Self-Reported Frailty and Health Care Utilization in Community-Dwelling Middle-Aged and Older Adults in the United States.

Abstract

Frailty, a dynamic state, is a consequence of cumulative deficits in multiple physiological systems accompanied by an increased vulnerability to stressor events. 1 Hoogendijk E.O. Afilalo J. Ensrud K.E. Kowal P. Onder G. Fried L.P. Frailty: implications for clinical practice and public health. Lancet. 2019; 394: 1365-1375 Abstract Full Text Full Text PDF PubMed Scopus (701) Google Scholar The aging of the population has increased the prevalence of frailty substantially, especially among the costliest patients 2 Kojima G. Increased healthcare costs associated with frailty among community-dwelling older people: a systematic review and meta-analysis. Arch Gerontol Geriatr. 2019; 84: 103898 Crossref PubMed Scopus (36) Google Scholar ; however, the current health care response to frailty is mainly reactive and acute care–based. Some have proposed primary care approaches to frailty management in community settings. 3 Turner G. Clegg A. British Geriatrics Society, Age UK, Royal College of General PractionersBest practice guidelines for the management of frailty: a British Geriatrics Society, Age UK and Royal College of General Practitioners report. Age Ageing. 2014; 43: 744-747 Crossref PubMed Scopus (345) Google Scholar Although frailty occurs more often in the older population, it can occur at any time in a person’s life. 1 Hoogendijk E.O. Afilalo J. Ensrud K.E. Kowal P. Onder G. Fried L.P. Frailty: implications for clinical practice and public health. Lancet. 2019; 394: 1365-1375 Abstract Full Text Full Text PDF PubMed Scopus (701) Google Scholar Thus, identifying frailty earlier is advantageous for its reversal or control. However, previous studies on frailty have mainly been conducted in people 65 years and older. It is well known that frailty in older adults is independently associated with health care burden across acute and post-acute care, and outpatient sectors. 4 Ensrud K.E. Kats A.M. Schousboe J.T. et al. Frailty phenotype and healthcare costs and utilization in older women. J Am Geriatr Soc. 2018; 66: 1276-1283 Crossref PubMed Scopus (60) Google Scholar There is a knowledge gap in understanding the association between frailty and health care utilization in community-dwelling middle-aged adults. With a few exceptions, 5 Bandeen-Roche K. Seplaki C.L. Huang J. et al. Frailty in older adults: a nationally representative profile in the United States. J Gerontol A Biol Sci Med Sci. 2015; 70: 1427-1434 Crossref PubMed Google Scholar ,6 Kurnat-Thoma E.L. Murray M.T. Juneau P. Frailty and determinants of health among older adults in the United States 2011-2016. J Aging Health. 2022; 34: 233-244 Crossref Scopus (4) Google Scholar most prior studies of frailty used nonrepresentative samples. With a nationally representative sample, we describe the prevalence of frailty in the United States and evaluate the associations between frailty and health care utilization in community-dwelling middle-aged and older adults. These results are discussed to inform policymaking and quality improvements in primary care settings.