Elderly

Nationally, the number of contacts per year increased from 61,000 in 2015 to approximately 138,000 in 2023. The number of contacts was more than doubled from 2015 to 2023 while the number of patients in treatment was doubled in the same period. This means that the number of contacts per patient increased from 5.5 in 2015 to 6.3 in 2023. This is in accordance with the findings of Husum et al. 2023, who examined the use of injection treatment from 2011 to 2021.

Injection treatment is relevant for patients with age-related macular degeneration (AMD), diabetic retinopathy, and vein occlusion. Nationally, the proportion of contacts with the diagnosis AMD decreased from about 78 % in 2015 to 73 % in 2023. However, in some referral areas, the proportion of contacts with the diagnosis AMD has increased during the period. In the catchment areas of Bergen and Stavanger, the proportion of contacts with a diagnosis of diabetic retinopathy or vein occlusion was very low in 2023.

The two most used drugs are bevacizumab and aflibercept. Bevacizumab has significantly lower costs and is the first choice in most places (Husum et al. 2023). Nationally, the proportion of contacts with the drug aflibercept increased from 46 % in 2015 to 56 % in 2020, and then decreased to 50 % in 2023. The proportion of contacts with aflibercept was highest in the Sørlandet referral area (67.5 % of contacts) and lowest in the Stavanger referral area (38 % of contacts) in 2023.

The number of patients in treatment increased by approximately 1,300 per year from 2015 to 2023, from 11,043 patients in 2015 to 21,911 patients in 2023. The reason for the patient growth is that this is a treatment for chronic conditions like age-related macular degeneration, and that the number of new patients each year exceeds the number of patients who discontinue their treatment. If the number of patients in treatment continues to increase in the coming years, changes in the organization of services may be needed to ensure access to good and equitable treatment.

Most of the patients were between 70 and 90 years old. The rate for women was 11,7 pastients pr 1 000 women and the rate for men was 9,5 patiens pr 1 000 men in 2023. There is significant geographical variation in the patient rate. This is in agreement with Husum et al. 2023, who suggest that the observed variation may be related to overtreatment in some areas and undertreatment in others. The authors point to a need for clearer management, national guidelines, and a national quality register in the field.

The number of consultations for heart failure has increased from 9,800 in 2015 to almost 22,000 in 2023, an increase of 123%. During the same period, the number of people in Norway aged 75 and over increased by 33%.

In approximately 30% of the consultations in 2023, the patient was a woman.

There is significant geographical variation in consultation rates. In the catchment areas with the highest rates, nearly three times as many consultations per 1,000 inhabitants are conducted compared to those with the lowest rates. In 2023, the rates ranged from 24.2 in Førde to 84.5 in Lovisenberg.

The rate for Finnmark remained between 12 and 17 during the period 2015–2022, lower than in all other health trusts. In 2023, however, the rate increased to 67, placing it among the highest values. This increase may be explained by the establishment of heart failure outpatient clinics by Finnmark Hospital Trust in 2022, with clinics now operating in Kirkenes, Alta, and Hammerfest. This information is quoted from finnmarkssykehuset.no/nyheter.

The number of consultations per patient was 2.3 in 2023. This value varied across catchment areas, from 1.4 in Førde and 1.7 in Bergen to just over 3.5 in Finnmark and Lovisenberg.

There was no significant decline associated with the pandemic. For some catchment areas, the rate increased, while for others, it decreased.

The number of patients has increased from 4,700 in 2015 to almost 9,400 in 2023, representing a doubling over the period. During the same period, the number of people in Norway aged 75 and over increased by 33%.

There was significant geographical variation in patient rates in 2023. The lowest rate was in the Innlandet catchment area, with 11.4 patients per 1,000 inhabitants, while the highest was in the Sørlandet catchment area, with 29.8.

In 2022, Finnmark Hospital Trust began establishing heart failure outpatient clinics. The rate for Finnmark had remained between 10 and 12.5 during the period 2015–2022, well below the national average. However, in 2023, the rate increased to 19, slightly below the national average. While the development in Finnmark resembled other catchment areas between these two points, the jump in Finnmark occurred in 2023 rather than gradually over the period, as seen in other areas.

Almost all catchment areas have seen a greater increase in the number of patients than in the number of residents during the period. The exception is the catchment area for Diakonhjemmet, where the number of patients has increased by 22%, while the number of residents has grown by 44%.

The number of consultations per patient saw a slight increase during the period, from 2.08 in 2015 to 2.33 in 2023. This value varied across catchment areas in 2023, ranging from 1.4 in Førde and 1.7 in Bergen to just over 3.5 in Finnmark and Lovisenberg.

There was no significant decline associated with the pandemic. For some catchment areas, rates increased, while for others, they decreased.

For patients aged 50 and older, 5,857 knee prostheses were implanted in 2015, increasing to 8,154 in 2023. This corresponds to a 39% increase. There was a slight decline in the number of operations during the pandemic year 2020. Following the pandemic, the level is higher than it was pre-pandemic. The proportion of partial knee prostheses has shown a clear increase over the period, from 12% in 2015 to 16% in 2023.

There is geographic variation in operation rates. In the catchment areas with the highest rates, more than twice as many operations per 1,000 inhabitants are performed compared to the areas with the lowest rates. In 2023, the rates ranged from 2.1 in the Lovisenberg HF catchment area to 4.8 in Førde. The ratio between total and partial prostheses also varies significantly across the different catchment areas. In 2023, the proportion of patients receiving partial prostheses ranged from less than 5% in Helgeland and Sørlandet to 32% at Diakonhjemmet and St. Olav.

Women are operated on more frequently than men, with women accounting for 57% of operations in 2023. The average age was approximately the same for both genders in 2023, just under 70 years.

On average, 8,225 hip prosthesis implantations were performed per year on patients aged 50 years and older. The number of surgeries increased by 27 %, from 7,441 in 2015 to 9,466 in 2023. The number of contacts per year saw a significant decline during the pandemic. After the pandemic, the numbers have risen higher than pre-pandemic levels.

Measured by the number of surgeries per 1,000 inhabitants, there has been only a slight change during the period. This rate increased by 5 %, from 4.4 to 4.6. During the same period, the number of residents in Norway aged 50 years and older increased by 16 %. This indicates that the rise in the number of surgeries is largely due to population growth.

Women undergo surgery more frequently than men, with 65 % of the operations performed on women in 2023. The average age was approximately the same for both genders in 2023, around 70 years.