Approach to frailty in the elderly in primary care and the community

Chen, Christine Yuanxin; Gan, Peiying; How, Choon How

doi:10.11622/smedj.2018052

Cited by 66 publications

(44 citation statements)

References 20 publications

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“…Among the healthcare service utilisation in the five different care settings, our study found that frailty had the most significant impact on hospitalisations in both 6-month period prior to and after the baseline, which is consistent with findings reported in prior studies [8,12,36]. The association between frailty and hospitalisations indicates that frail elderly in Singapore tend to present to the healthcare system, especially tertiary care, when they are in a more severe stage of frailty [37].…”

Section: Discussionsupporting

confidence: 89%

Frailty and healthcare utilisation across care settings among community-dwelling older adults in Singapore

Yap

Heng

et al. 2020

BMC Geriatr

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Background Frailty is frequently found to be associated with increased healthcare utilisation in western countries, but little is known in Asian population. This study was conducted to investigate the association between frailty and healthcare utilisation in different care settings among community-dwelling older adults in Singapore. Methods Data from a population health survey among community-dwelling adults were linked with an administrative database to retrieve data of healthcare utilisation (including government primary care clinic visits, specialised outpatient clinic visits, emergency department visits, day surgery and hospitalisations) occurred during a six-month look-back period and six-month post-baseline respectively. Baseline frailty status was measured using the five-item FRAIL scale, which was categorised into three groups: robust (0), pre-frail (1–2), and frail (3–5). Negative binomial regression was applied to examine the association between frailty with respective healthcare utilisation (dependent variables), controlling for other confounding variables. Results In our sample of 701 older adults, 64.8% were of robust health, 27.7% were pre-frail, and 7.6% were frail. Compared to the robust group, frail individuals had a higher rate of specialised outpatient clinic visits (incidence rate ratio (IRR): 2.8, 95% confidence interval (CI): 1.2–6.5), emergency department visits (IRR: 3.1, 95%CI: 1.1–8.1), day surgery attendances (IRR: 6.4, 95%CI: 1.3–30.9), and hospitalisations (IRR: 6.7, 95%CI: 2.1–21.1) in the six-month period prior to the baseline and in subsequent 6 months (IRR: 3.3, 95%CI: 1.6–7.1; 6.4, 2.4–17.2; 5.8, 1.3–25.8; 13.1, 4.9–35.0; respectively), controlling for covariates. Conclusions Frailty was positively associated with the number of specialised outpatient clinic visits, emergency department visits, day surgeries and hospitalisations occurred during 6 months prior to and after the baseline. As frailty is a potentially reversible health state with early screening and intervention, providing preventive activities that delay the onset or progression of frailty should have potential effect on delaying secondary and tertiary care utilisation.

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Section: Discussionsupporting

confidence: 89%

Frailty and healthcare utilisation across care settings among community-dwelling older adults in Singapore

Yap

Heng

et al. 2020

BMC Geriatr

View full text Add to dashboard Cite

show abstract

“…Among the healthcare service utilisation in the ve different care settings, our study found that frailty had the most signi cant impact on hospitalisations in both 6-months before and after baseline, which is consistent with ndings reported in prior studies [8,11,39]. The association between frailty and hospitalisations re ects that frail elderly in Singapore tend to present to the healthcare system, especially tertiary care, when they are in a more severe stage of frailty [40].…”

Section: Discussionsupporting

confidence: 90%

Frailty and healthcare utilisation across care settings among community-dwelling older adults in Singapore

