Association of frailty with health service utilisation and health care expenditure in sub-Saharan Africa: evidence from Côte d’Ivoire

Abstract

Background Frailty, a syndrome resulting in heightened risk of negative outcomes for older adults, is increasing across the globe. However, little is known about the health service impacts of frailty in low-income countries (LICs), and in particular, sub-Saharan Africa (SSA). This study explores the relationship between frailty and health service 1) utilisation and 2) expenditure within Côte d’Ivoire. Methods Participants aged 50 years and over participated in the Living Condition, Health and Resilience among the Elderly study. Frailty was assessed using a 30-item Frailty Index (FI). The association between frailty and self-reported health service utilisation was analysed for general practitioners (GPs), specialists, overnight hospitalisations, traditional practitioners and self-medication. Expenditure over the previous month included consulting, medications, hospitalisations and total expenditure. Results Among participants [n = 860, mean age (SD) = 61.8 (9.7) years, 42.9% female], 60.0% were frail, 22.8% pre-frail and 17.2% robust. The mean (SD) FI was 0.28 (0.17). Increased health service utilisation was associated with frailty for GP attendance, traditional practitioners and self-medication but not specialists or overnight hospitalisation. Pre-frailty and frailty were associated with increased total health service expenditure, with frailty also associated with aggregate consulting costs and medications. Conclusions Although frailty is associated with health service utilisation and expenditure in a variety of contexts, the study results suggest that such impacts may vary across the globe. The experience of frailty in LICs is likely to differ from that experienced elsewhere due to cultural traditions, attitudes to the health system, and accessibility, with more research needed.

Marital transitions and frailty among middle-aged and older adults in China: The roles of social support

“…Our study found that the mean FI was 0.23, which is similar to some studies in China ( Stolz et al, 2019 ) and South Africa ( Ambagtsheer & Moussa, 2021 ), but higher than the findings in Brazil ( Silva & Almeida, 2019 ), the UK ( Gale et al, 2018 ), Canada ( Perez-Zepeda et al, 2021 ) and other European countries ( Stolz et al, 2019 ). The different results may be due to the indicators for constructing FI in different studies and different socioeconomic statuses between developing and developed countries.…”

Development and Validation of an Electronic Frailty Index Using Routine Electronic Health Records: An Observational Study From a General Hospital in China

“…Previous studies has also suggested that frailty was associated with healthcare expenditure, both in developed and developing countries ( 5 , 8 – 11 , 15 , 16 ). Several small-sample studies have shown that frailty was associated with increased hospitalized costs for patients with colorectal surgery ( 6 ), cardiac surgery ( 13 ), or transcatheter aortic value implantation ( 35 ).…”

“…Frailty describes a decline in physiological capacity across multiple organ systems, characterized by an increased vulnerability to stressors (3). The condition of frailty is associated not only with a myriad of adverse outcomes (4) but also with increased healthcare costs (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). However, there is no gold standard assessment instrument for frailty (17,18).…”

Assessing frailty amongst older people admitted to hospital in a low-income setting: a multicentre study in northern Tanzania

“…Though comparisons must be drawn cautiously due to the high proportion of missing data, the prevalence using the FP represents a much greater burden of frailty than in the community in Tanzania, where the phenotypic prevalence in the Hai District was 9.3% [ 15 ]. This is an expected finding, given that older people living with frailty are more likely to utilise hospital services [ 31 ].…”