Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.
BMC Geriatr. 2010 Nov 4;10:83. doi: 10.1186/1471-2318-10-83.
Age and life expectancy of residents in many developed countries, including Australia, is increasing. Health resource and medicine use in the very old is not well studied. The purpose of this study was to identify annual use of health services and medicines by very old Australian veterans; those aged 95 to 99 years (near centenarians) and those aged 100 years and over (centenarians).
The study population included veterans eligible for all health services subsidised by the Department of Veterans' Affairs (DVA) aged 95 years and over at August 1st 2006. A cohort of veterans aged 65 to 74 years was identified for comparison. Data were sourced from DVA claims databases. We identified all claims between August 1st 2006 and July 31st 2007 for medical consultations, pathology, diagnostic imaging and allied health services, hospital admissions, number of prescriptions and unique medicines. Chi squared tests were used to compare the proportion of centenarians (those aged 100 years and over) and near centenarians (those aged 95 to 99 years) who accessed medicines and health services with the 65 to 74 year age group. For those who accessed health services during follow up, Poisson regression was used to compare differences in the number of times centenarians and near centenarians accessed each health service compared to 65 to 74 year olds.
A similar proportion (98%) of centenarians and near centenarians compared to those aged 65 to 74 consulted a GP and received prescription medicine during follow up. A lower proportion of centenarians and near centenarians had claims for specialist visits (36% and 57% respectively), hospitalisation (19% and 24%), dental (12% and 18%), physiotherapy (13% and 15%), pathology(68% and 78%) and diagnostic imaging services (51% and 68%) (p < 0.0001) and a higher proportion had claims for care plans (19% and 25%), occupational therapy (15% and 17%) and podiatry services (54% and 58%) (p < 0.0001). Compared to those aged 65 to 74, a lower proportion of centenarians and near centenarians received antihypertensives, lipid lowering therapy, antiinflammatories, and antidepressants (p < 0.0001) and a higher proportion received antibiotics, analgesics, diuretics, laxatives, and anti-anaemics (p < 0.0001).
Medical consultations and medicines are the health services most frequently accessed by Australian veteran centenarians and near centenarians. For most health services, the proportion of very old people who access them is similar to or less than younger elderly. Our results support the findings of other studies which suggest that longevity is not necessarily associated with excessive health service use.
包括澳大利亚在内的许多发达国家居民的年龄和预期寿命正在增加。对于非常高龄人群的健康资源和药物使用情况，研究并不充分。本研究的目的是确定澳大利亚高龄退伍军人（95 至 99 岁的接近百岁老人和 100 岁及以上的百岁老人）的年度卫生服务和药物使用情况。
研究人群包括 2006 年 8 月 1 日年龄在 95 岁及以上、有资格享受退伍军人事务部（DVA）所有补贴健康服务的退伍军人。还确定了一个年龄在 65 至 74 岁的退伍军人队列进行比较。数据来自 DVA 索赔数据库。我们确定了 2006 年 8 月 1 日至 2007 年 7 月 31 日期间所有用于医疗咨询、病理学、诊断成像和辅助医疗服务、住院、处方数量和独特药物的索赔。使用卡方检验比较百岁老人（100 岁及以上）和接近百岁老人（95 至 99 岁）与 65 至 74 岁年龄组使用药物和卫生服务的比例。对于在随访期间使用卫生服务的人群，使用泊松回归比较百岁老人和接近百岁老人与 65 至 74 岁年龄组相比，每次使用每种卫生服务的次数差异。
在随访期间，与年龄在 65 至 74 岁的人相比，同样比例（98%）的百岁老人和接近百岁老人看了全科医生并接受了处方药物。百岁老人和接近百岁老人看专科医生的比例较低（分别为 36%和 57%）、住院（19%和 24%）、牙科（12%和 18%）、物理治疗（13%和 15%）、病理学（68%和 78%）和诊断成像服务（51%和 68%）（p<0.0001），而更多的人有护理计划（19%和 25%）、职业治疗（15%和 17%）和足病治疗服务（54%和 58%）（p<0.0001）。与年龄在 65 至 74 岁的人相比，百岁老人和接近百岁老人接受降压药、降脂药、消炎药和抗抑郁药的比例较低（p<0.0001），接受抗生素、镇痛药、利尿剂、泻药和抗贫血药的比例较高（p<0.0001）。
医疗咨询和药物是澳大利亚高龄退伍军人百岁老人和接近百岁老人最常使用的卫生服务。对于大多数卫生服务，使用这些服务的高龄人群的比例与或低于较年轻的老年人。我们的结果支持了其他研究的发现，即长寿不一定与过度使用卫生服务有关。
