Cho Jinmyoung, Salas Joanne, Scherrer Jeffery F, Grossberg George
Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA.
AHEAD Institute, Saint Louis University, St. Louis, MO, USA.
J Frailty Aging. 2025 May 23;14(4):100053. doi: 10.1016/j.tjfa.2025.100053.
Frailty increases vulnerability for adverse outcomes in older adults. Characterizing the prevalence and distribution of frailty can help guide healthcare service decision-making and policy.
This study evaluated the association between frailty and healthcare utilization and interactions by demographic characteristics.
Using electronic health records (2018-2022), we conducted a retrospective cohort study with 355,266 patients ≥65 years of age who had ≥2 ambulatory office visits in separate years in the 4-year baseline period (2018-2021). The Gilbert Frailty Index (GFI) was calculated (low vs. intermediate vs. high) using ICD-10 codes. One-year utilization outcomes in 2022 included high outpatient clinic utilizations (OCU), inpatient (IP), emergency department (ED), and nursing home (NH) admissions. Fully adjusted log-binomial regression models were calculated overall and by race (White vs. Black), age groups, and gender.
The sample was 74.5(±7.5) years of age, 57.7 % female, 89.2 % White, and 13.5 % categorized as GFI high. After adjustment for covariates, GFI high had the highest risk for all outcomes (RR=3.31 for IP; 2.77 for ED; 4.26 for NH; 1.60 for high OCU). We observed significant interactions by race, gender, and age for some outcomes. Effects of GFI high vs. low were larger for White (IP, ED, & high OCU), female patients (ED & high OCU), and younger patients (IP). Conversely, the effects of GFI high vs. low were strongest in older patients for ED, IP and high OCU.
Monitoring frailty and paying attention to patient's demographic characteristics is needed to best estimate associations between frailty and healthcare utilization.
衰弱会增加老年人出现不良后果的易感性。了解衰弱的患病率和分布情况有助于指导医疗服务决策和政策制定。
本研究评估了衰弱与医疗服务利用之间的关联以及按人口统计学特征的相互作用。
利用电子健康记录（2018 - 2022年），我们对355,266名65岁及以上的患者进行了一项回顾性队列研究，这些患者在4年基线期（2018 - 2021年）的不同年份有≥2次门诊就诊。使用国际疾病分类第十版（ICD - 10）编码计算吉尔伯特衰弱指数（GFI）（低、中、高）。2022年的一年利用结果包括高门诊诊所利用率（OCU）、住院（IP）、急诊科（ED）和疗养院（NH）入院情况。总体上以及按种族（白人对黑人）、年龄组和性别计算了完全调整的对数二项回归模型。
样本年龄为74.5（±7.5）岁，女性占57.7%，白人占89.2%，13.5%被归类为GFI高。在对协变量进行调整后，GFI高的患者出现所有结果的风险最高（IP的风险比RR = 3.31；ED的RR = 2.77；NH的RR = 4.26；高OCU的RR = 1.60）。我们观察到某些结果在种族、性别和年龄方面存在显著的相互作用。对于白人（IP、ED和高OCU）、女性患者（ED和高OCU）以及年轻患者（IP），GFI高与低的影响更大。相反，对于ED、IP和高OCU，GFI高与低的影响在老年患者中最为明显。
需要监测衰弱情况并关注患者的人口统计学特征，以便最好地估计衰弱与医疗服务利用之间的关联。
