Claims‐Based Frailty and Outcomes: Applying an Aging Measure to Older Adults with Parkinson's Disease

Abstract

A BS TRACT: Background: Frailty is a geriatric syndrome with negative health impacts not captured by comorbidity and disability alone. The prevalence of frailty in Parkinson's disease (PD) has been described, but data on frailty-associated outcomes are limited. Objective: To describe the level of frailty and investigate the association between frailty and outcomes in a Medicare sample of persons diagnosed with PD. Methods: We used the claims-based frailty index to assess frailty in a cohort of Medicare beneficiaries with PD in 2013. Frailty was categorized as non-frail/pre-frail, mildly frail, moderately frail, and severely frail. Adjusted logistic regression models examined the relationship between frailty and mortality, hospitalization, emergency department visits, and fall-related injuries through 2014. Results: Of 62,786 beneficiaries with PD in 2013, 55.3% were frail. Frail individuals were more likely to be female, older, Black, metropolitan dwelling, without neurologist care, nursing facility residents, or multimorbid. The average daily levodopa equivalent dose initially increased, then decreased from the pre-frail to the severely frail groups. Compared to non-frail/pre-frail persons, severely frail persons had higher adjusted odds of 1-year mortality (AOR 2.74, 95% CI 1.98, 3.78), hospitalization (AOR 2.34, 95% CI 1.74, 3.14), emergency department visits (AOR 2.97, 95% CI 2.14, 4.13), and fall-related injury (AOR 1.43, 95% CI 0.90, 2.26). Conclusions: Frailty is common and differentially distributed among older adults with PD. Frailty in PD is associated with adverse health outcomes and death. Observational study analyses may benefit from adjustment for frailty; claims-based frailty surveillance may identify vulnerable PD patients in health system, registry, or administrative data.

Physical Frailty, Genetic Predisposition, and Incident Parkinson Disease

“…In a claims-based cross-sectional study of 62 786 beneficiaries with PD, 55.3% were diagnosed with frailty. 17 The findings support other studies with a small sample size of patients with PD showing frailty was highly prevalent in PD. 11,13,15,16 A case-control study found significant increments in the mean number of frailty phenotypes and cumulative frailty index in patients with PD compared with controls.…”

“…Previous studies found that frailty was common in adults with PD. In a claims-based cross-sectional study of 62 786 beneficiaries with PD, 55.3% were diagnosed with frailty . The findings support other studies with a small sample size of patients with PD showing frailty was highly prevalent in PD .…”

“…3 Frailty and PD share common features like age-related fatigue, low gait speed, weak grip strength, and similar pathological mechanisms. [4][5][6][7][8][9] Previous cross-sectional research investigated that frailty is common in patients with PD [10][11][12][13][14][15][16][17] and a study found that the frailty index is associated with both motor and nonmotor features of PD. 18 Patients with PD with frailty were more likely associated with cognitive impairment, dementia, orthostatic hypotension, fatigue, hallucinations, and mortality.…”

Frailty in Parkinson's disease and its association with early dementia: A longitudinal study

“…Despite the potential overestimation of index-based methods [17], frailty has consistently been shown (regardless of the tool or definition used for its estimation) to be a significant predictor of negative outcomes, both general and disease-specific, across several different diseases, settings, and regions [4,21]. In addition, one study conducted in the US from Medicare beneficiaries reported that severe frailty was associated with higher 1-year mortality, hospitalization, emergency department visits, and fall-related injury in patients with PD [22]. A negative effect of frailty on important patient-reported outcomes such as quality of life scores in Community-Dwelling Persons with PD has also been reported [23].…”

Effects of physician visit frequency for Parkinson’s disease treatment on mortality, hospitalization, and costs: a retrospective cohort study

“…Other factors with a negative influence on survival time were sex (male), older age at the time of PD diagnosis, and higher levels of long-term care. Previous studies of PD also revealed that being male [ 4 , 20 ], older [ 4 , 20 , 21 ], and experiencing severe motor symptoms [ 21 ] and frailty [ 22 ] were associated with mortality. Although the present study only included newly diagnosed patients, a higher long-term care level at the time of diagnosis showed a shorter survival time even if the estimates were adjusted for age and comorbidity.…”