Frailty and healthcare costs—longitudinal results of a prospective cohort study

Hajek, André; Bock, Jens‐Oliver; Saum, Kai Uwe; Matschinger, Herbert; Brenner, Hermann; Holleczek, Bernd; Haefeli, Walter E.; Heider, Dirk; König, Hans Helmut

doi:10.1093/ageing/afx157

Cited by 154 publications

(105 citation statements)

References 30 publications

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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

245

180

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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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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

245

180

View full text Add to dashboard Cite

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“…Frailty is a dynamic state, and the possibility of slowing or reversing the cascade of decline in functional capacity with targeted multicomponent interventions has been proposed [11]. The total healthcare cost increase related to an individual transitioning into a frail state is remarkable, so the possibility of preventing or delaying the transition might lead to substantial cost-savings [12]. Physician's assessment of a patient's risk for adverse effects has been shown to be poorer than an objective measurement [13].…”

Section: Introductionmentioning

confidence: 99%

Frailty, walking ability and self-rated health in predicting institutionalization: an 18-year follow-up study among Finnish community-dwelling older people

Viljanen

Salminen

Irjala³

et al. 2020

Aging Clin Exp Res

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Background In clinical practice, there is a need for an instrument to screen older people at risk of institutionalization. Aims To analyze the association of frailty, walking-ability and self-rated health (SRH) with institutionalization in Finnish community-dwelling older people. Methods In this prospective study with 10-and 18-year follow-ups, frailty was assessed using FRAIL Scale (FS) (n = 1087), Frailty Index (FI) (n = 1061) and PRISMA-7 (n = 1055). Walking ability was assessed as self-reported ability to walk 400 m (n = 1101). SRH was assessed by a question of general SRH (n = 1105). Cox regression model was used to analyze the association of the explanatory variables with institutionalization. Results The mean age of the participants was 73.0 (range 64.0-97.0) years. Prevalence of institutionalization was 40.8%. In unadjusted models, frailty was associated with a higher risk of institutionalization by FS in 10-year follow-up, and FI in both follow-ups. Associations by FI persisted after age-and gender-adjustments in both follow-ups. By PRISMA-7, frailty predicted a higher risk of institutionalization in both follow-ups. In unadjusted models, inability to walk 400 m predicted a higher risk of institutionalization in both follow-ups and after adjustments in 10-year follow-up. Poor SRH predicted a higher risk of institutionalization in unadjusted models in both follow-ups and after adjustments in 10-year follow-up. Discussion Simple self-reported items of walking ability and SRH seemed to be comparable with frailty indexes in predicting institutionalization among community-dwelling older people in 10-year follow-up. Conclusions In clinical practice, self-reported walking ability and SRH could be used to screen those at risk.

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“…It is defined as a loss of resources in several domains leading to the inability to respond to physical or psychosocial stress [1][2][3]. Frailty predicts increased falls, hospitalization, dependence, morbidity, mortality and increase in healthcare costs [1,2,[4][5][6][7]. Prevalence of frailty has varied to some extent between studies, but it has been found to increase with age and to be higher in women than in men [8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Frailty and mortality: an 18-year follow-up study among Finnish community-dwelling older people

et al. 2019

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Background There is a lack of agreement about applicable instrument to screen frailty in clinical settings. Aims To analyze the association between frailty and mortality in Finnish community-dwelling older people. Methods This was a prospective study with 10-and 18-year follow-ups. Frailty was assessed using FRAIL scale (FS) (n = 1152), Rockwood's frailty index (FI) (n = 1126), and PRISMA-7 (n = 1124). To analyze the association between frailty and mortality, Cox regression model was used. Results Prevalence of frailty varied from 2 to 24% based on the index used. In unadjusted models, frailty was associated with higher mortality according to FS (hazard ratio 7.96 [95% confidence interval 5.10-12.41] in 10-year follow-up, and 6.32 [4.17-9.57] in 18-year follow-up) and , and 3.95 [3.16-4.94], respectively) in both follow-ups. Also being pre-frail was associated with higher mortality according to both indexes in both follow-ups (FS 2.19 [1.78-2.69], and 1.69 [1.46-1.96]; FI 1.81[1.25-2.62], and 1.31 [1.07-1.61], respectively). Associations persisted even after adjustments. Also according to PRISMA-7, a binary index (robust or frail), frailty was associated with higher mortality in 10-(4.41 [3.55-5.34]) and 18-year follow-ups (3.78 [3.19-4.49]). Discussion Frailty was associated with higher mortality risk according to all three frailty screening instrument used. Simple and fast frailty indexes, FS and PRISMA-7, seemed to be comparable with a multidimensional time-consuming FI in predicting mortality among community-dwelling Finnish older people. Conclusions FS and PRISMA-7 are applicable frailty screening instruments in clinical setting among community-dwelling Finnish older people.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Frailty and healthcare costs—longitudinal results of a prospective cohort study

Abstract: our data stress the economic relevance of frailty in late life. Postponing or reducing frailty might be fruitful in order to reduce healthcare costs.

Cited by 154 publications

References 30 publications

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

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

Frailty, walking ability and self-rated health in predicting institutionalization: an 18-year follow-up study among Finnish community-dwelling older people

Frailty and mortality: an 18-year follow-up study among Finnish community-dwelling older people

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