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Targeting elderly people with complex health problems and severe needs in Sweden. Some methodological reflections

Equity Sweden

6 September 2012

Targeting elderly people with complex health problems and severe needs in Sweden. Some methodological reflections

Mats Thorslund, The Karolinska Institute, Sweden
Lennarth Johansson, Social Styrelsen, Sweden
Bettina Meinow, The Karolinska Institute, Sweden


Background: Elderly people with multiple health problems and functional declines present a challenge to care services as they often need a mix of services from multiple providers. However, as there is no consensus on how to conceptualise this complexity in health problems, existing definitions vary considerably. The vast majority of empirical studies have addressed complex health problems by using detailed clinical criteria when operationalising e.g. “frailty” or “multimorbidity”. From a social policy and planning perspective it is important to define and identify relevant target groups – groups that are characterised by functional and cognitive limitations, and therefore dependent on help both from health- and social care services as well as from their families. In 2010 the Swedish national government granted financial incentives to stimulate new, innovative eldercare models, which could alleviate the problems associated with the provision of coordinated round the clock services and care to “very frail older people living at home”. However, due to the lack of explicitly defined target groups, comparisons between projects and interventions have proven problematic.

Objectives: How to define elderly people with complex health problems? And how to identify and target these people? The different concepts and definitions of “complex health problems” have different aims. For example, the epidemiological perspective often aims to estimate the prevalence of health problems within populations, while a clinical perspective aims to find cases/patients for different kind of interventions. In this presentation, alternative definitions of complex health problem will be compared regarding their aims, and the possibilities of identifying older persons who fulfil the different criteria, for example through national registries. What kind of care are older people with complex health problems receiving today?

Methods: Based on several Swedish research studies as well as different kinds of local and national registers, the prevalence rates for a number of different concepts will be compared.

Results: The preliminary results demonstrate that when using different definitions of complex health problems, prevalence rates differ significantly. The prevalence of complex health problems in the general population 75+ varied between 4 to 65 %. The percentage living in institution varied between zero to almost 50%.

Conclusions: Our mission is not to promote a golden definition of “complex health problems”. However, there is a need to increase our consciousness about similarities and differences between existing definitions. To what extent do the effects of different interventions vary in differently defined target groups? And for which groups of elderly people do we have to discuss and plan for new and alternative kinds of service models?