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Background
Worldwide, the oldest old are the fastest growing section of the population yet there is little up-to-date information about their health or factors which maintain health and independence. The Newcastle 85+ Study is exploring the spectrum of health within an inception cohort of 85 year-olds and examining health trajectories and outcomes as the cohort ages. Health status at baseline will be presented.
Methods
Members of the 1921 birth cohort were recruited from general practices in Newcastle and North Tyneside, UK during 2006–7. Participation entailed a detailed multi-dimensional health assessment (questionnaires, measurements and fasting blood sample), conducted in the home by a research nurse, together with review of general practice medical records. Undiagnosed disease was estimated by comparing assessment findings with the presence or absence of a recorded diagnosis in the general practice records.
Findings
Of the 1409 individuals contacted, 73.9% (1041) were recruited; 60.3% (850) to “face-to-face” assessment plus review of general practice records, 13.3% (188) to review of general practice records only and 0.2% (3) to “face-to-face” assessment only. Of the 853 assessed, 62.1% were female and 10.4% were living in institutional care. Socio-demographically, the sample was broadly representative of 85-year-olds in Newcastle and North Tyneside and, apart from ethnic diversity, in England and Wales. The most prevalent diseases were hypertension (57.5%) and osteoarthritis (51.8%). With regard to undiagnosed disease, 81.5% of those with a GDS-15 score suggestive of severe depression had not consulted their GP with depression in the previous year; 53.3% of those classified as moderately or severely cognitively impaired did not have a diagnosis of dementia and 27.5% of those with recorded atrial fibrillation were unknown to the GP. A quarter of those without a diagnosis of hypertension had a measured blood pressure in the hypertensive range. Sixty percent reported hearing impairment and over a third visual impairment; 38.3% reported at least one fall in the previous year; a quarter reported severe or profound urinary incontinence and 8.6% faecal incontinence. Almost a fifth were fully independent in all 17 activities of daily living and over three-quarters rated their health, compared to others of the same age, as good, very good or excellent with only 3.5% rating it as poor.
Interpretation
The results revealed good overall levels of function and self-rated health in spite of high levels of disease and impairment. Depression, dementia, atrial fibrillation and hypertension appeared to be significantly under-diagnosed.