Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.
J Am Geriatr Soc. 2018 Jul;66(7):1276-1283. doi: 10.1111/jgs.15381. Epub 2018 Apr 23.
To determine the association of the frailty phenotype with subsequent healthcare costs and utilization.
Prospective cohort study (Study of Osteoporotic Fractures (SOF)).
Four U.S. sites.
Community-dwelling women (mean age 80.2) participating in SOF Year 10 (Y10) examination linked with their Medicare claims data (N=2,150).
At Y10, frailty phenotype defined using criteria similar to those used in the Cardiovascular Health Study frailty phenotype and categorized as robust, intermediate stage, or frail. Participant multimorbidity burden ascertained using claims data. Functional limitations assessed by asking about difficulty performing instrumental activities of daily living. Total direct healthcare costs and utilization ascertained during 12 months after Y10.
Mean total annualized cost±standard deviation (2014 dollars) was $3,781±6,920 for robust women, $6,632±12,452 for intermediate stage women, and $10,755 ± 16,589 for frail women. After adjustment for age, site, multimorbidity burden, and cognition, frail women had greater mean total (cost ratio (CR)=1.91, 95% confidence interval (CI)=1.59-2.31) and outpatient (CR=1.55, 95% CI=1.36-1.78) costs than robust women and greater odds of hospitalization (odds ratio (OR)=2.05, 95% CI=1.47-2.87) and a skilled nursing facility stay (OR=3.85, 95% CI=1.88-7.88). There were smaller but significant effects of the intermediate stage category on these outcomes. Individual frailty components (shrinking, poor energy, slowness, low physical activity) were also each associated with higher total costs. Functional limitations partially mediated the association between the frailty phenotype and total costs (CR further adjusted for self-reported limitations=1.32, 95% CI=1.07-1.63 for frail vs robust; CR=1.35, 95% CI=1.18-1.55 for intermediate stage vs robust women).
Intermediate stage and frail older community-dwelling women had higher subsequent total healthcare costs and utilization after accounting for multimorbidity and functional limitations. Frailty phenotype assessment may improve identification of older adults likely to require costly, extensive care.
确定虚弱表型与随后的医疗保健成本和利用之间的关联。
前瞻性队列研究（骨质疏松性骨折研究（SOF））。
美国四个地点。
参加 SOF 第 10 年（Y10）检查的社区居住女性（平均年龄 80.2 岁），并与她们的医疗保险索赔数据相关联（N=2150）。
在 Y10 时，使用与心血管健康研究虚弱表型中使用的标准相似的标准定义虚弱表型，并分为强壮、中间阶段或虚弱。使用索赔数据确定参与者的多种合并症负担。通过询问进行日常活动的工具性活动的困难来评估功能限制。在 Y10 后 12 个月内确定总直接医疗保健费用和使用情况。
强壮女性的平均年化总成本±标准差（2014 美元）为 3781±6920 美元，中间阶段女性为 6632±12452 美元，虚弱女性为 10755±16589 美元。调整年龄、地点、多种合并症负担和认知后，虚弱女性的总（成本比（CR）=1.91，95%置信区间（CI）=1.59-2.31）和门诊（CR=1.55，95% CI=1.36-1.78）成本均高于强壮女性，并且虚弱女性住院（比值比（OR）=2.05，95% CI=1.47-2.87）和入住熟练护理设施（OR）的几率更高=3.85，95% CI=1.88-7.88）。中间阶段类别的这些影响较小，但具有统计学意义。虚弱表型的个别脆弱成分（萎缩、能量差、速度慢、体力活动少）也与总费用较高相关。功能限制部分解释了虚弱表型与总费用之间的关联（进一步调整为报告的限制的脆弱比强壮的 CR=1.32，95% CI=1.07-1.63；CR=1.35，95% CI=1.18-1.55 对于中间阶段比强壮的女性）。
在考虑多种合并症和功能限制后，年龄较大的社区居住女性处于中间阶段和虚弱状态，随后的总医疗保健费用和利用率较高。虚弱表型评估可能会改善识别需要昂贵、广泛护理的老年人。
