Multimorbidity and the use of health and social care
Multimorbidity – the presence of two or more long term conditions – is increasing in prevalence in Scotland. It has several negative outcomes including higher mortality, decreased quality-of-life, decreased functional status, and higher usage of healthcare. Little is known, however, about the relationship between multimorbidity and social care and how sociodemographic factors influence receipt of care.
The overall aim of this study is to assess whether multimorbidity has an impact on the type and amount of social care people over the age of 65 received between 2011 and 2016 in Scotland, comparing unscheduled healthcare use for those that receive social care in the study period, with those that do not.
The data analysed for this project includes linked data from the Prescribing Information System; the CHI (Community Health Index); the Unscheduled Care Data Mart; deaths records; and the social care survey.
First phase research findings
The first phase of this research has now been completed, and has found that, for those aged over 65 in Scotland, multimorbidity is associated with receipt of care. Furthermore, the probability of receiving social care increases with severity of multimorbidity, and those living in more deprived areas were more likely to receive social care.
Led by David Henderson of Edinburgh Napier University and the Scottish Centre for Administrative Data Research, the researchers found that:
Almost all of those receiving social care had multimorbidity.
After adjusting for age, sex, and deprivation status, the probability of receiving social care increased with severity of multimorbidity.
The probability of receiving social care increased with deprivation status (measured by Scottish Index of Multiple Deprivation decile of residence) although the magnitude of this effect was lower than seen for multimorbidity and age factors after adjustment.
Unsurprisingly, increasing age is associated with receipt of social care. Those aged over 95 had an increased probability of almost 50% of receiving care compared to those aged 65-69.
Despite accounting for two-thirds of all social care receipt, after adjustment for other variables in our models women were only marginally more likely to receive care social care than men.
A full briefing of the findings from the first phase of research can be found on the Scottish Centre for Administrative Data Research website.
The second phase of research is currently being scoped.
The benefits of this research are manifold. First, this new and novel analyses is one of the first projects to utilise individual-level data on social care for research purposes and provides a detailed picture of the patterns of social care services delivery across Scotland, and how multimorbidity impacts social care provision. Second, it aids an understanding of the association and service interaction between health and social care for those with multimorbidity. Third, this work is helping to identify the gaps in data coverage and improve our understanding of the quality of the linked health and social care dataset.
David Henderson (Edinburgh Napier University; Scottish Centre for Administrative Data Research).