Frailty and Health Care Utilization among Community-Dwelling Older Patients with Diabetes Mellitus

Abstract

Frailty is a state of vulnerability to stressors resulting in higher morbidity, mortality and healthcare utilization in older adults. Frailty impact on healthcare utilization in patients with T2DM is not well characterized. The aim of this study was to determine in a community cohort of older patients (65 years and older) with type 2 diabetes mellitus (T2DM) whether frailty is associated with healthcare utilization. Community dwelling Veterans with T2DM underwent frailty assessment with the validated 5-item FRAIL Scale (frail ≥ 3; pre-frail 1-2; robust 0 points) between January 2016 and December 2017. At one year follow-up, we aggregated data on patients with a least one primary care visit, hospitalization and/or ER visit. Binomial logistic regression was used to examine the association between frailty and emergency department (ED) visits or hospitalizations. Among 868 patients (mean age 74 ± 7 years, 98% men), 31% were robust, 36% prefrail, and 33% frail. Over a mean follow-up period of 274 ± 90 days, 1221 primary care visits, 396 ED visits, and 219 hospitalizations occurred. Frailty was associated with an increased risk for ED visits (odds ratio: 1.73, 95% CI 1.19-2.52) and an increased risk for hospitalizations (odds ratio: 3.88, 95% CI 1.18-8.22). The population-attributable risk associated with frailty was 51% for ED visits and 40% for hospitalizations. In conclusion, frailty is a strong predictor of ED visits and hospitalizations in older patients with T2DM. As frailty is a potentially treatable condition, it should be part of the clinical evaluation of patients with T2DM. Disclosure S. Priyadarshni: None. S. Nelluri: None. Z. Rahaman: None. M.J. Mintzer: None. S. Dang: None. W. Valencia: None. J.G. Ruiz: None.