Using a Claims-Based Frailty Index to Investigate Frailty, Survival, and Healthcare Expenditures among Older Adults Hospitalized for COVID-19 at an Academic Medical Center

Background Frailty is associated with mortality in older adults hospitalized with COVID-19, yet few studies have quantified healthcare utilization and spending following COVID-19 hospitalization. Objective To evaluate whether survival and follow-up healthcare utilization and expenditures varied as a function of claims-based frailty status for older adults hospitalized with COVID-19. Design Retrospective cohort study Participants 136 patients aged 65 and older enrolled in an Accountable Care Organization (ACO) risk contract at an academic medical center and hospitalized for COVID-19 between March 11, 2020 - June 3, 2020 Measurements We linked a COVID-19 Registry with administrative claims data to quantify a frailty index and its relationship to mortality, healthcare utilization, and expenditures over 6 months following hospital discharge. Kaplan Meier curves and Cox Proportional Hazards models were used to evaluate survival by frailty. Kruskal-Wallis tests were used to compare utilization. A generalized linear model with a gamma distribution was used to evaluate differences in monthly Medicare expenditures. Results Much of the cohort was classified as moderate to severely frail (65.4%), 24.3% mildly frail, and 10.3% robust or pre-frail. Overall, 27.2% (n=37) of the cohort died (n=26 during hospitalization, n=11 after discharge) and survival did not significantly differ by frailty. Among survivors, inpatient hospitalizations during the 6-month follow-up period varied significantly by frailty (p=0.02). Mean cost over follow-up was $856.37 for the mild and $4914.16 for the moderate to severe frailty group, and monthly expenditures increased with higher frailty classification (p <.001). Conclusions In this cohort, claims-based frailty was not significantly associated with survival but was associated with follow-up hospitalizations and Medicare expenditures. Electronic Supplementary Material Supplementary material is available for this article at 10.14283/jfa.2023.15 and is accessible for authorized users.

Using a Claims-Based Frailty Index to Investigate Frailty, Survival, and Healthcare Expenditures among Older Adults Hospitalized for COVID-19 at an Academic Medical Center.

BACKGROUND: Frailty is associated with mortality in older adults hospitalized with COVID-19, yet few studies have quantified healthcare utilization and spending following COVID-19 hospitalization. OBJECTIVE: To evaluate whether survival and follow-up healthcare utilization and expenditures varied as a function of claims-based frailty status for older adults hospitalized with COVID-19. DESIGN: Retrospective cohort study. PARTICIPANTS: 136 patients aged 65 and older enrolled in an Accountable Care Organization (ACO) risk contract at an academic medical center and hospitalized for COVID-19 between March 11, 2020 - June 3, 2020. MEASUREMENTS: We linked a COVID-19 Registry with administrative claims data to quantify a frailty index and its relationship to mortality, healthcare utilization, and expenditures over 6 months following hospital discharge. Kaplan Meier curves and Cox Proportional Hazards models were used to evaluate survival by frailty. Kruskal-Wallis tests were used to compare utilization. A generalized linear model with a gamma distribution was used to evaluate differences in monthly Medicare expenditures. RESULTS: Much of the cohort was classified as moderate to severely frail (65.4%), 24.3% mildly frail, and 10.3% robust or pre-frail. Overall, 27.2% (n=37) of the cohort died (n=26 during hospitalization, n=11 after discharge) and survival did not significantly differ by frailty. Among survivors, inpatient hospitalizations during the 6-month follow-up period varied significantly by frailty (p=0.02). Mean cost over follow-up was $856.37 for the mild and $4914.16 for the moderate to severe frailty group, and monthly expenditures increased with higher frailty classification (p <.001). CONCLUSIONS: In this cohort, claims-based frailty was not significantly associated with survival but was associated with follow-up hospitalizations and Medicare expenditures.

Assessing the Unmet Needs of Spanish Speaking Family Caregivers of Persons Living with Dementia in the Greater Boston Area

Background: Spanish-speaking family caregivers of persons living with dementia (PLD) have limited resources in Spanish to aid in psychological coping with caregiver burden. They often have difficulty attending in-person training due to barriers such as transportation costs, identifying substitute care, and ongoing COVID-19 pandemic containment measures. There are few studies identifying Spanish language caregiver unique needs and preferences regarding desired caregiving skills and stress-reduction interventions. In this study, we sought to identify the unmet needs of Spanish-speaking family caregivers of PLD in the greater Boston area, as well as their preferences for virtual intervention frequency and duration. Method(s): We conducted two virtual focus groups with twelve Spanish language family caregivers of PLD (ages 37 to 87 years) recruited from the greater Boston area. Participants were asked semi-structured questions regarding their unmet needs for caregiver skills training and stress reduction. We employed an inductive and deductive driven mixed method analytic approach. A taxonomy was created to organize results based on participant responses. Result(s): Three major thematic clusters emerged. First, caregivers noted a desire to develop skills for managing stress, emotional reactivity, frustration, and grief. Second, there was an expressed need for education regarding disease-specific knowledge such as stages of dementia, common manifestations, management of challenging symptoms and communication strategies with the PLD;how to navigate the health care system;and finding additional resources for care in the community. Third, there was an interest in learning about interventions for the PLD, such as specific activities to help keep them engaged and active. A particular interest was expressed in any interventions that might slow disease progression. Regarding frequency and duration for virtual intervention, caregivers most commonly preferred weekly sessions for 6-10 weeks. Conclusion(s): Unmet needs of Spanish language family caregivers of PLD in the greater Boston area include education regarding disease-specific symptoms and their management, and resources to enhance well-being both in the caregiver and the PLD. Based on these results, we will develop a comprehensive virtual therapeutic intervention incorporating stress reduction techniques to facilitate emotion regulation, caregiver skills training, psychoeducation regarding dementia and caregiver resources, and healthful activities for the PLD. Copyright © 2022 the Alzheimer's Association.