Dr Tim Frendin Physician, Hawke's Bay DHB, Hastings, NZ
Originally an Australian medical graduate I commenced physician training in Christchurch in 1983. Having explored several branches of medicine I started my current consultant roles in general and geriatric medicine in Hawke’s Bay 1992. During this time my professional roles have included Clinical Director Older Person’s Health HBDHB 2003-2014, ASMS National Executive member 2009-2019 and current Prevocational Education Supervisor for MCNZ since 2014. My clinical interests include acute care of the older individual and trying to understand the links between an ageing population, demands of frailty and implications for sustainability of our Public Health service.
Dependency, Clinical Outcomes and Health Demand – the Campylobacter and Subsequent Health (CaSH) Study To explore potential links between baseline dependency, health outcomes and Healthcare utilisation we recruited 354 older people living at home within 2 major retirement complexes in Havelock North at time of the campylobacter outbreak August 2016. All individuals were followed for 3 years, results were stratified according to baseline modified Interval Dependency. Primary outcome measure was time to either transfer to residential care or death, secondary outcomes included attributable costs of healthcare above baseline. For control (unaffected) group increasing baseline dependency identified increasing risk of adverse health outcomes (HR primary outcome at 3y, dep2 vs dep0 =2.5). For affected individuals, increasing baseline dependency identified increasing incremental hazard of adverse outcomes and associated costs (incremental HR primary outcome at 3y, infected vs control dep2 individuals = 1.2). Additionally, for both groups, greater dependency was more predictive of adverse outcomes than either greater age or comorbidity. Conclusion that, in an older population, dependency, clinical vulnerability and Healthcare demand are inextricably linked. Recommendation that incorporation of simple measures of frailty is necessary to understand and predict Healthcare demand in context of an ageing population.
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