Modelling deterioration of foot health in older people following discharge from NHS podiatry services

Background Podiatry services across the country have different access criteria for treatment and increasing pressure on resources has led to increasing moves to ‘treat and discharge’ rather than retaining patients for regular monitoring. Aim This study seeks to model the probability of the development of a medium or high risk foot pathology following discharge from NHS podiatry services. Method Clinical foot health data were collected from 343 patients aged 65 years and over who had been discharged from NHS podiatry services and who had a ‘low risk’ podiatric condition. These patients were followed up at approximately 8 monthly intervals and a maximum of 3 assessments per patient were obtained (on 247 patients). A logistic regression analysis was performed to predict the probability of developing a medium or high risk podiatric complaint within the time limit of the study (mean time from discharge to completion of third assessment = 26 months, S.D. = 8.7 m). Results Eleven percent of the sample developed high-risk conditions and 4% developed medium risk conditions within the time of the study. Three risk factors were found for the development of medium to high-risk pathology. These were low levels of independence (OR = 0.65, 95% CI = 0.45–0.94), age at discharge (OR = 1.069, 95% CI = 1.003–1.139) and a diabetes/age interaction. Conclusions Logistic regression analysis allows risk factors for deterioration of foot health after discharge from NHS podiatry services to be identified. The main risk factors are related to lack of independence, age and having diabetes. The study found a relatively high proportion of older people deteriorated rapidly without professional surveillance. The results of this study indicate that regular foot health monitoring would prevent undetected deterioration and should be targeted at older age groups, at those who have decreased levels of independence and those with diabetes.