老年人虚弱表型与医疗保健费用和利用
Frailty Phenotype and Healthcare Costs and Utilization in Older Men.
机构信息
Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota, USA.
出版信息
J Am Geriatr Soc. 2020 Sep;68(9):2034-2042. doi: 10.1111/jgs.16522. Epub 2020 May 13.
OBJECTIVES
To determine the association of the frailty phenotype with subsequent healthcare costs and utilization.
DESIGN
Prospective cohort study (Osteoporotic Fracture in Men [MrOS]).
SETTING
Six US sites.
PARTICIPANTS
A total of 1,514 community-dwelling men (mean age = 79.3 years) participating in the MrOS Year 7 (Y7) examination linked with their Medicare claims data.
MEASUREMENTS
At Y7, the frailty phenotype was operationalized using five components and categorized as robust, pre-frail, or frail. Multimorbidity and a frailty indicator (approximating the deficit accumulation index) were derived from claims data. Functional limitations were assessed by asking about difficulty performing instrumental activities of daily living. Total direct healthcare costs and utilization were ascertained during 36 months following Y7.
RESULTS
Mean of total annualized costs (2018 dollars) was $5,707 (standard deviation [SD] = 8,800) among robust, $8,964 (SD = 18,156) among pre-frail, and $20,027 (SD = 27,419) among frail men. Compared with robust men, frail men (cost ratio [CR] = 2.35; 95% confidence interval [CI] = 1.88-2.93) and pre-frail men (CR = 1.28; 95% CI = 1.11-1.48) incurred greater total costs after adjustment for demographics, multimorbidity, and cognitive function. Associations of phenotypic pre-frailty and frailty with higher total costs were somewhat attenuated but persisted after further consideration of functional limitations and a claims-based frailty indicator. Each individual frailty component was also associated with higher total costs. Frail vs robust men had higher odds of hospitalization (odds ratio [OR] = 2.62; 95% CI = 1.75-3.91) and skilled nursing facility (SNF) stay (OR = 3.36; 95% CI = 1.83-6.20). A smaller but significant effect of the pre-frail category on SNF stay was present.
CONCLUSION
Phenotypic pre-frailty and frailty were associated with higher subsequent total healthcare costs in older community-dwelling men after accounting for a claims-based frailty indicator, functional limitations, multimorbidity, cognitive impairment, and demographics. Assessment of the frailty phenotype or individual components such as slowness may improve identification of older community-dwelling adults at risk for costly extensive care.
目的
确定虚弱表型与随后的医疗保健费用和利用之间的关联。
设计
前瞻性队列研究（男性骨质疏松性骨折[MrOS]）。
地点
美国六个地点。
参与者
共有 1514 名居住在社区的男性（平均年龄=79.3 岁）参加了 MrOS 第 7 年（Y7）检查，并与他们的医疗保险索赔数据相关联。
测量
在 Y7 时，使用五个组成部分操作虚弱表型，并分为强壮、前期虚弱或虚弱。多种合并症和虚弱指标（近似于缺陷积累指数）来自索赔数据。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 Y7 后 36 个月期间确定总直接医疗保健费用和利用情况。
结果
强壮男性的平均年度总成本（2018 美元）为 5707 美元（标准差[SD]=8800），前期虚弱男性为 8964 美元（SD=18156），虚弱男性为 20027 美元（SD=27419）。与强壮男性相比，虚弱男性（成本比[CR]=2.35；95%置信区间[CI]=1.88-2.93）和前期虚弱男性（CR=1.28；95%CI=1.11-1.48）在调整人口统计学、多种合并症和认知功能后，总费用更高。表型前期虚弱和虚弱与更高的总费用之间的关联在一定程度上减弱，但在进一步考虑功能限制和基于索赔的虚弱指标后仍然存在。每个虚弱的单独组成部分也与更高的总费用相关。虚弱与强壮的男性住院（比值比[OR]=2.62；95%置信区间[CI]=1.75-3.91）和入住熟练护理机构（SNF）（OR=3.36；95%CI=1.83-6.20）的可能性更高。前期虚弱类别对 SNF 入住的影响较小，但仍有显著意义。
结论
在考虑基于索赔的虚弱指标、功能限制、多种合并症、认知障碍和人口统计学因素后，老年社区居住男性的虚弱表型与随后的总医疗保健费用较高相关。虚弱表型或速度等单个组成部分的评估可能会改善对需要昂贵广泛护理的老年社区居住成年人的风险识别。
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