Frailty Phenotype and Healthcare Costs and Utilization in Older Men

Abstract

OBJECTIVES To determine the association of the frailty phenotype with subsequent healthcare costs and utilization. DESIGN Prospective cohort study (Osteoporotic Fracture in Men [MrOS]). SETTING Six US sites. PARTICIPANTS A total of 1,514 community‐dwelling men (mean age = 79.3 years) participating in the MrOS Year 7 (Y7) examination linked with their Medicare claims data. MEASUREMENTS At Y7, the frailty phenotype was operationalized using five components and categorized as robust, pre‐frail, or frail. Multimorbidity and a frailty indicator (approximating the deficit accumulation index) were derived from claims data. Functional limitations were assessed by asking about difficulty performing instrumental activities of daily living. Total direct healthcare costs and utilization were ascertained during 36 months following Y7. RESULTS Mean of total annualized costs (2018 dollars) was $5,707 (standard deviation [SD] = 8,800) among robust, $8,964 (SD = 18,156) among pre‐frail, and $20,027 (SD = 27,419) among frail men. Compared with robust men, frail men (cost ratio [CR] = 2.35; 95% confidence interval [CI] = 1.88‐2.93) and pre‐frail men (CR = 1.28; 95% CI = 1.11‐1.48) incurred greater total costs after adjustment for demographics, multimorbidity, and cognitive function. Associations of phenotypic pre‐frailty and frailty with higher total costs were somewhat attenuated but persisted after further consideration of functional limitations and a claims‐based frailty indicator. Each individual frailty component was also associated with higher total costs. Frail vs robust men had higher odds of hospitalization (odds ratio [OR] = 2.62; 95% CI = 1.75‐3.91) and skilled nursing facility (SNF) stay (OR = 3.36; 95% CI = 1.83‐6.20). A smaller but significant effect of the pre‐frail category on SNF stay was present. CONCLUSION Phenotypic pre‐frailty and frailty were associated with higher subsequent total healthcare costs in older community‐dwelling men after accounting for a claims‐based frailty indicator, functional limitations, multimorbidity, cognitive impairment, and demographics. Assessment of the frailty phenotype or individual components such as slowness may improve identification of older community‐dwelling adults at risk for costly extensive care.

Catastrophic Health Expenditure Associated With Frailty in Community-Dwelling Chinese Older Adults: A Prospective Cohort Analysis

“…Another longitudinal study in Germany indicated that the onset of exhaustion was the only symptom associated with an increase in total healthcare costs (32). Ensrud et al (33,34) conducted cohort studies among older women and men separately in the United States and All models were adjusted for the predefined full list of covariates (i.e., age, gender, residence, education, marital status, income, health insurance, smoking, drinking, and physical comorbidity) except the stratification variable. p for interaction (p interaction ) was examined using the likelihood-ratio test.…”

“…observed that each frailty component was associated with higher total costs (33,34). The findings are still scarce and inconsistent so that further attention is necessary to improve the identification of high-risk older adults through frailty symptom assessment.…”

The Impact of Frailty on Spine Surgery: Systematic Review on 10 years Clinical Studies

“…A recent study from Norway highlights that patients over 65 years represent only 15% of the population, but are responsible for almost half of the total healthcare cost [ 11 ]. Moreover, in a prospective cohort study from US, pre-frailty and frailty are associated with higher subsequent total healthcare costs in older community-dwelling men [ 12 ].…”

Life‐space mobility and healthcare costs and utilization in older men

“…A study of over 30,000 Medicare fee‐for‐service beneficiaries reported that difficulty with three or more ADLs or iADLs was associated with $3121 and $895 higher total annual costs of care, respectively, after adjustment for comorbidities, depression, and dementia 33 . Studies of community‐dwelling older men and women have shown an association between the frailty phenotype and higher subsequent healthcare costs after adjustment for functional status and claims‐based indicators of multimorbidity and frailty 3,26 . Neither self‐reported function nor frailty are systematically assessed in clinical practice, nor are these measures included in models commonly used to predict future healthcare costs, such as the CMS Hierarchical Condition Category (HCC) cost prediction model 34 .…”

“…Limitations in activities of daily living (ADLs) (bathing/showering and getting in and out of bed and chairs), instrumental ADLs (iADLs) (shopping, heavy housework, meal preparation, managing money, or managing medications), and mobility (walking 2–3 blocks, climbing 10 stairs) were defined as self‐report of any difficulty with these activities. The frailty phenotype was defined using a modified version 26 of the Cardiovascular Health Study frailty definition 27 . This definition uses five components (shrinking, weakness, poor energy, slowness, low physical activity) to define frailty status (0 components = robust, 1–2 components = prefrail, ≥3 components = frail).…”