The impact of frailty on healthcare utilisation in Ireland: evidence from the Irish longitudinal study on ageing

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Abstract

Introduction

To examine the impact of frailty on medical and social care utilisation among the Irish community-dwelling older population to inform strategies of integrated care for older people with complex needs.

Methods

Participants aged ≥65 years from the Irish Longitudinal Study on Ageing (TILDA) representative of the Irish community-dwelling older population were analysed ( n = 3507). The frailty index was used to examine patterns of utilisation across medical and social care services. Multivariate logistic and negative binomial regression models were employed to examine the impact of frailty on service utilisation outcomes after controlling for other factors.

Results

The prevalence of frailty and pre-frailty was 24% (95% CI: 23, 26%) and 45% (95% CI: 43, 47%) respectively. Frailty was a significant predictor of utilisation of most social care and medical care services after controlling for the main correlates of frailty and observed individual effects.

Conclusions

Frailty predicts utilisation of many different types of healthcare services rendering it a useful risk stratification tool for targeting strategies of integrated care. The pattern of care is predominantly medical as few of the frail older population use social care prompting questions about sub-groups of the frail older population with unmet care needs.

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-017-0579-0) contains supplementary material, which is available to authorized users.

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Most cited references 28

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Five Laws for Integrating Medical and Social Services: Lessons from the United States and the United Kingdom

Walter N. Leutz (1999)

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Explaining the decline in coronary heart disease mortality in Finland between 1982 and 1997.

Tiina Laatikainen, Simon Capewell, Erkki Vartiainen … (2005)

In Finland since the 1980s, coronary heart disease mortality has declined more than might be predicted by risk factor reductions alone. The aim of this study was to assess how much of the decline could be attributed to improved treatments and risk factor reductions. The authors used the cell-based IMPACT mortality model to synthesize effectiveness of treatments and risk factor reductions with data on treatments administered to patients and trends in cardiovascular risk factors in the population. Cardiovascular risk factors were measured in random samples of patients in 1982 (n=8,501) and 1997 (n=4,500). Mortality and treatment data were obtained from the National Causes of Death Register, Hospital Discharge Register, social insurance data, and medical records. Estimated and observed changes in coronary heart disease mortality were used as main outcome measures. Between 1982 and 1997, coronary heart disease mortality rates declined by 63%, with 373 fewer deaths in 1997 than expected from baseline mortality rates in 1982. Improved treatments explained approximately 23% of the mortality reduction, and risk factors explained some 53-72% of the reduction. These findings highlight the value of a comprehensive strategy that promotes primary prevention programs and actively supports secondary prevention. It also emphasizes the importance of maximizing population coverage of effective treatments.

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Frailty predicts increased hospital and six-month healthcare cost following colorectal surgery in older adults.

Marc Moss, Gregory Stiegmann, D. Wu … (2011)

The purpose of this study was to determine the relationship of frailty and 6-month postoperative costs. Subjects aged ≥ 65 years undergoing elective colorectal operations were enrolled in a prospective observational study. Frailty was assessed by a validated measure of function, cognition, nutrition, comorbidity burden, and geriatric syndromes. Frailty was quantified by summing the number of positive characteristics in each subject. Sixty subjects (mean age, 75 ± 8 years) were studied. Inpatient mortality was 2% (n = 1). Overall, 40% of subjects (n = 24) were considered nonfrail, 22% (n = 13) were prefrail, and 38% (n = 22) were frail. With advancing frailty, hospital costs increased (P < .001) and costs from discharge to 6-months increased (P < .001). Higher degrees of frailty were related to increased rates of discharge institutionalization (P < .001) and 30-day readmission (P = .044). A simple, brief preoperative frailty assessment accurately forecasts increased surgical hospital costs and postdischarge to 6-month healthcare costs after colorectal operations in older adults. Published by Elsevier Inc.

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Author and article information

Contributors

Lorna Roe:

ORCID: http://orcid.org/0000-0002-6751-313X

loroe@tcd.ie

Charles Normand: normandc@tcd.ie

Maev-Ann Wren: maev-ann.wren@esri.ie

John Browne: j.browne@ucc.ie

Aisling M. O’Halloran: aiohallo@tcd.ie

Journal

Journal ID (nlm-ta): BMC Geriatr

Journal ID (iso-abbrev): BMC Geriatr

Title: BMC Geriatrics

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2318

Publication date (Electronic): 5 September 2017

Publication date PMC-release: 5 September 2017

Publication date Collection: 2017

Volume: 17

Electronic Location Identifier: 203

Affiliations

[1 ]ISNI 0000 0004 1936 9705, GRID grid.8217.c, Centre for Health Policy and Management, , Trinity College Dublin, ; 3-4 Foster Place, College Green, Dublin 2, Ireland

[2 ]GRID grid.18377.3a, The Economic and Social Research Institute, Whitaker Square, ; Sir John Rogerson’s Quay, Dublin 2, Ireland

[3 ]ISNI 0000000123318773, GRID grid.7872.a, Epidemiology & Public Health, , University College Cork, ; College Road, Cork, Ireland

[4 ]ISNI 0000 0004 1936 9705, GRID grid.8217.c, The Irish Longitudinal Study on Ageing, , Trinity College Dublin, ; College Green, Dublin 2, Ireland

Author information

Lorna Roe http://orcid.org/0000-0002-6751-313X

Article

Publisher ID: 579

DOI: 10.1186/s12877-017-0579-0

PMC ID: 5583758

PubMed ID: 28874140

SO-VID: 6944520d-4f50-4be5-8705-25671cefafaf

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 13 April 2017

Date accepted : 4 August 2017

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100010414, Health Research Board;

Award ID: PHD/2007/16

Award Recipient : Lorna Roe

Funded by: Irish Institute of Public Health, Division of Ageing Research and Development (formerly, Centre for Ageing Research and Development in Ireland- CARDI)

Award ID: LP3

Custom metadata

ScienceOpen disciplines: Geriatric medicine

Keywords: frailty,healthcare utilisation,complex needs,ageing,health and social care planning

Data availability:

ScienceOpen disciplines: Geriatric medicine

Keywords: frailty, healthcare utilisation, complex needs, ageing, health and social care planning

The impact of frailty on healthcare utilisation in Ireland: evidence from the Irish longitudinal study on ageing

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Introduction

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Most cited references 28

Five Laws for Integrating Medical and Social Services: Lessons from the United States and the United Kingdom

Explaining the decline in coronary heart disease mortality in Finland between 1982 and 1997.

Frailty predicts increased hospital and six-month healthcare cost following colorectal surgery in older adults.

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