Abstract
BackgroundFrailty 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.MethodsData 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.ResultsIn 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 6 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.ConclusionsFrailty 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.
Highlights
Frailty is frequently found to be associated with increased healthcare utilisation in western countries, but little is known in Asian population
This study aims to investigate the association of frailty and healthcare utilisation in community-dwelling older adults aged 60 years and above, with utilisation data collected in two different periods of time: 1) 6 months prior to the baseline frailty assessment, and 2) 6 months after the baseline assessment
Comparing the profile across the three frailty groups (Table 2), we showed that frail elderly were significantly older, and had a higher proportion with multimorbidity or required assistance in any Activities of daily living (ADLs)
Summary
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. In Singapore, 21.4% of the total population consisted of individuals aged 60 years and above in 2019 [5], which is projected to reach 40% by year 2050 [6] Such drastic rise in both the number and proportion of older population inevitably translate into a surge in the number and proportion of frail individuals [7], which brings various challenges to health care and healthcare delivery as they are recognised as intensive users of health care services [8]. To forge a frailty-ready healthcare system, Singapore has re-organised its public healthcare system from six regional healthcare systems (RHS) into three integrated clusters to allow each cluster to have a fuller range of assets, capabilities, services and networks across different care settings to meet the challenges of population ageing and further care needs [9].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
