Medical characteristics of the oldest old: retrospective chart review of patients aged 85+ in an academic primary care centre

Abstract

Background: The population aged 85 + - the "oldest old" - is now the fastest growing age segment in Canada. Although existing research demonstrates high health services utilization and medication burden in this population, little clinically derived evidence is available to guide care. This is a descriptive study in a primary care context seeking to describe the most common health conditions and medications used in the "oldest old".

Methods: We conducted a retrospective chart review of all family practice patients aged 85+ (N = 564; 209 males, 355 females) at Sunnybrook Health Sciences Centre in Toronto, Canada. Electronic medical records were reviewed for all current chronic conditions and medication prescriptions, and then stratified by sex and age subgroup (85-89, 90-94, 95+) for descriptive analysis.

Results: On average, patients experienced 6.4 concurrent chronic conditions and took 6.8 medications. Most conditions were related to cardiovascular (79%) and bone health (65%). Hypertension (65%) was the most common condition. Bone-related conditions (e.g. osteoarthritis, osteoporosis) and hypothyroidism predominantly affected women, while coronary artery disease and type 2 diabetes were more prevalent in men. The top two prescribed medications were atorvastatin (33%) and aspirin 81 mg (33%). Males were more likely to be prescribed lipid-lowering medications, while females were more likely to receive osteoporosis therapy. Patients received less lipid-lowering therapy with increasing age.

Conclusions: Multimorbidity and polypharmacy are highly prevalent in patients in the 85+ age group. The most common clinical conditions are related to cardiovascular and bone health, and the most commonly prescribed medications are directed towards risk factors for these illnesses. In the absence of data to guide clinical decision-making, this study provides a first look at the common health concerns and medication profiles in this population and reveals trends that give rise to reflections on how clinical care for these patients can be improved.