While older patients are lifting their game, those in their middle years appear immune to public-health programs
While older patients are lifting their game, those in their middle years appear immune to public health programs
A population bulge of middle-aged Australians clinging to high-risk habits and tending to overweight is heading towards a healthcare home near you, probably sooner than anyone expects.
Final reports from Sydney University’s Bettering the Evaluation and Care of Health (BEACH) program show a burgeoning increase in chronic disease among the 45 to 64 age group.
This cohort now accounts for 31% more investigations and 14% more consultation time than the average GP patient, according to the reports, released last week by the university’s Family Medicine Research Centre.
One in five of this group – fully 1.2 million people – suffered from three or more chronic conditions, while 37% had two. In bald numbers, 3.54 million middle-aged Australians had a chronic disease, 300,000 more than in the 65-plus age bracket.
Associate Professor Helena Britt, BEACH director, said it was highly possible some of these patients had been diagnosed through GP health checks for 45 to 49-year-olds.
As a result, they would be receiving far more cost-effective care than if they had delayed treatment and ended up in hospital – but stubbornly high rates of risk behaviours did “not bode well for the future health of this age group visiting GPs”.
“While the prevalence of daily smoking and hazardous alcohol consumption fell significantly among all adult patients, there was no change in the 45 to 64 age group,” Professor Britt said.
One in five middle-aged people were still daily smokers and one in four drank at hazardous levels.
The results took BEACH researchers by surprise.
“We were stunned,” Professor Britt told The Medical Republic. She said more research was needed to understand why clinical and public health programs had not affected their lifestyle choices, along with more effective interventions.
“Let’s not wait until they are 65,” she said.
Early enrolment in healthcare homes – the new GP-led care model intended originally to coordinate care for the ailing elderly – could be one solution to ease the looming chronic disease burdens of 45 to 64 year olds, she said.
More than 70% of the mid-life cohort was overweight or obese in 2015-16, according to the new findings.
The proportion of morbidly obese had risen to 6%, from 3% in 2001, and more people had moved higher up the obesity scale during the same period, the research showed.
But in this respect, the middle-aged were not alone. Obesity rates increased in all age groups.
BEACH research into middle-aged patients in general practice encounters also revealed high rates of co-morbidity where 9% had six or more chronic conditions and 1% had 10 or more.
The most common pairing of conditions was hypertension and hyperlipidaemia, occurring in 10% of surveyed patients, followed by hypertension and osteoarthritis.
RACGP President Dr Frank Jones said the research underscored how a rapidly changing health demography was creating greater demand for GP services.
In the past 10 years, GP-patient encounters had become more complex in the volume and multiplicity of clinical issues being managed under mounting time and funding pressures, he said.
“We’re seeing patients with more problems. The number of patients presenting with three or more has increased by 10% and those with four or more has increased by a staggering 30%,” Dr Jones said.
“The burden of disease is now higher and more is being crammed into the average consultation of around 15 minutes.”
Australia’s GPs managed 67 million more health problems at patient encounters in 2015–16 than they did in 2006–07.
The latest BEACH reports will be the last of an internationally admired series that has analysed trends in Australian general practice over more than 18 years.
The centre has been unable to secure funding to continue its work.
