Abstract
BackgroundThe concept of frailty is rapidly gaining attention as an independent syndrome with high prevalence in older adults. Thereby, frailty is often related to certain adverse outcomes like mortality or disability. Another adverse outcome discussed is increased health care utilization. However, only few studies examined the impact of frailty on health care utilization and corresponding costs. The aim of this study was therefore to investigate comprehensively the relationship between frailty, health care utilization and costs.MethodsCross sectional data from 2598 older participants (57–84 years) recruited in the Saarland, Germany, between 2008 and 2010 was used. Participants passed geriatric assessments that included Fried’s five frailty criteria: weakness, slowness, exhaustion, unintentional weight loss, and physical inactivity. Health care utilization was recorded in the sectors of inpatient treatment, outpatient treatment, pharmaceuticals, and nursing care.ResultsPrevalence of frailty (≥3 symptoms) was 8.0 %. Mean total 3-month costs of frail participants were €3659 (4 or 5 symptoms) and €1616 (3 symptoms) as compared to €642 of nonfrail participants (no symptom). Controlling for comorbidity and general socio-demographic characteristics in multiple regression models, the difference in total costs between frail and non-frail participants still amounted to €1917; p < .05 (4 or 5 symptoms) and €680; p < .05 (3 symptoms). Among the 5 symptoms of frailty, weight loss and exhaustion were significantly associated with total costs after controlling for comorbidity.ConclusionsThe study provides evidence that frailty is associated with increased health care costs. The analyses furthermore indicate that frailty is an important factor for health care costs independent from pure age and comorbidity. Costs were rather attributable to frailty (and comorbidity) than to age. This stresses that the overlapping concepts of multimorbidity and frailty are both necessary to explain health care use and corresponding costs among older adults.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1360-3) contains supplementary material, which is available to authorized users.
Highlights
The concept of frailty is rapidly gaining attention as an independent syndrome with high prevalence in older adults
We calculated two-part models [52, 53], with the first part specified as ‘logit’, and the second part as glm with log link function and gamma distribution. For both total and sectoral regression models, we present the marginal effects at means of all variables obtained from the ‘twopm’ command [54], which can be interpreted in the same metric as the dependent variable, i.e. 3-month health care costs
Frailty was strongly associated with total health care costs with this association persisting in regression models that controlled for comorbidity
Summary
The concept of frailty is rapidly gaining attention as an independent syndrome with high prevalence in older adults. As the number of people in old age increases, many studies investigated the impact of multimorbidity on health care costs [4]. These studies find in general a positive association of multimorbidity and health care. Another medical phenomenon associated with age is people’s vulnerability to negative health outcomes and the general loss of resources. This phenomenon of frailty has increasingly received attention during the past decades. It has been shown that frailty is frequent in old age [5], and the number of frail people is expected to rise rapidly due to demographic change, stressing its importance for health care systems
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