Use of Health Resources and Healthcare Costs associated with Frailty: The FRADEA Study.

BACKGROUND: Frailty is associated with adverse health outcomes, but its association with hospital healthcare costs has not been analyzed. The main objective was to estimate the adjusted annual costs and use of hospital healthcare resources in frail older adults compared to non frail ones. DESIGN: FRADEA Study. Mean follow-up 1044 days (SD 314). SETTING: Albacete city, Spain. PARTICIPANTS: 830 adults ≥70 years. MEASUREMENTS: Age, sex, comorbidity measured with the Charlson index and Fried´s Frailty phenotype as independent variables, and use of hospital resources (hospital admissions, emergency visits, and specialist visits), and hospital healthcare costs as outcome variables. Outcome data were collected from Minimum Data Set of the Complejo Hospitalario Universitario Albacete. The cost base year was 2013. Logistic regression and two-part models were used to analyze the association between frailty and the use of healthcare resources. Generalized Linear Models were applied to estimate the impact of frailty and comorbidity on the healthcare costs. RESULTS: The average cost associated with the use of health resources was 1,922€/year. Frail participants had an average total cost of health resources of 2,476€/year, pre-frail 2,056€/year, and non-frail 1,217€/year. 67% of the total health cost was associated with hospital admission cost, 29% with specialist visits cost and 4% with emergency visits cost. Frailty and comorbidity were the most important factors associated with the use of hospital healthcare resources. Adjusted healthcare costs were 592€/year and 458€/year greater in frail and pre-frail participants respectively, compared to non-frail ones, and having a Charlson index ≥ 3, was associated with an increased costs of 2,289€/year. CONCLUSION: Frailty and comorbidity are meaningful and complementary associated with increased hospital healthcare resources use, and related costs.

Association between Functional Assessment Instruments and Frailty in Older Adults: The FRADEA Study.

OBJECTIVES: To determine the association between functional assessment instruments and frailty. DESIGN: Concurrent cohort study. SETTING: Albacete Health Area (Spain). PARTICIPANTS: 993 subjects aged ≥ 70 years, participating in the FRADEA Study. MEASUREMENTS: The following functional instruments were applied: Barthel index, Lawton index and Short Form-Late Life Function and Disability Instrument (SF-LLFDI) as disability questionnaires; Holden´s Functional Ambulation Classification (FAC) as ambulation scale, and seven performance tests: gait speed (m/s), Timed up and go (TUG) (sec), unipodal balance time (sec), 5-chair-sit-to-stand test (sec), Short Physical Performance Battery (SPPB), hand grip strength (kg) and elbow flexion strength (kg). Frailty was assessed by Fried´s criteria. The association between functional instruments and frailty was assessed, ROC curves were constructed and the area under the curves (AUC) calculated. The best cut-point was identified for each instrument and their sensitivity (S) and specificity (SP) are described. RESULTS: 16.9% participants were frail. The AUC, best cut-point, S and SP for each instrument were respectively: Barthel (0.916; ≤ 85; 0.90, 0.82), Lawton (0.917; ≤ 3; 0.86, 0.93), SF-LLFDI (0.948; ≤ 90; 0.87, 0.91), FAC (0.885; ≤ 4; 0.81, 0.83), gait speed (0.938; ≤ 0.62; 0.90, 0.90), TUG (0.984; ≥ 17.8; 0.93, 0.98), unipodal balance time (0.753; ≤ 5; 0.73, 0.71), 5-chair-sit-to-stand test (0.880; ≥ 15; 0.78, 0.76), SPPB (0.956; ≤ 6; 0.88, 0.88), hand grip strength (0.807; ≤ 26; 0.75, 0.75) and elbow flexion strength (0.924; ≤ 15; 0.89, 0.87). CONCLUSION: The best performance tests to identify frail subjects are the Timed Up and Go test, gait speed and the SPPB, and the best questionnaire is the SF-LLFDI.