Effect of frailty on resource use and cost for Medicare patients

Simpson, Kit N.; Seamon, Bryant A.; Hand, Brittany N.; Roldan, Courtney O; Taber, David J.; Moran, William P.; Simpson, Annie N.

doi:10.2217/cer-2018-0029

Cited by 41 publications

(38 citation statements)

References 23 publications

(28 reference statements)

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“…The observed hospitalization rate (for all frailty types) in this study was much lower than that for several studies [19][20][21][22][23][24][25][26][27][28]. This nding reveals that elderly Malaysians are probably healthier than elderly in other countries.…”

Section: Discussioncontrasting

confidence: 75%

Out Of Pocket Payments For Health Care Among The Elderly With Cognitive Frailty In Malaysia

Alkhodary

Aljunid

Ismail³

et al. 2020

Preprint

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Abstract Background Recently, there is a concern on cognitive frailty, as a potent risk factors for dementia, functional disability, poor quality of life and mortality among elderly. Cognitive frailty is a reversible pathological transitional stage between healthy aging and disability; it is associated with increased health care utilization and co-morbidities. The study purpose was to identify socio-demographic characteristics, co-morbidities, and out-of-pocket payments for health care among elderly Malaysians with cognitive frailty. Methods The study included all participants of the third phase of Malaysian representative LRGS-TUA community based study. Multiple types of data were collected through a structured interviewed questionnaire including Fried’s test; Clinical dementia rating test; inpatient and outpatient health care utilization and amount paid. Results A total of 1,006 participants were interviewed, with 66.18% response rate. Only 730 respondents found satisfying the inclusion criteria of not having physical disability or psychiatric problem, not terminally ill, and no history of alcohol or drugs abuse. The prevalence of cognitive frailty was 4.5%. Males represented 66.6%. Hypertension, high cholesterol level, joint pain, diabetes mellitus, and vision problems, were the most common chronic diseases among cognitive frail elderly in Malaysia (69.7%, 66.7%, 48.5%, 39.4% and 39.4%, respectively). During last six months, cognitive frailty participants utilized outpatient care at governmental clinic, governmental hospitals, and private clinics (60.6%, 21.2%, and 21.2%, respectively). Out of the cognitive frail patients, only 3.0% were admitted to hospitals during last year. Around half (53%) of the study participants were spending less than RM100 per six months for health care out of their pockets, while 26%, 13%, 8% of the study participants were spending RM101 to RM200, RM201 to RM300, and > RM300 every six months out of their pockets for seeking of care, respectively. The mean total out-of-pocket payments for six months seeking of care for elderly Malaysian citizens with cognitive frailty was around RM84 (SD = 96.0) per six months. Conclusions Cognitive frailty is not a costly phenomena among elderly Malaysian citizens. Elderly Malaysians with cognitive frailty are probably characterized with good health and well controlled co-morbidities.

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Section: Discussioncontrasting

confidence: 75%

Out Of Pocket Payments For Health Care Among The Elderly With Cognitive Frailty In Malaysia

Alkhodary

Aljunid

Ismail³

et al. 2020

Preprint

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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

275

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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“…Based on self-reported incidence of healthcare resource utilisation, cross-sectional studies in international literature have found frailty to be associated with an increased likelihood of general practice (adjusted odds ratios (OR): 2.1-4.4), specialist (OR 1.3-1.8), emergency department (OR 2.5-6.2) and inpatient (OR 2.1-3.3) service utilisation [8,[10][11][12]. These ndings were also supported by the results from prospective cohort studies [13][14][15] as well as panel studies [16].…”

Section: Introductionmentioning

confidence: 63%

Frailty and healthcare utilisation across care settings among community-dwelling older adults in Singapore

Ge¹,

Yap²,

Heng³

et al. 2020

Preprint

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Background Frailty is frequently found to be associated with increased healthcare utilisation in western countries, but little is known in Asian population. This study was conducted to investigate the association between frailty and healthcare utilisation in different care settings among community-dwelling older adults in Singapore. Methods Data from a population health survey among community-dwelling adults were linked with an administrative database to retrieve data of healthcare utilisation (including government primary care clinic visits, specialised outpatient clinic visits, emergency department visits, day surgery and hospitalisations) occurred during a six-month look-back period and six-month post-baseline respectively. Baseline frailty status was measured using the five-item FRAIL scale, which was categorised into three groups: robust (0), pre-frail (1–2), and frail (3–5). Negative binomial regression was applied to examine the association between frailty with respective healthcare utilisation (dependent variables), controlling for other confounding variables. Results In our sample of 701 older adults, 64.8% were of robust health, 27.7% were pre-frail, and 7.6% were frail. Compared to the robust group, frail individuals had a higher rate of specialised outpatient clinic visits (incidence rate ratio (IRR): 2.8, 95% confidence interval (CI): 1.2-6.5), emergency department visits (IRR: 3.1, 95%CI: 1.1-8.1), day surgery attendances (IRR: 6.4, 95%CI: 1.3-30.9), and hospitalisations (IRR: 6.7, 95%CI: 2.1-21.1) in the six-month period prior to the baseline and in subsequent six months (IRR: 3.3, 95%CI: 1.6-7.1; 6.4, 2.4-17.2; 5.8, 1.3-25.8; 13.1, 4.9-35.0; respectively), controlling for covariates. Conclusions Frailty was positively associated with the number of specialised outpatient clinic visits, emergency department visits, day surgeries and hospitalisations occurred during 6 months prior to and after the baseline. As frailty is a potentially reversible health state with early screening and intervention, providing preventive activities that delay the onset or progression of frailty should have potential effect on delaying secondary and tertiary care utilisation.

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Effect of frailty on resource use and cost for Medicare patients

Abstract: Frailty contributes greatly to cost of care, but while often correlated, is not synonymous with MCCs. Thus, it is important to control separately for frailty in studies that compare medical care use and cost.

Cited by 41 publications

References 23 publications

Out Of Pocket Payments For Health Care Among The Elderly With Cognitive Frailty In Malaysia

Out Of Pocket Payments For Health Care Among The Elderly With Cognitive Frailty In Malaysia

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

Frailty and healthcare utilisation across care settings among community-dwelling older adults in Singapore

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