Background Several definitions exist for multimorbidity, frailty or polypharmacy, but no formal definition exists for complex health needs. We aimed to identify and characterise older people with complex health needs based on healthcare resource use (unplanned hospitalisations or polypharmacy) or frailty. Methods In this cohort study, data was extracted from UK primary care records (CPRD GOLD), with linked Hospital Episode Statistics inpatient data. People aged >65 on 1st January 2010, registered in CPRD for ≥1 year were included. We identified complex health needs as the top quintile of unplanned hospitalisations, number of prescribed medicines, and electronic frailty index. We characterised all three cohorts, and quantified point-prevalence and incidence rates of preventative medicines use. Results Overall, 90597, 110225 and 116076 individuals were included in the hospitalisation, frailty, and polypharmacy cohorts respectively. Frailty and polypharmacy cohorts had the highest bi-directional overlap. Most comorbidities such as diabetes and chronic kidney disease were more common in the frailty and polypharmacy cohorts compared to the hospitalisation cohort. Generally, prevalence of preventative medicines use was highest in the polypharmacy cohort compared to the other two cohorts: For instance, one-year point-prevalence of statins was 64.2% in the polypharmacy cohort vs. 60.5% in the frailty cohort. Conclusions Three distinct groups of older people with complex health needs were identified. Compared to the hospitalisation cohort, frailty and polypharmacy cohorts had more comorbidities and higher preventative therapies use. Research is needed into the benefit-risk of different definitions of complex health needs and use of preventative therapies in the older population.

中文翻译：

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描述老年人群的复杂健康需求和预防性疗法的使用：基于人群的英国初级保健和医院相关数据的队列分析

背景 存在多种疾病、虚弱或多药治疗的定义，但对于复杂的健康需求没有正式的定义。我们的目的是根据医疗资源使用（计划外住院或多种药物）或虚弱来识别和描述具有复杂健康需求的老年人。方法 在这项队列研究中，数据是从英国初级保健记录 (CPRD GOLD) 中提取的，并带有关联的医院事件统计住院患者数据。纳入 2010 年 1 月 1 日年龄 >65 岁、在 CPRD 登记≥1 年的人群。我们将复杂的健康需求确定为计划外住院、处方药数量和电子脆弱指数的前五分之一。我们对所有三个队列进行了表征，并量化了预防药物使用的点流行率和发病率。结果总体而言，90597，110225 人和 116076 人分别被纳入住院、虚弱和多药治疗队列。虚弱和多药治疗队列具有最高的双向重叠。与住院队列相比，糖尿病和慢性肾病等大多数合并症在体弱和多药治疗队列中更为常见。一般来说，与其他两个队列相比，综合用药队列中预防性药物使用的流行率最高：例如，综合用药队列中他汀类药物的一年点流行率为 64.2%，而虚弱队列为 60.5%。结论 确定了三组具有复杂健康需求的不同老年人群。与住院队列相比，体弱和多药治疗队列有更多的合并症和更多的预防性治疗使用。