Ge¹,

Yap²,

Heng³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Frailty is frequently found to be associated with increased healthcare utilisation in western countries, but little is known in Asian population. This study was conducted to investigate the association between frailty and healthcare utilisation in different care settings among community-dwelling older adults in Singapore. Methods Data from a population health survey among community-dwelling adults were linked with an administrative database to retrieve data of healthcare utilisation (including government primary care clinic visits, specialised outpatient clinic visits, emergency department visits, day surgery and hospitalisations) occurred during a six-month look-back period and six-month post-baseline respectively. Baseline frailty status was measured using the five-item FRAIL scale, which was categorised into three groups: robust (0), pre-frail (1–2), and frail (3–5). Negative binomial regression was applied to examine the association between frailty with respective healthcare utilisation (dependent variables), controlling for other confounding variables. Results In our sample of 701 older adults, 64.8% were of robust health, 27.7% were pre-frail, and 7.6% were frail. Compared to the robust group, frail individuals had a higher rate of specialised outpatient clinic visits (incidence rate ratio (IRR): 2.8, 95% confidence interval (CI): 1.2-6.5), emergency department visits (IRR: 3.1, 95%CI: 1.1-8.1), day surgery attendances (IRR: 6.4, 95%CI: 1.3-30.9), and hospitalisations (IRR: 6.7, 95%CI: 2.1-21.1) in the six-month period prior to the baseline and in subsequent six months (IRR: 3.3, 95%CI: 1.6-7.1; 6.4, 2.4-17.2; 5.8, 1.3-25.8; 13.1, 4.9-35.0; respectively), controlling for covariates. Conclusions Frailty was positively associated with the number of specialised outpatient clinic visits, emergency department visits, day surgeries and hospitalisations occurred during 6 months prior to and after the baseline. As frailty is a potentially reversible health state with early screening and intervention, providing preventive activities that delay the onset or progression of frailty should have potential effect on delaying secondary and tertiary care utilisation.

show abstract

“…Among the healthcare service utilisation in the ve different care settings, our study found that frailty had the most signi cant impact on hospitalisations in both 6-month period prior to and after the baseline, which is consistent with ndings reported in prior studies [8,12,36]. The association between frailty and hospitalisations indicates that frail elderly in Singapore tend to present to the healthcare system, especially tertiary care, when they are in a more severe stage of frailty [37].…”

Section: Discussionsupporting

confidence: 89%

Frailty and healthcare utilisation across care settings among community-dwelling older adults in Singapore

Ge¹,

Yap²,

Heng³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Frailty is frequently found to be associated with increased healthcare utilisation in western countries, but little is known in Asian population. This study was conducted to investigate the association between frailty and healthcare utilisation in different care settings among community-dwelling older adults in Singapore.Methods Data from a population health survey among community-dwelling adults were linked with an administrative database to retrieve data of healthcare utilisation (including government primary care clinic visits, specialised outpatient clinic visits, emergency department visits, day surgery and hospitalisations) occurred during a six-month look-back period and six-month post-baseline respectively. Baseline frailty status was measured using the five-item FRAIL scale, which was categorised into three groups: robust (0), pre-frail (1–2), and frail (3–5). Negative binomial regression was applied to examine the association between frailty with respective healthcare utilisation (dependent variables), controlling for other confounding variables. Results In our sample of 701 older adults, 64.8% were of robust health, 27.7% were pre-frail, and 7.6% were frail. Compared to the robust group, frail individuals had a higher rate of specialised outpatient clinic visits (incidence rate ratio (IRR): 2.8, 95% confidence interval (CI): 1.2-6.5), emergency department visits (IRR: 3.1, 95%CI: 1.1-8.1), day surgery attendances (IRR: 6.4, 95%CI: 1.3-30.9), and hospitalisations (IRR: 6.7, 95%CI: 2.1-21.1) in the six-month period prior to the baseline and in subsequent six months (IRR: 3.3, 95%CI: 1.6-7.1; 6.4, 2.4-17.2; 5.8, 1.3-25.8; 13.1, 4.9-35.0; respectively), controlling for covariates. Conclusions Frailty was positively associated with the number of specialised outpatient clinic visits, emergency department visits, day surgeries and hospitalisations occurred during 6 months prior to and after the baseline. As frailty is a potentially reversible health state with early screening and intervention, providing preventive activities that delay the onset or progression of frailty should have potential effect on delaying secondary and tertiary care utilisation.

show abstract

Approach to frailty in the elderly in primary care and the community

Cited by 66 publications

References 20 publications

Frailty and healthcare utilisation across care settings among community-dwelling older adults in Singapore

Frailty and healthcare utilisation across care settings among community-dwelling older adults in Singapore

Frailty and healthcare utilisation across care settings among community-dwelling older adults in Singapore

Frailty and healthcare utilisation across care settings among community-dwelling older adults in Singapore

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