Frailty Phenotype and Healthcare Costs and Utilization in Older Women

Ensrud, Kristine E.; Kats, Allyson M; Schousboe, John T.; Taylor, Brent C.; Cawthon, Peggy M.; Hillier, Teresa A.; Yaffe, Kristine; Cummings, Steve; Cauley, Jane A.; Langsetmo, Lisa

doi:10.1111/jgs.15381

Cited by 103 publications

(112 citation statements)

References 38 publications

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“…56 Multiple studies using cohorts of community-dwelling older adults have showed that the health care costs of frail individuals are sometimes several-fold higher than those of non-frail counterparts. [57][58][59][60][61] Older adults form the main users of medical and social care services, 62 and the majority of health care costs are incurred by them. In the context of ongoing population aging, with an unprecedented growing number and proportion of older adults, this epidemiological and demographic population shift is starting to have a major impact on health care systems.…”

Section: Impacts Of Frailty On Health Care Systemsmentioning

confidence: 99%

<p>Frailty syndrome: implications and challenges for health care policy</p>

Kojima

Liljas

Iliffe

2019

RMHP

305

220

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Older adults are a highly heterogeneous group with variable health and functional life courses. Frailty has received increasing scientific attention as a potential explanation of the health diversity of older adults. The frailty phenotype and the Frailty Index are the most frequently used frailty definitions, but recently new frailty definitions that are more practical have been advocated. Prevalence of frailty among the community-dwelling population aged 65 years and older is ~10% but varies depending on which frailty definitions are used. The mean prevalence of frailty gradually increases with age, but the individual's frailty level can be improved. Older adults, especially frail older adults, form the main users of medical and social care services. However, current health care systems are not well prepared to deal with the chronic and complex medical needs of frail older patients. In this context, frailty is potentially a perfect fit as a risk stratification paradigm. The evidence from frailty studies has not yet been fully translated into clinical practice and health care policy making. Successful implementation would improve quality of care and promote healthy aging as well as diminish the impact of aging on health care systems and strengthen their sustainability. At present, however, there is no effective treatment for frailty and the most effective intervention is not yet known. Based on currently available evidence, multi-domain intervention trials, including exercise component, especially multicomponent exercise, which includes resistance training, seem to be promising. The current challenges in frailty research include the lack of an international standard definition of frailty, further understanding of interventions to reverse frailty, the best timing for intervention, and education/training of health care professionals. The hazards of stigmatization should also be considered. If these concerns are properly addressed, widespread application of public health approaches will be possible, including screening, identification, and treatment of frailty, resulting in better care and healthier aging for older people.

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Section: Impacts Of Frailty On Health Care Systemsmentioning

confidence: 99%

<p>Frailty syndrome: implications and challenges for health care policy</p>

Kojima

Liljas

Iliffe

2019

RMHP

305

220

View full text Add to dashboard Cite

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“…45 Frailty, in turn, is associated with higher total and outpatient healthcare costs and higher rates of hospitalization and SNF stays. 19 Our findings suggest that clinical attention to older adults with even mild, and not just moderate to severe, depressive symptoms may be warranted. Total healthcare costs are also an indicator of healthcare and illness burden among older individuals, and hence our data suggest that pharmacologic and/or psychotherapeutic interventions to address even mild depressive symptoms may be appropriate for some patients.…”

Section: Discussionmentioning

confidence: 73%

“…Two studies of individuals aged 65 years and older have shown that positive affect reduces the risk of incident frailty; in the SOF Caregiver study, this association remained significant after adjustment for age, comorbid medical conditions, and functional limitations . Frailty, in turn, is associated with higher total and outpatient healthcare costs and higher rates of hospitalization and SNF stays …”

Section: Discussionmentioning

confidence: 97%

Depressive Symptoms and Total Healthcare Costs: Roles of Functional Limitations and Multimorbidity

