Abstract
BackgroundFrailty, 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.MethodsParticipants 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.ResultsAmong 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.ConclusionsAlthough 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.
Highlights
Frailty, a syndrome resulting in heightened risk of negative outcomes for older adults, is increasing across the globe
Despite a faster progression of ageing in low-income and middle-income countries (LMICs) than in high income countries (HICs) [7, 8], there is a dearth of information about the impacts of frailty within these regions [7, 9, 10]
The added complication of HIV-infection, which has been associated with increased frailty and premature ageing within one sub-Saharan Africa (SSA) study [22], might be expected to have a compounding effect on both health service costs and usage
Summary
A syndrome resulting in heightened risk of negative outcomes for older adults, is increasing across the globe. Several previous studies conducted within HICs have observed a positive relationship between frailty and health service expenditure and usage respectively. The added complication of HIV-infection, which has been associated with increased frailty and premature ageing within one SSA study [22], might be expected to have a compounding effect on both health service costs and usage. It is unclear what the overall effect of these differences might be with respect to the overall impact on the relationship between frailty, health service costs and health service utilisation
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