Wales (%)
p value†
Men
Women
37.9 (323)
62.1 (530) -
33.5
66.5
32.6
67.3
Ethnic origin
White
Non white
99.6 (846)
0.4 (3)
99.8 (526)
0.2 (1)
99.4 (320)
0.6 (2)
99.3*
0.7*
98.5*
1.5*
0.304
Housing
Standard
Sheltered
Institution
Other
76.8 (655)
12.7 (108)
10.4 (89)
0.1 (1)
73.0 (387)
14.2 (75)
12.6 (67)
83.0 (268)
10.2 (33)
6.8 (22)
0 (0)
12.0
11.2
0.007
Living arrangements ‡
Alone
With spouse only
With others
61.0 (465)
28.1 (214)
10.9 (83)
73.3 (338)
13.9 (64)
12.8 (59)
42.2 (127)
49.8 (150)
8.0 (24)
57.0
55.0
<0.001
Marital status
Widowed
Married
Never married
Divorced or separated
59.0 (500)
30.0 (254)
8.3 (70)
2.8 (24)
70.4 (371)
16.3 (86)
9.9 (52)
3.4 (18)
30.2 (129)
52.3 (168)
5.6 (18)
1.9 (6)
62.3*
27.0*
8.0*
2.8*
61.2*
27.6*
8.2*
2.4*
Multiple deprivation scores indicate a more deprived sample

9. Demographics All Men Women Widowed 59% 70% 42% Married 30% 16% 52%
Living alone
61%
73%
Institution
10%
12% 7%
Collerton et al. BMJ 2009

10. Psychological Wellbeing
Collerton et al BMJ 2009

11. Loneliness after 85 years of age
Brittain et al. Ageing and Society 2015

12. Prevalence of geriatric conditions
Collerton et al BMJ 2009

13. Cognitive function 3% scored 10 or less 10% (81) scored 11-21
70% not impaired (26-30)
16% scored 30

14. Disease prevalence Median disease count : 4 (men), 5 (women)
6 or more diseases: 28% (men) and 32% (women)
Collerton et al BMJ 2009

15. Multimorbidity 58% Hypertension
52% Osteoarthritis
47% Cataract
47% Atherosclerosis
17% COPD
13% Diabetes
8% Dementia
Multimorbidity is common in very old people
Single disease-based healthcare delivery
Collerton et al BMJ 2009

16. Multimorbidity 58% Hypertension
52% Osteoarthritis
47% Cataract
47% Atherosclerosis
17% COPD
13% Diabetes
8% Dementia
Multimorbidity is common in very old people
Single disease-based healthcare delivery

17. Joint pain -. 48% women experience joint pain on most days
Joint pain - 48% women experience joint pain on most days 40% men experience joint pain on most days Median number painful joints - Women 3 (IQR: 2 – 5), Men 2 (IQR: 1 – 3)
Duncan et al Age and Ageing 2011

18. Methods – assessment of disability
Mobility
Are you able to up and down stairs/steps?
Are you able to get around the house?
Are you able to walk 400 yards
Basic activities of daily living
Are you able to get in and out of bed?
Are you able to get and out of a chair?
Are you able to get on and off the toilet?
Are you able to dress and undress yourself?
Are you able to wash your face and hands?
Are you able to wash yourself all over?
Are you able to cut your own toenails?
Are you able to feed yourself?
Instrumental activities of daily living
Are you able to cook a hot meal?
Are you able to shop for your groceries?
Are you able to do light housework?
Are you able to do heavy housework?
Are you able to manage money?
Are you able to manage your medications?
17 Items (score)
No disability/difficultly
Disability/performed with difficulty

19. Disability
20% able to perform without difficulty all 17 activities of daily living (ADLs)

20. Disability trajectories
9% of men remained fully able over the 5 years
Kingston et al. Archives of Gerontology and Geriatrics 2014

21. Need for care 75% in care homes If at home main carer child
If at home main carer spouse (34%), child (31%)
4% in care homes
If at home main carer child (37%), no-one (18%)
Critical (requires 24-hour care)
Short-interval (requires help at regular times daily)
Long-interval (requires help less than daily)
Independent
Jagger et al. BMC Geriatrics 2011

22. Implications of care needs
Projected numbers in E&W aged 80+ by interval-need dependency,
79% (302k to 541k)
80% (215k to 384k)
76% (1.02m to 1.8m)
91% (1.05m to 2.01m)
Jagger et al BMC Geriatrics 2011

24. Disease influence on incident low and medium/high dependency

25. Influence of other factors on incident low and medium/high dependency

26. What does this mean for Healthcare usage?
At baseline in primary care, 94% of participants had consulted their GP and 77% the practice nurse in the last 12 months.
Between aged 85 and 90 years healthcare demands increased in primary care and participants were far more likely to consult their GP.
No significant increase in secondary care use as defined by inpatients stays, outpatient attendance or attendance at the emergency department between 85 and 90 years.

27. Management of the very old
Third of participants had one or more fragility fractures
Fracture risk assessment score (FRAX) in conjunction with National Osteoporosis Guidelines (NOGG) – only 28% receiving adequate treatment
GPRR diagnosis of osteoporosis recorded -62% were on adequate treatment

28. Further qualitative work
Understanding multimorbidity, frailty and disability in the very old: longitudinal study in primary care
Reducing malnutrition and frailty in older people in primary care: understanding the impact of oral health
International TULIPS collaboration with New Zealand (LILACS study), Japan (TOOTH study) and Netherlands Leiden 85+ study)
(i) Confirming trajectories of disability and estimating years spent with disability and frailty between age 85 and 95.
(ii) Identifying predictors of “healthy” ageing to age 95.
(iii) Establishing how health and social care resources change between the ninth and tenth decade, particularly regarding informal care.
(iv) Determining late life factors influencing frailty, in particular cognition?
(v) Exploring the levels of participation and loneliness.

29. Embedded qualitative studies
Health at Experiences of living and of accessing services at an advanced age
- Semi-structured interviews exploring participants day to day lives and support networks (formal and informal)
Uncovering ways in which carers of very old people can be supported to maintain their own physical and psychological wellbeing
Longitudinal study of older people aged over 95 years
- Understanding health-seeking behaviour (and changes in this) in advanced old age, in particular, primary care.
- How the interface between health and social care is interpreted and navigated.
- Examining the ways in which formal and informal care is negotiated in the context of change.
- Identify unmet need and whether services are fit for purpose.

30. Come and study with the Newcastle 85+ team!
Largest cohort of the very old in the United Kingdom
Aim - to study the complex clinical, biological and psychological factors affecting the very old
Over 1000 participants at baseline - followed up over 10 years – currently 95 years old
Completed the 10 year interviews with participants and now commencing embedded qualitative studies
Published over 63 articles from the study to date
We are seeking enthusiastic students with an interest in studying the very old to join our team There are many opportunities linked to this huge data set and if you would like to discuss it further please contact the PI, Rachel Duncan at Newcastle 85+ website:

34. Acknowledgements Barbara Hanratty Carol Jagger Andrew Kingston
Carmen Martin-Ruiz
Louise Robinson
Helen Hanson
Tom Kirkwood
General practices
Study participants