Article Impact Level: HIGH Data Quality: STRONG Summary of Geriatrics & Gerontology International, ggi.14955. https://doi.org/10.1111/ggi.14955 Dr. Barbara Toson et al.
Points
- In a cohort study of individuals aged 65 and older, researchers investigated the effects of frailty on the use of permanent residential aged care (PRAC), healthcare costs, and mortality over 36 months after their first government-funded home care assessment.
- The matched cohort included 13,315 non-frail controls and 52,678 participants, revealing that frail individuals had a significantly higher mortality rate (IRR: 1.76) and were more likely to enter PRAC (IRR: 1.73) than non-frail individuals.
- Over three years, healthcare costs for frail individuals totaled $1.28 billion, compared to the expected $885 million if they were not frail, indicating a substantial economic impact of frailty.
- Hospital admissions were the primary contributor to the mean monthly excess cost for frail individuals, accounting for $345 (75%) of the additional $457 cost per person.
- Early interventions and home care services for older adults before they become frail could reduce the progression of frailty, lower the need for residential care, and decrease healthcare expenditures.
Summary
In a cohort study of individuals aged 65 years and older, researchers explored the impact of frailty on the utilization of permanent residential aged care (PRAC), healthcare costs, and mortality following their first assessment by an Aged Care Assessment Team (ACAT) for a government-funded home care package. The study included participants who completed their first ACAT assessment in 2013, with a follow-up period of up to 36 months. Frail and non-frail individuals were matched using caliper matching without replacement to adjust for potential unobserved confounders. Poisson regression was employed to estimate the incidence rate ratios (IRRs) for PRAC admission and mortality rates. Healthcare costs—including hospital admissions, emergency department presentations, primary care consultations, and pharmaceutical use—were summarized monthly from the ACAT assessment to the end of follow-up, PRAC entry, or death, stratified by frailty status.
The matched cohort comprised 13,315 non-frail controls and up to three frail individuals per control, totaling 52,678 participants. Frail individuals exhibited a significantly higher mortality rate than non-frail individuals, with an IRR of 1.76 (95% confidence interval [CI]: 1.70–1.83). Similarly, the likelihood of entering PRAC was greater among frail individuals, with an IRR of 1.73 (95% CI: 1.67–1.79). Over the three-year post-assessment period, total healthcare costs for 39,363 frail individuals amounted to $1,277,659,900, compared to expected costs of $885,322,522 had they not been frail. The primary contributor to the mean monthly excess cost per frail individual was hospital admissions, accounting for $345 (75%) of the excess $457 (standard deviation [SD]: $3,192) per person.
The study concludes that frailty is associated with higher mortality rates, increased admission to permanent residential aged care, and substantial and sustained excess healthcare costs over time. These findings emphasize the potential economic value of providing home care services to older adults before they become frail, suggesting that early interventions could reduce the progression to frailty, decrease the need for residential care, and lower healthcare expenditures.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1111/ggi.14955
References Toson, B., Edney, L. C., Haji Ali Afzali, H., Visvanathan, R., Khadka, J., & Karnon, J. (2024). Economic burden of frailty in older adults accessing community‐based aged care services in Australia. Geriatrics & Gerontology International, ggi.14955. https://doi.org/10.1111/ggi.14955
