The role of age in moderating access to cardiac rehabilitation in Scotland

Access to health care should be determined by clinical need and not by age. Older people form an increasing proportion of the general population and of those with coronary heart disease, but compared with younger people they are less likely to be invited for cardiac rehabilitation programmes and more likely not to complete them. This study examined the factors that contribute to these trends in Scotland. A national survey of rehabilitation centres (n = 30) found that the majority of their programme co-ordinators believe that age does influence access to rehabilitation. While only one programme used an overt age criterion, age was widely perceived to influence access, both during initial assessment and in assessments for exercise components; and while the respondents acknowledged that other criteria influenced selection, the factors cited most often were all more common during old age, e.g. the presence of other medical ailments, lower initial exercise tolerance, and poor access to private or public transport. Focus groups undertaken with a sub-sample of the co-ordinators revealed that staff appeared to have knowledge of the benefits of cardiac rehabilitation for older people, but that the scarcity of resources prevented them from offering more accessible and appropriate services.