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.
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.
Study Type
OBSERVATIONAL
Enrollment
3,000
Academic Unit for Ageing and Stroke Research
Bradford, West Yorkshire, United Kingdom
Frequency of blood pressure measurements
the proportion of individuals entering a care home, with a diagnosis of hypertension, have their blood pressure measured in the year following admission
Time frame: from the point of admission up to 12 months following admission
change in antihypertensive medication
change in the number or type of antihypertensive mediation from six months before care home admission to six months following care home admission
Time frame: 6 months before admission to 6 months following admission
Injurious falls
one year incidence of a fall resulting in hospital attendance in those entering a care home
Time frame: from the point of admission up to 12 months after admission
Prevalence of hypertension
the proportion of individuals in the care home cohort with a diagnosis of hypertension at the point of care home admission
Time frame: at the day of admission to a care home (this will vary between each individual)
Antihypertensive medication
the number and type of antihypertensive medication prescribed at the point of admission
Time frame: at the day of admission to a care home (this will vary between each individual)
Blood pressure treatment
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)
Time frame: 12 months following admission
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