Nicholas Steel, Max Bachmann, Susan Maisey, Paul Shekelle, Elizabeth Breeze, Michael Marmot, and David Melzer
In spite of increases since 1950 in life expectancy across wealthy countries, evidence indicates that there are many untapped opportunities to improve the quality and length of life through the timely provision of recommended care. Nicholas Steel, a 2002–03 Harkness Fellow in Health Care Policy and Practice, and his coauthors assessed whether adults in England age 50 or older with serious health conditions are receiving recommended care.
The researchers analyzed data from the 2002 English longitudinal study of aging, focusing on 4,417 individuals with one of 13 serious health conditions. The percentage of recommended care received was highest for ischemic heart disease (83%), followed by hearing problems (79%), pain management (78%), diabetes (74%), smoking cessation (74%), hypertension (72%), stroke (65%), depression (64%), patient-centered care (58%), poor vision (58%), osteoporosis (53%), urinary incontinence (51%), falls management (44%), and osteoarthritis (29%). More indicated care was received for general medical conditions than for geriatric conditions (74% vs. 57%), and more care was received for conditions included in the general practice pay-for-performance contract than for those excluded from it (75% vs. 58%).
Noting that shortfalls in receipt of recommended care were most common in areas associated with disability and frailty, the authors conclude that "efforts to improve care have substantial scope to achieve better health outcomes and particularly need to include chronic conditions that affect quality of life of older people."