Aging, Hypertension
Conditions
Keywords
Nursing Home, Residential Home, Deprescribing
Brief summary
The UK care home population is projected to increase significantly over the coming decades. A high proportion of individuals in a care home have multiple long-term conditions and take large amounts of prescribed medication. This means they are routinely excluded from research studies and so there is little evidence on which to base treatment of long-term conditions such as high blood pressure. Furthermore, given that 1 in 4 people admitted into a care home die within 1 year, the benefit of treating high blood pressure to reduce the risk of heart attack or stroke must be balanced with the need to optimise quality of life. The aim of this study is to describe the health and social characteristics of the UK care home population with a particular focus on the management of blood pressure in the population. It is hoped that the findings of this study will help inform future research into the management of chronic conditions in care home residents.
Detailed description
The investigators will use the connected Bradford dataset to examine UK electronic health records to describe the UK care home population and management of hypertension in this population. The sample will include all adults aged 65 and over who have been admitted into a care home between January 2016 and December 2019. The investigators will extract data at the time of care home admission including age, sex, ethnicity, coded diagnosis of hypertension, indices of frailty and risk of falls as well as comorbidities relevant to cardiovascular risk and falls risk. Analysis will include looking at the prevalence of hypertension amongst the care home population, describing treatment patterns (i.e. number and type of prescribed anti-hypertensive medications, frequency of blood pressure monitoring) and the proportion of patients with blood pressure controlled according to National Institute of Health and Care Excellence (NICE) guidelines. The investigators will also look to establish whether there are any changes in the number and type of prescribed antihypertensive medication before and after admission to a care home (i.e. intensification of pharmacological therapy or deprescribing) and whether this differs amongst different subgroups of populations including patients with terminal illness and stroke diagnosis. The investigators will also estimate frequency of falls in the year following care home admission.
Interventions
None listed
Sponsors
Bradford Teaching Hospitals NHS Foundation Trust
University of Leeds
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Inclusion criteria
* registered to a GP practice contributing to the Connected Bradford dataset at the point of admission * a recorded length of stay in a care home of longer than six weeks * recorded social care entry for nursing or residential care in the Bradford council social care data.
Exclusion criteria
* no
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Injurious falls | from the point of admission up to 12 months after admission | one year incidence of a fall resulting in hospital attendance in those entering a care home |
| Frequency of blood pressure measurements | from the point of admission up to 12 months following admission | the proportion of individuals entering a care home, with a diagnosis of hypertension, have their blood pressure measured in the year following admission |
| change in antihypertensive medication | 6 months before admission to 6 months following admission | change in the number or type of antihypertensive mediation from six months before care home admission to six months following care home admission |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Blood pressure treatment | 12 months following admission | of those with a diagnosis of hypertension and a blood pressure value recorded in the 12 months after admission, proportion a blood pressure value below the target set by the National Institute for Health and Care Excellence (i.e. for those aged 80 and over 150/90 and those aged below 80 years 140/90) |
| Prevalence of hypertension | at the day of admission to a care home (this will vary between each individual) | the proportion of individuals in the care home cohort with a diagnosis of hypertension at the point of care home admission |
| Antihypertensive medication | at the day of admission to a care home (this will vary between each individual) | the number and type of antihypertensive medication prescribed at the point of admission |
Other
| Measure | Time frame | Description |
|---|---|---|
| change in systolic pressure following care home admission | 12 months before admission for the first measure and 12 months after admission for the second measure. | the difference between systolic blood pressure recorded before care home admission (defined as less than 12 months for care home admission) and systolic blood pressure recorded after care home admission (blood pressure recorded within 12 months following admission) |
Countries
United Kingdom
Outcome results
None listed