PAM4 HEALTHCARE UTILIZATION AND HOSPITALIZATION COSTS AMONG FRAIL AND AT-NUTRITIONAL RISK OR MALNOURISHED OLDER ADULTS

Abstract

Despite the high prevalence of malnutrition risk among community-dwelling older adults, the economic impact of malnutrition has not been thoroughly examined. The objective is to determine how nutritional status and frailty affect healthcare resource utilization and hospitalization costs in a population-based cohort of Spanish older adults. Data from 1,660 community-dwelling adults (≥65 years) participating in the Toledo Study on Healthy Ageing waves 2 (year 2011-2013) and 3 (year 2015) were analyzed. Criteria for being at nutritional risk included body mass index (BMI) between 20-25 kg/m2, unintentional weight loss (≥4.5 kg in the last year), and/or low hand grip strength (<30.4 kg for men or 19.8 kg for women). Malnutrition status was defined as BMI<20 kg/m2 and participants met any of the other two criteria. Since only 6 participants were classified as malnourished, a single group was created including both at-risk and malnourished participants. Frailty status was measured by the 40-item Frailty Index and the Frailty Trait Score, which identify different but sometimes overlapping frail populations. Generalized-linear models were employed for healthcare resources utilization and hospitalization costs, including nutritional status and frailty, and adjusting for covariates. Compared to frail and well-nourished individuals, frail and at-risk/malnourished individuals had longer hospital stays (4.0-4.6 days vs. 2.4-3.5 days depending on the frailty measure used, p= 0.042), and higher hospitalization costs (€773-€856 vs. €467-€499, p<0.001). Moreover, in frail older adults, being at-risk/malnourished at baseline significantly predicted longer hospital stays and higher hospital costs in the following wave, regardless of the number of covariates introduced. Spanish frail older adults who were at-risk/malnourished and living in the community experienced longer hospital stays and greater hospital costs. These results highlight the importance of proper identification of nutritional status among frail older adults living in the community and targeted nutrition-focused interventions to prevent and properly treat malnutrition.