Out-of-pocket expenses related to aging in place for frail older people: a scoping review

Abstract

Objective: The objective of this scoping review was to map and describe the available evidence reporting out-of-pocket expenses related to aging in place for older people with frailty and their caregivers. Introduction: As the global population ages, there has been increasing attention on supporting older people to live at home in the community as they experience health and functional changes. Older people with frailty often require a variety of supports and services to live in the community, yet the out-of-pockets costs associated with these resources are often not accounted for in health and social care literature. Inclusion criteria: Sources that reported on the financial expenses incurred by older people (60 years or older) with frailty living in the community, or on the expenses incurred by their family and friend caregivers, were eligible for inclusion in the review. Methods: We searched for published and unpublished (ie, policy papers, theses, and dissertations) studies written in English or French between 2001 and 2019. The following databases were searched: CINAHL, MEDLINE, Scopus, Embase, PsycINFO, Sociological Abstracts, and Public Affairs Index. We also searched for gray literature in a selection of websites and digital repositories. JBI scoping review methodology was used, and we consulted with a patient and family advisory group to support the relevance of the review. Results: A total of 42 sources were included in the review, including two policy papers and 40 research papers. The majority of the papers were from the United States (n = 18), with others from Canada (n = 6), the United Kingdom (n = 3), Japan (n = 2), and one each from Australia, Brazil, China, Denmark, Israel, Italy, The Netherlands, Poland, Portugal, Singapore, South Korea, Taiwan, and Turkey. The included research studies used various research designs, including cross-sectional (n = 18), qualitative (n = 15), randomized controlled trials (n = 2), longitudinal (n = 2), cost effectiveness (n = 1), quasi-experimental (n = 1), and mixed methods (n = 1). The included sources used the term “frailty” inconsistently and used various methods to demonstrate frailty. Categories of out-of-pocket expenses found in the literature included home care, medication, cleaning and laundry, food, transportation, medical equipment, respite, assistive devices, home modifications, and insurance. Five sources reported on out-of-pocket expenses associated with people who were frail and had dementia, and seven reported on the out-of-pocket expenses for caregivers of people with frailty. While seven articles reported on specific programs, there was very little consistency in how out-of-pocket expenses were used as outcome measures. Several studies used measures of combined out-of-pocket expenses, but there was no standard approach to reporting aggregate out-of-pocket expenses. Conclusions: ...

MAiD for geriatric syndromes: Special considerations

“…Managing these symptoms becomes the responsibility of the person and family and comes with costs in informal (unpaid, often friends and family) caregiver time and potential caregiver burden and/or formal (paid) supports either provided in home or institutional settings. 22,23 Given that home care and nursing home care are not covered by the Canada Health Act, depending on policies in place in individual provinces, "public" nursing home care costs upwards of $3,000/month. 24 Care in the home, both in terms of Home Support Worker time and any safety devices that are required, can also be costly.…”

“…Managing these symptoms becomes the responsibility of the person and family and comes with costs in informal (unpaid, often friends and family) caregiver time and potential caregiver burden and/or formal (paid) supports either provided in home or institutional settings. 22 , 23 …”

Effectiveness of programs that offer individualized, multifactorial support to community-dwelling older people with ongoing health and social care needs: a systematic review protocol

“…7 The term "frailty" is increasingly being used to describe a segment of the older adult population that is vulnerable to functional decline and other poor health outcomes. 8 While multimorbidity (ie, the co-occurrence of 2 or more chronic or ongoing health conditions) is highly prevalent in the frail older adult population, 9 there are also many older people who are frail without specific medical diagnoses. 10 It has therefore been difficult to obtain consensus on an operational definition of frailty, and the term is not used consistently in the literature.…”

“…10 It has therefore been difficult to obtain consensus on an operational definition of frailty, and the term is not used consistently in the literature. 8 We will operationalize the concept of frailty by examining studies on people aged 60 or over, with either multiple chronic conditions or significant functional impairments that require ongoing support for daily tasks.…”

Aspects of cognition that impact aging‐in‐place and long‐term care planning

“…Over time older adults face increasing frailty and disability, requiring additional support 11 . The lifetime probability of becoming disabled in at least two activities of daily living or being cognitively impaired is 68% for people aged 65 and older yet individuals underestimate the likelihood that they will need assistance in the future with only 40% believing that they will ever require LTC services 12,13 …”