ABSTRACT
@#Life expectancy from birth is increasing dramatically. Due to this increase, the population of elderly people will increase. Consequently, geriatric related illnesses will increase leading to increased necessity to build up comprehensive and coordinated cost effective health care services appropriate for elderly people. Frailty is not a disease, but rather considered as a syndrome requiring comprehensive and multidisciplinary care approach. It is a prevalent reversible pathological transitional stage between healthy aging and disability. Frailty is associated significantly with increased health care utilization, mortality, and comorbidities such falls, hospitalizations, physical dependence, and poor perception of health. The aim of this review is to compile existing literature on the economic cost of frailty syndrome among elderly people in the recent years. Search queries were constructed to look for articles related to the economic cost of frailty in the electronic databases available at the National University of Malaysia library for articles published between the years 2011 and 2019. The accessed electronic database included New England journal of medicine, Science Direct, SCOPUS, BMJ, Cochrane, and Wiley Online Library. Articles included in this review when they were original research, participants were defined as frail elderly, manuscripts written in English language, and involved clearly described measures of frailty cost. Among the literature, twenty one articles were found to satisfy the inclusion criteria of the review process. The cost of care for frail elderly was ranging from US $ 8,620 to 29,910 per patient per year. The cost of health care was ranging from US $ 2,540 to 221,400. The health care cost was accounting for 40% to 76% of the total care cost. Hospitalization cost was the highest, it was ranging from US $ 806 to 152,726. Outpatient cost was ranging from US $ 200 to 18,000. Medications cost was ranging from US $ 7 to 3,434 per frail elderly patient per year. Home help cost was ranging from US $ 804 to 19,728 per frail elderly patient per year. In conclusion, frailty is a costly syndrome. It can be considered as a cost effective target for health promoting interventions to contain future elderly cost.
ABSTRACT
Many investigators have shown that stress suppresses food intake and reduces body weight in rats. The effect of vitamin E on body weight and food intake in rats exposed to stress were studied. Male Sprague Dawley rats [n = 80] were fed with either normal chow, vitamin E deficient diet or vitamin E with or without oral supplementation of either tocopherol, tocotrienol or Tocomin at 60mg/kg body weight. The rats were treated with these different diet regimes for 28 days prior to exposure to stress. Repetitive stress was applied, whereby the rats were restrained 2 hours daily for 4 consecutive days. The body weight and food intake was measured, weekly and after exposure to stress. The findings showed that vitamin E deficiency induced by feeding rats with vitamin E deficient diet for 28 days resulted in significantly lower body weight and food intake compared to the control animals given [normal chow]. Supplementation with vitamin E in different forms, tocopherol, tocotrienol or Tocomin to the deficient diet was unable to increase the body weight or food intake, where both parameters were comparable with rats fed with deficient diet alone. It is possible that the dose of the vitamin E given was inadequate to maintain the food consumption and prevent the drop in body weight. Exposure to stress caused a further reduction in both the food intake and body weight in all groups and this suggests that the normal level of vitamin E in normal chow nor the supplementation with tocopherol and tocotrienol at the dose 60mg/kg was able to protect against changes in the body weight and food intake due to stress. We therefore conclude that vitamin E deficiency and stress can reduce food intake and cause a reduction in body weight. Stress can worsen the status of the two parameters and in vitamin E supplementation at 60 mg/kg body weight is not sufficient to prevent the changes in the body weight or food intake due to vitamin E deficiency or stress