Schousboe

Kats

et al. 2019

J American Geriatrics Society

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OBJECTIVES Depressive symptoms can be both a cause and a consequence of functional limitations and medical conditions. Our objectives were to determine the association of depressive symptoms with subsequent total healthcare costs in older women after accounting for functional limitations and multimorbidity. DESIGN Prospective cohort study (Study of Osteoporotic Fractures [SOF]). SETTING Four US sites. PARTICIPANTS A total of 2508 community‐dwelling women (mean age = 79.4 years) participating in the SOF year 10 (Y10) examination linked with their Medicare claims data. MEASUREMENTS At Y10, depressive symptoms were measured using the 15‐item Geriatric Depression Scale (GDS) and functional limitations were assessed by number (range = 0‐5) of impairments in performing instrumental activities of daily living. Multimorbidity was ascertained by the Elixhauser method using claims data for the 12 months preceding the Y10 examination. Total direct healthcare costs, outpatient costs, acute hospital stays, and skilled nursing facility during the 12 months following the Y10 examination were ascertained from claims data. RESULTS Annualized mean (SD) total healthcare costs were $4654 ($9075) in those with little or no depressive symptoms (GDS score = 0‐1), $7871 ($14 534) in those with mild depressive symptoms (GDS score = 2‐5), and $9010 ($15 578) in those with moderate to severe depressive symptoms (GDS score = 6 or more). After adjustment for age, site, self‐reported functional limitations, and multimorbidity, the magnitudes of these incremental costs were partially attenuated (cost ratio = 1.34 [95% confidence interval {CI} = 1.14‐1.59] for those with mild depressive symptoms, and cost ratio = 1.29 [95% CI = 0.99‐1.69] for those with moderate to severe depressive symptoms vs women with little or no depressive symptoms). CONCLUSION Depressive symptoms were associated with higher subsequent healthcare costs attributable, in part, to greater functional limitations and multimorbidity among those with symptoms. Importantly, even mild depressive symptoms were associated with higher healthcare costs. J Am Geriatr Soc 67:1596–1603, 2019

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“…10,11 We used a gamma distribution with a log link given our right-skewed cost distribution and a previous study using similar models. 12 The correlation structure was assumed to be exchangeable for repeated observations. Once the GEE model was fitted to our data, we extracted the marginal percent difference in costs due to frailty from the beta estimate for frail and nonfrail patients.…”

Section: Resultsmentioning

confidence: 99%

The Marginal Cost of Frailty Among Medicare Patients on Hemodialysis

Streja

Grimes

et al. 2020

Kidney International Reports

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Introduction: Dialysis patients incur disproportionately high costs compared with other Medicare beneficiaries. Care for frail individuals may be even more costly. We examined the extent to which frailty contributes to higher costs among dialysis patients. Methods: We used ACTIVE/ADIPOSE (A Cohort to Investigate the Value of Exercise/Analyses Designed to Investigate the Paradox of Obesity and Survival in ESRD) enrollees (adult hemodialysis patients evaluated from June 2009 to August 2011) in a retrospective cohort analysis. Individuals using Medicare as the primary payer were included. Fried's frailty phenotype was evaluated at baseline, 12, and 24 months. Costs were derived from linkage with the US Renal Data System (USRDS) and Medicare claims data. We used generalized estimating equations (GEEs) incorporating time-updated frailty and costs to evaluate adjusted point estimates and the marginal cost associated with being frail. We also investigated if frail patients who died during the study incurred higher costs than those who survived. Results: Among 771 enrollees in ACTIVE/ADIPOSE, 425 met inclusion criteria. Mean age was 56 AE 13 years, body mass index (BMI) 29.2 AE 7.1 kg/m 2 , 42.4% were women, and 29.0% were frail at baseline. Over a mean follow-up of 2.3 years, frail individuals incurred 22% (95% confidence interval [CI] 9.6%-35.8%) higher costs compared with nonfrail individuals ($87,600 per patient per year [pppy], 95% CI 76,800-100,000, vs. $71,800 pppy, 95% CI 64,800-79,600), the difference was driven primarily by higher inpatient expenditures. The difference between frail and nonfrail patients' inpatient expenditures was even more pronounced among those who died during the study compared with those who survived. Conclusions: Frail dialysis patients incur a significantly higher cost relative to their nonfrail counterparts, primarily driven by higher inpatient costs. Frail patients near end of life incur even higher costs.

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Frailty Phenotype and Healthcare Costs and Utilization in Older Women

Cited by 103 publications

References 38 publications

<p>Frailty syndrome: implications and challenges for health care policy</p>

<p>Frailty syndrome: implications and challenges for health care policy</p>

Depressive Symptoms and Total Healthcare Costs: Roles of Functional Limitations and Multimorbidity

The Marginal Cost of Frailty Among Medicare Patients on Hemodialysis

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