Frailty Phenotype and Healthcare Costs and Utilization in Older Men

for the Osteoporotic Fractures in Men Study (MrOS)

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2034-2042
Number of pages9
JournalJournal of the American Geriatrics Society
Volume68
Issue number9
DOIs
StatePublished - Sep 1 2020

Bibliographical note

Funding Information:
The Osteoporotic Fractures in Men Study is supported by National Institutes of Health (NIH) funding. The following provide support: the National Institute on Aging, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the National Center for Advancing Translational Sciences, and the NIH Roadmap for Medical Research under these grant numbers: U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, and UL1 TR000128. Kristine E. Ensrud has received grant support from the NIH (and supporting agencies) grant as previously listed. Peggy M. Cawthon has consulted with BioAge Labs and has received research support to her institution from Nestle and Abbott, both for work outside of this project. The remaining authors have declared no conflicts of interest for this article. Study concept and design, acquisition of subjects and data, interpretation of data, and preparation of manuscript: Ensrud. Interpretation of data and critical review of the manuscript: Kats, Schousboe, Taylor, Vo, Cawthon, Hoffman, and Langsetmo. The funding agencies had no direct role in the conduct of the study; the collection, management, analyses and interpretation of the data; or preparation or approval of the manuscript. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the US Department of Veterans Affairs or the US government.

Funding Information:
Kristine E. Ensrud has received grant support from the NIH (and supporting agencies) grant as previously listed. Peggy M. Cawthon has consulted with BioAge Labs and has received research support to her institution from Nestle and Abbott, both for work outside of this project. The remaining authors have declared no conflicts of interest for this article.

Funding Information:
The Osteoporotic Fractures in Men Study is supported by National Institutes of Health (NIH) funding. The following provide support: the National Institute on Aging, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the National Center for Advancing Translational Sciences, and the NIH Roadmap for Medical Research under these grant numbers: U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, and UL1 TR000128.

Publisher Copyright:
Published 2020. This article is a U.S. Government work and is in the public domain in the USA.

Keywords

  • frailty
  • functional limitations
  • healthcare costs
  • healthcare utilization
  • multimorbidity

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

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